C. difficile infections are bad news for the elderly. They run rampant in nursing homes, hospitals and other medical facilities, where they lead to thousands of deaths each year.
In this post, I will discuss some of the reasons this infection is so hard to contain, then ask YOU to share your opinion on prevention solutions below!
Are Medical Staff Solely Responsible for Spreading C. Diff?
Last week I was researching information on fecal transplants for an article on elderly health concerns. Mainly, for digestive illnesses caused by C. difficile infections.
Although still in the experimental phase, several studies have shown the treatment to be extremely safe and effective. Importantly, it could break the cycle of antibiotic dependency that keeps the elderly at risk for repeat infections.
Because the treatment is still relatively rare, (especially when compared to antibiotic prescriptions), it can be difficult to match eligible donors to needy recipients. At this point, the cost is still out-of-pocket for those needing the treatment.
I was seeking an answer to the question:
"Is it worth the cost and effort to obtain this treatment for those who are advanced in age? Even those who may not live another decade?"
(Of course, there is no definite answer to that question. My opinion is that if a treatment offers relief and possibly improves the quality of life and perhaps the length of life, then yes, it is worthwhile, regardless of individual situations or life expectancies.)
What I found instead, was a user comment targeted toward long-term care facilities, stating that if staff members were doing their jobs correctly, then C. difficile infections wouldn't even be an issue. (theoretically saving tons of money on the cost of the procedure.)
Even though that comment was over a year old, I felt the need to fashion a response to the suggestion that care providers alone are responsible for the spreading of the C. diff infection.
What is This Clostridium Difficile Infection, and How Does It Spread?
If you are a caregiver at home, or if your loved one is in a long-term care facility, then you need to be aware of this infection. It is a very real problem that can affect anyone of any age.
If your aging loved one is a facility or hospital, then you also need to be aware of how this spreads, and how it is impossible for staff members to completely control it.
Clostridium difficile is a bacterium that can infect the human digestive tract. It is more common in people who take antibiotics, which can upset the balance between "good" and "bad" intestinal bacteria.
It can cause severe diarrhea, colitis, and even perforation of the colon, which can be fatal. It is transferred from human to human via contact with fecal matter.
C. difficile can live for a very long time (up to several weeks, or even months, in favorable conditions) on a variety of surfaces. C. diff bacteria can be present in residual amounts on surfaces such as tubs and commodes, and anything that was touched with contaminated hands.
A Matter of Dignity?
In one facility where I worked we cared for three residents infected with c. diff.
Precautions were the same for ALL residents. All staff had to use gloves when giving showers, changing bed linens, etc. However, we had complaints from family members that wearing gloves made the nursing home "too clinical".
There were a few people who tried to force the facility in eliminating the use of gloves to make the environment seem "homelike and appealing".
Not only would that have been a danger to ALL residents, including those who were already fighting off the infection, it would have been a risk to staff members and visitors, too.
We were never officially ordered to stop wearing gloves when performing care tasks, but it was suggested to us that we only use gloves in the presence of family members if we thought we would be coming into contact with bodily fluids.
We did not comply. We gloved.
A Matter of Mobility
The three residents who were infected were mobile and independent. That means that they took care of their own toileting and grooming needs, with the exception of showers.
By policy, aides could not force these residents to wash their hands. You could suggest it. You could offer to help.
But you could not MAKE someone wash their hands. You could NOT even tell them that it was to prevent the spread of an illness they were carrying.
You could not forcibly wash or wipe their hands. You could not make them take a shower or bath if they refused. This was part of the dignity policy.
MOST residents would agree to be showered every other day. Sometimes, that was the only times their hands would be cleaned.
So what does that mean?
Well, in an ideal situation, aides would make certain that everyone's hands were thoroughly washed after every trip to the bathroom.
In reality, it meant we had three residents carrying a highly infectious disease. Three people who toileted themselves, and possibly did a poor job cleaning themselves. After which, they did not wash their hands.
They were free to go wherever they pleased. Which meant that over the course of a day, they could touch hundreds of surfaces.
So What About Keeping Things Sanitized?
According to the CDC, bleaching surfaces contaminated with C. diff is the preferred protocol. It is recommended that people with the infection have one bathroom solely for their use. Some people even recommend keeping dishes and linens separate too.
Things don't work that way in a nursing facility. Private rooms may have their own bathrooms, but many residents share bathrooms. Showers and tubs are shared.
So are recreational supplies, furniture, tables, door knobs, light switches, handrails etc.
Without putting a resident into complete isolation, there is no way to keep them from spreading c. diff if they are mobile.
That doesn't mean that cleaning staff aren't doing their jobs. But unless you have one person assigned to follow an infected resident around and bleach each surface as soon as it is touched, then you have a window of opportunity for another resident to touch a contaminated object.
Scenario:
Marge uses the toilet without washing her hands. She walks down the hall while holding her walker and the handrail for support. She goes to the lobby and sits down.
Meanwhile, two other residents walk down the hall touching the handrail.
Another resident, a visitor or a staff member pushes Marge's walker to the side so that no one will trip on it, touching the contaminated surface.
When Marge goes to the dining room, another resident sits in the chair.
Its that easy.
Residents might make multiple trips around the facility in the course of a day. They might go outdoors, they might ride the bus to church services.
Completely preventing the spread of C diff by constantly bleaching surfaces was (and is) impossible in a multi-resident facility. You also get complaints from visitors if your facility smells too strongly of bleach or other chemicals.
Visitors--The Other Factor
C. diff doesn't always come from the healthcare facility, either. Visitors can carry the infection, and if they aren't washing their hands, they can pass it to their loved ones or to other residents.
This makes sense if you consider some numbers.
The majority of residents in our facility ranged between 78-95 years of age.
That put their visiting children in the age groups of mid-50's to mid-70's.
Siblings and friends would fall in those age groups as well.
The CDC states that 1 out of every 3 C. difficile infections occurs in patients 65 years or older People who use antibiotics are more likely to become infected.
You can get it anywhere. Public restrooms, restaurants, the door handle of your grocery store. A younger person with a healthy immune system who is not taking antibiotics stands a good chance of fighting off the infection.
However, if a person is susceptible, and becomes ill, they may be treated with antibiotics, thus starting a cycle. They may spend time themselves in a hospital where they can become infected.
If that person visits a loved one in the nursing home, and brings in any contaminated item (dirty hands, clothing, a cup, homemade cookies) then they could possibly start an infection inside the facility.
Especially if their loved one is on antibiotics or just has a very weak immune system.
On the other hand, they can also accidentally transfer the infection outside of the facility. This can happen when a family member visits a loved one who has C. diff, and comes in contact with the spores. This can be from simply holding their hand, or using their bathroom, or helping them change soiled clothing.
They may take an item out of the facility, such as soiled quilt, in order to have it cleaned. Now it is possible that they can continue to pass the infection back and forth with their loved one.
So, Who Is to Blame for the Spreading of C. Difficile in Nursing Homes?
Truthfully? Everyone is potentially to blame. It could be a careless staff member. It could be a resident who refuses to wash their hands.
It could be a family member or a visitor. It could be the fault of a hospital or doctor who sent a resident back to a nursing facility without informing the staff about precautions.
It can be the fault of the people who make policies. It can be the fault of all the people who say "its mean to make the elderly wash if they don't want to do so."
Really, no individual is to blame. However, maybe our attitude and approach toward elder care might be to blame.
Here is something that should shake us all awake:
- In 2012, it was reported that 20,000 Americans die each year from c. diff.
- Clostridium difficile (C. difficile) caused almost half a million infections among patients one year (in just the US)
- 29,000 of those infected died within a month of being diagnosed.
- 80% of the deaths were people 65 years or older.
What is Your Opinion?
What do you, as a caregiver, think should be done about preventing Clostridium difficile infections? Should healthcare facilities implement stricter rules about hygiene for patients or residents as well as staff?
Should staff numbers be increased to keep infections under control? Should people who are infected be kept in isolation until they are no longer contagious, (even if it is your loved one)?
Should health care providers work harder to educate family about being proactive in regards to infection prevention?
Should we work harder to eliminate the use of un-necessary antibiotics as an act of prevention? Or should we just seek out more efficient treatment options (such as fecal transplants) after the fact?
Share your thoughts in the comments!
(Go here to read CDC information.)
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