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The difficult bacillus Clostridium difficile

The difficult bacillus Clostridium difficile. JANE O’DONNELL ASSISTANT DIRECTOR INFECTION CONTROL. Worth remembering. If only causes 10 – 20% of antibiotics associated diarrhoea. Potted history. First described in 1935 Linked to Pseudomomembranous colitis in 1978 by Bartlett et al

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The difficult bacillus Clostridium difficile

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  1. The difficult bacillusClostridium difficile JANE O’DONNELL ASSISTANT DIRECTOR INFECTION CONTROL

  2. Worth remembering If only causes 10 – 20% of antibiotics associated diarrhoea

  3. Potted history • First described in 1935 • Linked to Pseudomomembranous colitis in 1978 by Bartlett et al • Shown to cause disease in Hamsters • Toxins A & B recognised (1982) • Nosocomial outbreaks observed (1999)

  4. C. Difficile – why it is a problem? • Found in environment and companion animals • Selected in bowel by antibiotic use • Causes mild to severe diarrhoea • Can be difficult to treat • Can spread to other patients • Can cause deaths or make other diseases worse.

  5. Problems with understanding how C. difficile acts • 10% of elderly may carry asymptomatically • 70% of babies carry asymptomatically • In hospital carriage may rise to 15-20%, with no diarrhoea • Colonised patients are less likely to develop diarrhoea when exposed to antibiotics, due to IgG • ?vary immune response to toxin A Kyne L et al NEJM 342 390-97

  6. Costs of HAI some examples • C. difficile diarrhoea - £4,000 (Wilcox et al.) • 20-40% of patients die within 4 weeks of C. difficile positive stool (W. Yorks. Data)

  7. What makes patients vulnerable? • Age • Antibiotics • Proton pump inhibitors • Length of stay (>21 days) • Viral gastroenteritis • Immunocompromised

  8. What measures help? • Don’t treat unnecessarily • Avoid high risk agents • Use low risk agents • Use short courses – review regularly • Don’t use 2 when 1 will do • Avoid multiple courses • Actimel? (St Thomas’ study)

  9. Other measures • Patients with diarrhoea in side-room • Hand washing important • Cleaning of room probably important as organism found in environment round patient • Improve personal hygiene of patients

  10. C. difficile and public health • Increasing number of detections – Why? Increasing awareness Increasing age and vulnerability of patients Increased bed occupancy and ward closures • Increased use of Proton Pump Inhibitors • Effect of D & V due to other causes (Wilcox et al 2007) • Resistant strains e.g. 027

  11. Case Numbers

  12. Case Numbers

  13. What the Trusts are doing • Recording all cases • Reducing patient movement • Visiting and carrying out RCAs • Enhancing training • Improving Antibiotic policies and control measures • Improving environment and cleaning • Enhancing information to staff and patients • Spotting outbreaks more readily • Discharge planning • Environmental surveillance and typing

  14. The Target • Is it useful • Missed targets cause bad publicity • Meeting target becomes main aim not improving patient care

  15. Any questions?

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