C-Difficile

In my family, the “Family Business” is nursing. My mother is a nurse, and an associate professor at NMSU, as well as the chairperson for their CNA program. One of my sisters just finished her nursing program and is studying for her NCLEX and my other sister is an ER nurse just starting her DNP program. So when they each, independently, gave me the following advice, I took it to heart, but assumed they were being facetious, and using humor to help me remember a very important health care worker concept: “Pretend everything around you is covered in sh*t. ” After reading this article, I realize they were not kidding!
C-Difficile is a bacteria found in the intestines of a small number of people. Not all bacteria are bad, particularly when the bacteria are where they are supposed to be. C-Difficile becomes a “bad” bacteria when it overpopulates the intestine, causing stomach cramping and diarrhea. The overpopulation occurs when antibiotics are used to fight the original infection a patient has, and that antibiotic kills off the normal flora living in the intestines. Once that happens, C-Diff is able to make its way out of the intestines and onto health care workers hands, clothing, surfaces (such as call lights and bed rails) and the skin of the patient.
It is transmitted via the fecal-oral route, simply meaning that infected feces made its way into someone’s mouth, causing an infection. An infected person can spread the bacteria by having a bout of diarrhea, not washing their hands with soap and water, and then touching an object, leaving spores on it. Another person comes along, touches the same object, and picks the spores up. That second person (with unwashed hands) then touches their face, mouth or prepares food, and ingests the spores, introducing the bacteria into their body.

C-Diff is able to lay dormant on surfaces for a very long time because it is both anaerobic and spore forming; meaning it does not need oxygen to live, and it forms a spore, protecting itself from being destroyed by typical cleaning measures. However, a bleach and water solution has been effective in killing the spores. It has been found that it takes ingestion of as few as two spores to infect a person. The spores are extremely hearty and upon ingestion, are able to withstand the gastric acids, passing all the way through to the intestines unharmed.
Once they reach the intestines and they are exposed to the bile acids they emit two toxins. Those two toxins are responsible for the damage to the colon, and that damage ultimately causes the symptoms of C-Diff. Namely, in mild cases, abdominal cramping and diarrhea, all the way to severe damage such as pseudomembranous colitis (an illness that’s symptoms mimic colitis). In the most severe cases, fatalities have even occurred in as high as 80% of the cases. The most effective way to prevent the spread of C-Diff is using proper hand-washing techniques.
However, it should be noted that hand-washing does not kill the spores; it simply removes the spores from the hands so that they are not carried to another location. Soap and water is a must, as the alcohol-gel based hand sanitizers do not kill the spores. A CNA should don PPE’s (gowns and gloves) when assisting patients/residents who have C-Diff. This will prevent the CNA from carrying the spores on their clothes to another person. Again, the number one prevention that a CNA can utilize is properly washing their hands, especially when travelling from one patient to another.

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