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Clostridium difficile It’s Like Seeing a Train Coming…and You Can’t Get Off of the Tracks

Categories: Antimicrobial Resistance, Clostridium difficile

CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion

Looking back now, it is like a movie playing out in my mind. We were at the 2004 IDSA conference in Boston, and my colleagues from the CDC lab, Dr. Dale Gerding’s laboratory, other scientific collaborators, and I were presenting on a new strain of Clostridium difficile called NAP1. I’m not sure everyone understood the implications. Some realized NAP1 could be big; others felt that C. diff wasn’t that big of a deal. For me, it was like seeing a train coming, and you can’t get off the tracks.

Clostridium difficile infections have been an important part of my career. Upon wrapping up the SARS investigations for CDC in Toronto, I turned my attention to C. difficile, as I sensed there was something going on that needed further investigation. Now, here we are 8 years later, and NAP1, which causes severe infection, is still a major issue in the United States.

C. difficile has become a problem across medical care settings.  So much so that the March issue of CDC’s Vital Signs report highlights these deadly infections. The report shows that C. difficile is causing many Americans to suffer or die. Although other healthcare-associated infections (HAIs) have declined in recent years, C. difficile has climbed to historic highs and remains at unacceptable levels. It also points out that C. difficile is no longer just a problem in hospital settings; these infections are a patient-safety concern everywhere medical care is provided.

However, there is good news — these infections can be prevented. Prevention programs in Illinois, Massachusetts, and New York are all reporting 20% declines in hospital C. difficile infection rates as a result of focused infection prevention efforts.

Looking ahead, I foresee the trend lines in hospitalizations and deaths turning around and coming back down. A realistic, near-term goal is to return C. diff infection rates back to where they were before the arrival of NAP1 (1999). Our long-term goal is to pursue the discovery of new prevention methods, which will continue to move us toward the ultimate goal of elimination. By focusing first on the following, we can get there: 1) use antibiotics carefully, 2) detect C. difficile early, 3) isolate patients who test positive immediately, 4) use gloves and gowns to treat, and 5) when patients transfer to another facility, be sure to let the receiving medical team know if the patient has a C. difficile infection. Facilities can also prevent C. difficile by ensuring the cleaning staff uses an EPA-approved, spore-killing disinfectant to clean rooms where C. difficile patients are treated.

Over the past 8 years as C. difficile has marched on, it has been a formidable foe. But there is reason for real encouragement in our ability to combat it. Today, we have tools that we simply didn’t have available at that time. As a country, we have a new-found ability to mobilize to address these deadly HAIs. We are finally at a place where public health is interfacing with healthcare delivery. As a result, I have real optimism in our ability to combat this adversary.

What is your facility doing to prevent the spread of deadly Clostridium difficile infections?

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. September 30, 2012 at 7:55 pm ET  -   panashe

    My wife is 36 yrs old, last year in Nov when she was 4 months pregnant, she was hospitalised for fevers but unfortunately contracted c-diff. She was treated but the bug resurfaced and an emergency colostomy was done on xmas eve to remove her severely damaged colon. Then in Feb she had a c-section done because the baby was in distress and in April another emergency surgery was done to remove a blockage that had accumulated in her bowel. She has to go for one more surgery to reverse the colostomy so she does not have to use the bag but she is still experiencing trauma from the 3 surgeries she had in a space of 6 months.

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  2. April 11, 2012 at 1:03 am ET  -   MaryEllen Rupright

    I am a 66 year old woman who was hospitalized six days with C. Diff. almost two years ago. Until recently I was still experiencing loose stools with incomplete evacuation and a low energy level. The gastroenterologist told me I have “post-C.Diff IBS,” and I took a drug he prescribed (can’t remember the name) for several months with no improvement. I finally discontinued the drug and out of desperation I started putting a few drops of peppermint oil in my drinking water. After a week or so my toilet problems improved dramatically. Coincidence? I don’t know.

    However, I still feel tired and very sleepy. Some days I am too tired to get out of bed. Is this related to IBS?

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  3. April 9, 2012 at 12:24 pm ET  -   Computer repairs in Kent

    Great blog lots of information Looks like alot of time has Been taken here

    Link to this comment

  4. March 21, 2012 at 12:21 pm ET  -   Connie White RN, BSN, CIC

    Has anyone researched the effects of the stool transplant treatment? More and bigger antibiotics don’t seem to be doing the trick. Is it not true that we all carry Cdiff in our bowels, and the abx simply allow it to flourish? Does the stool transplant (from a family member in the same home) replace bacteria that we are not aware of? Is that why it seems to work more often?

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  5. March 21, 2012 at 12:16 pm ET  -   Connie White RN, BSN, CIC

    May want to explore the “stool transplant” option. Does work wonders…check the research. If we can get by the “ick” factor, we may be able to save thousands of lives. Of course, with no one making a profit on medication, no one is really pursuing this option…

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  6. March 19, 2012 at 8:13 am ET  -   Precle

    Thank You!!!

    I have been looking for this information everywhere :)

    Thank You & Redgards,

    Precle

    Link to this comment

  7. March 14, 2012 at 8:45 am ET  -   Precle

    Great comment has become a problem across medical care settings. So much so that the March issue of CDC’s Vital Signs report highlights these deadly infections.

    Link to this comment

  8. March 12, 2012 at 12:50 pm ET  -   Traci

    The facility where I work has strict precautions to protect patients and prevent the spread of C.diff. We use a “contact” protocol. It includes using gowns and gloves when entering an infected patient room, posting a “contact” sign on the door, washing with soap and water, and cleaning with proper disinfectants. Preventing the spread of C.diff infection is a priority at our facility. Trainings and education are routine to help remind us about the importance of preventing the spread of infection.

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  9. March 10, 2012 at 10:44 am ET  -   Kathy Day RN

    Has anyone recommended probiotics for your father? If not, ask about this. Like the recent CDC press release said…antibiotics are the cause and they are also the cure. Unfortunately, they do not always cure C Diff.

    Link to this comment

  10. March 8, 2012 at 4:00 pm ET  -   Joy

    We isolate the patient with the infection. We clean their rooms once daily with specific cleaners to maintain the cleanliness of the room. We wash our hands after every patient contact instead of using hand sanitizers. We use gowns and gloves everytime we might come in contact with the patient or their rooms. We ask that any persons other than the patient that are in the room to wash their hands frequently.

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  11. March 8, 2012 at 7:43 am ET  -   Dotti

    My dad took antibiotics for pneumonia and then got C. Difficile back in December. He thought he was over it, but we soon found out that he was not. So, more antibiotics! Finally, mid-February, he tested negative. But!!!! Two weeks later, he got sick again – now he is in the hospital – with C. Difficile again. He is 80 years old and he is a sick man. They gave him the top two antibiotics, metronidazole (Flagyl), and vancomycin (Vancocin). Two days after the antibiotics, dad was not getting any better, so they have stopped the vancomycin.

    PRMC in Salisbury, Maryland

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