Wednesday, 21 March 2012

Clostridium difficle: People, who use toilets in hospitals, clinics, nursing homes, and diagnostic centres, should wash their hands with soap or spore-killing disinfectants, warn doctors

Syed Akbar
Hyderabad: People, who use toilets in hospitals, clinics,
nursing homes, and diagnostic centres, should wash their hands with
soap or spore-killing disinfectants, warn doctors. Clostridium
difficile, a harmful bacterium, has now emerged as a major concern for
patient safety. It is present in all types of medical facilities, not
just hospitals as earlier believed. C. difficile harms patients just
about everywhere medical care is given, and simple hand sanitizers are
ineffective.

What troubles health experts is that this organism infects even
outpatients. C. difficile causes severe diarrhea and other health
issues including death, if timely treatment was not provided. The
mortality rate often touches 25 per cent if the patients are weak and
old. In the USA, the death rate has gone up by almost 400 per cent.
There are no medical records as far as India is concerned, but it
could be even higher, given the compromised sanitary conditions here.
The bacterium, moreover, has become stronger of late.

The organism is spread by hospitalized patients on antibiotics
treatment. One-third of hospitalized patients themselves do not
exhibit any C. difficile infection, but they silently pass on the
bacterium into the hospital environment. Thanks to lack of technology,
there is not much research on C. difficile-associated diarrhea in
India. Moreover, it is difficult to culture the pathogen.

According to gastroenterologist Dr Ch Vaishnavi, the prevalence of C.
difficile in India is around 30 per cent among patients. “It is a
growing hospital and public health problem. Clinical suspicion is more
important than ever before because stool assays for diagnosing C.
difficile- associated diarrhea are not widely available. Wherever
available it is fraught with inherent problems,” she points out.

Earlier it was believed that patients, who are on antibiotics, are the
source of C. difficile infection. “The spectrum is changing. Factors
like proton pump inhibitors, immunosuppressive agents, stay in
intensive care unit and inflammatory bowel disease now also play a key
role in the spread of the infection,” says gastroenterologist Dr D
Devendra.

According to the latest Centres for Disease Control and Prevention
(CDC) report on C. difficile, almost half of infections occur in
people younger than 65, but more than 90 per cent of deaths occur in
people 65 and older. About 25 per cent of C. difficile infections
first show symptoms in hospital patients; 75 per cent first show in
nursing home patients or in people recently cared for in doctors'
offices and clinics. 

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