Tips

These tips are a selection of the “best of” from this sites discussion forums. The tips have been written by C-Diff sufferers who have tried them and found them to work. Most have been written by people who do not have a medical background and they are not a substitute for seeking proper medical advice from a qualified medical practitioner. We cannot accept responsibility for the advice given here.
If you are at all concerned, please go and see your doctor.

Infection Control Measures

Handwashing

Hand Washing is the single most important method of controlling infection by C-Diff. C-Diff spores are highly resistant to most cleaning materials, therefore the physical action of hand washing is important. If you are visiting someone in hospital, the alcohol gel on wards will not help: it will simply rub the spores around your hands.

Hands should be washed:-

After visiting the toilet
Before helping someone with their food
Before handling, preparing, serving or eating food
When the hands are visibly soiled
How to wash your hands

Studies show that handwashing techniques are often poor and the most commonly neglected areas are the tips of the fingers, palm of the hand, and the thumb. It is important that hand washing is carried out correctly to prevent the spread of infection. Washing hands with soap and warm water will remove the majority of germs, preventing their spread to other people.

Wet your hands with warm, running water and apply liquid or clean bar soap. Lather well.
Rub your hands vigorously together for at least 15 seconds.
Scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
Rinse well.
Dry your hands with a clean or disposable towel
Cleaning Around the Home

Clostridium Difficile Spores are highly resistant to cleaning agents and will live for between 70-90 days outside the body and are only killed by cleaning agents containing Chlorine Bleach. Hard surfaces that will not be damaged by these cleaners such as toilets, (don’t forget the flush and door handles) baths and work surfaces should be cleaned with proprietary cleaning agents containing bleach. Obviously please use some common sense and don’t use cleaning products containing bleach on unsuitable surfaces such as carpets or soft furnishings.

Washing Clothes

There is some evidence that at low temperature washes (30 Degrees) Clostridium Difficile spores may be washed out of contaminated clothes and remain within the washing machine pipe work and sump. The spores could then be washed back onto clean clothes. Therefore, it is a good idea to use a washing powder containing chlorine bleach i.e. NOT a “colour” or non-bio product, and to use powder rather than liquid. This is because liquid detergents contain bleaching agents which may or may not contain chlorine bleach, whereas powders contain actual chlorine bleach in low levels which help to kill any spores. It is also a good idea to run a 90 degree wash once a month with the machine empty and a full load of detergent to completely clean out your washing machine. This ensures that all potential c-diff spores are killed and also cleans out any old soap residue from your machine making for more efficient washes.

C-Diff Sufferer Care

Pro Biotics While pro-biotics are highly beneficial in re-establishing gut flora, two important details must be considered:
It is of no use to take pro-biotics while you’re being treated with antibiotics for Clostridium Difficile. Any “friendly bacteria” will be killed off immediately by the antibiotics treating the C-Diff and will not get a chance to establish themselves. Wait until you have completed your course of antibiotics.
There is considerable debate in medical circles about how much bacteria is actually “live” in commercial pro-biotic products. There is concern that not many live bacteria get through the concentrated acid in the stomach. There is also debate about which strain of good bacteria is most beneficial. Pro-biotics are therefore a can of worms with large commercial interests at stake. Very few products have been medically tested and approved (with the exception of VSL3 from Sigma Tau Pharmaceuticals which at this point (Feb 2007) is not distributed in the UK. However this is going to change in the next few months
Therefore the best current advice is to make your own live yoghurt using an electric yoghurt maker with full cream UHT milk and a “live” starter such as “Total” yoghurt, or another brand of live yoghurt, and leave it to ferment for a full 24 hours. This gives a finished yoghurt that tastes great, has a bacterial yield in the trillions that you know are live, has not been through a long supply chain where the bacteria may have started to die, and the lactose in the milk has been broken down making it easier to digest. It is not a good idea to use the Easy-Yo Yoghurt Maker for pro-biotic yoghurt as it is not heated and therefore unsuitable for a 24-hour fermentation process.

Oats

Oats contain beta glucans that are highly beneficial in helping to re-establish the gut flora. If you can manage it try to include some oats in your diet in any form. For active C-Diff, fine ground oats like “Ready Brek” or fine oatmeal made into a simple porridge are easy to digest, but any products containing oats will help.

If you have a relative or friend in hospital with C diff

Here are some facts and figures about C. diff which should help you.

Getting Infected

Usually the patient will have been given a broad spectrum antibiotic. This kills off all bacteria, friendly and unfriendly, leaving the patient vulnerable to C. diff spores which are very resilient. The source of the infection can be anything from contaminated equipment (e.g. portable apparatus for measuring blood pressure) which goes from patient to patient, toilet handles and sink taps, cups of tea where the care assistant has previously cleared up another patient’s mess, or even through the air if another infected patient uses a commode nearby. The spores must be ingested. Infection rates are thought to be 10-20% for the first two weeks and over 50% after a month. C. diff 027 is particularly virulent strain.

Symptoms
We all know about the diarrhoea, but there is a period of incubation usually, but not always, after the original antibiotic has finished. Associated with C. diff are low grade fever, overgrowth of white blood cells, and episodes of low blood pressure. The patient feels unwell and will probably experience some abdominal discomfort. The diarrhoea is relentless, very watery, and may have blood and mucus in it. Loperamide (Immodium) is not recommended in the UK, but in parts of the US it is prescribed for C. diff diarrhoea. The thinking is that as long as waste products are still ‘going through’; this is gentler on the colon and less debilitating for the patient. Blood in the stools is a strong indicator of pseudomembranous colitis. This is a potentially dangerous stage of C. diff where dead tissue forms a sort of plaque on the surface of the colon. When this dead tissue is shed into the stools, a raw surface is left on the colon. This can become infected with other bacteria leading to sepsis. This last causes toxic shock which can lead to organ failure and death.

Diagnosis and Treatment

A stool sample is tested for the presence of C. diff toxins A and B. Colon damage can be assessed during a sigmoid or colonoscopy which can diagnose pseudomembranous colitis. Thickening of the bowel wall is also seen in a CT scan. Usually testing is only carried out when diarrhoea is present, but you could push for a stool test if your relative/friend has any of the incubation symptoms. Two antibiotics are most commonly used to treat C. diff: Metronidazole and Vancomycin. Metronidazole is the preferred first option. It is cheaper than Vancomycin and does not mutate certain gut bacteria. Metronidazole is very sick making but it is effective against C. diff. Unfortunately C. diff can recur. Again, if you suspect C. diff, don’t wait for test results, badger the medics to start treatment with Metronidazole or Vancomycin. C. diff is very fast acting and if you wait for even a few days, irreversible damage may be done. Better safe than sorry.

Getting Information From Hospital Staff
Don’t wait to be told! You have to be very persistent if you want information. Instead of asking open ended questions like ‘Tell me about C.diff’. Ask specific ones like these: ‘Has he had a C.diff positive stool sample?’ ‘Does she have pseudomembranous colitis?’ If the answer is no or not sure, ask what steps they are taking to find out. Get the idea? Don’t ask for permission to give life saving probiotics to your relative. Just do it!!

Action

It goes without saying that a positive C.diff test should result in isolation from other patients. Does this always happen? Not on your life! The main reason is that there are not enough side rooms for the huge number of cases. Also nurses cheerfully drag the same equipment in and out of wards and side rooms. Again, you have to be insistent here. C.diff cases on an open ward are a danger to the other patients. So if your relative or another patient in the bay has C.diff, insist on isolation. If they refuse or procrastinate, say you will complain to the health authority or the newspapers. Take pencil and paper and get names and dates. Look obvious. Believe me, they will act! Also insist on dedicated ‘Obs’ equipment for infected patients.

TLC

If you have a good network of friends and family, try to organise a rota to be with your relative/friend as much as possible. C.diff does not just affect the colon. It does funny things to your head! Patients lose their ‘spirit’ and become apathetic and resigned. Yet it is very important that morale is maintained because you have to ‘fight’ C.diff, particularly the pseudomembranous colitis sepsis. Also, people can keep an eye on whether medications are being given properly and the patient is clean and comfortable. It is important to keep up fluid intake, through a drip if necessary, and try to get your relative to eat
Reading Medical Notes

Medical notes can be pretty impenetrable so please feel free to download this file which while written for the Americans contains a lot of the medical shorthand used in the UK

Reading Medical Notes
Medical notes can be pretty impenetrable so please feel free to download this file which while written for the Americans contains a lot of the medical shorthand used in the UK


http://www.cdiff-support.co.uk/Downloads/Medical.txt
(462k Text File)