HEALTHCARE HYGIENE A DIFFICILE PROBLEM
Scientists have come up with a number of ingenious ways of tackling C Difficile since the first serious outbreaks occurred in the 1990s. Jamie Wright, from Tork manufacturer SCA, looks at these and considers the importance of hand hygiene in tackling this dangerous healthcare-acquired infection.
Clostridium Difficile (C Difficile) – a virulent hospital-acquired infection – has repeatedly hit the headlines since the first serious outbreaks were recorded in the 1990s.
There is good reason why it should feature so prominently in the news. C Difficile is responsible for around 39% of cases of antibiotic-associated diarrhoea in the western world. This is the assertion of Science Daily1
, which also
claims that an estimated 10% of patients die of the condition – mainly due to the lack of an effective treatment.
But despite the relatively recent publicity there is nothing new about C Difficile. First identified in 1935, its role in causing potentially life-threatening illnesses was not discovered until more than 40 years later.
C Difficile in itself is not a killer, however. Around 3% of healthy adults and two thirds of babies harbour C Difficile bacteria in their gut while suffering no symptoms. Problems only occur when the normal bacteria in the gut are disadvantaged – usually when antibiotics are taken – which allows C Difficile to grow at unusually high levels. This causes it to produce a toxin that attacks the intestine and leads to symptoms such as diarrhoea or even a life-threatening inflammation of the intestines. Other symptoms can include fever, loss of appetite, nausea and abdominal pain or tenderness.
Those at particular risk are people who have taken antibiotics and the elderly. In fact, more than 80% of C Difficile cases occur in the over-65s.
Since the late 1990s a number of severe outbreaks have been documented throughout the world, the first of which were reported in the UK. The height of the epidemic was in 2007-2008 when C Difficile was said to be a contributory factor in 34 deaths at Dunbartonshire’s Vale of Leven Hospital. A total of 143 patients
30 | Tomorrow’s Cleaning October 2016
Since this period, UK cases of the condition have gradually declined. However, a new series of infection ‘clusters’ have caused alarm bells to ring.
Between January and May 2013, for example, 96 cases of C Difficile were reported at Glan Clwyd Hospital in Wales, leading to the death of 30 patients.
A 6% rise in new cases was reported across the UK overall in 2014-2015 compared with the previous year.
In the US, too, a 4% rise in C Difficile rates was recorded between 2013 and 2014 according to the Centers for Disease Control. And a 2015 inspection at the Portiuncula Hospital in Galway, Ireland revealed that Clostridium Difficile rates were ‘significantly higher’ than the levels considered to be acceptable by Ireland’s health authority.
These reports have sparked a series of attempts by specialists to come up with ingenious new ways of preventing and controlling the infection. For example, a dog has been brought in to a hospital in Canada to help ‘sniff out’ C Difficle.
Angus the springer spaniel has been trained to find hidden reservoirs of the bacteria in patient rooms and in general hospital areas. Once the dog
contracted the illness between 2007 and 2008 during what was described as the ‘worst C Difficile outbreak in Scotland’s history’.
has managed to hone in on the bug, a state-of-the-art disinfection robot is employed to kill off the C Diff spores.
In 2015 a US team came up with a treatment that involved fighting C Difficile with yet more C Difficile. Researchers at Loyola University Health System in Illinois treated 173 patients with spores of non-toxin- producing C Difficile. Results published in the Journal of the American Medical Association revealed that the odds of repeat infection among those in the trial had been cut dramatically and that the healthier bacteria took hold in the gut 69% of the time.
In May this year a UK university came up with another new treatment – one that some C Difficile patients would probably find hard to swallow.
Faeces taken from pre-screened healthy donors was frozen and stored at the University of Portsmouth’s Queen Alexandra Hospital with the view to being ‘transplanted’ into the gut of C Difficile patients. The treatment involves ingesting 50ml of the healthy faeces, possibly in the form of a pill or capsule. Researchers believe that faecal transplants could help save countless lives.
And a US pharmaceutical firm is working on a new clinical treatment that is claimed to be able to neutralise the C Difficile toxin that can damage the gut wall and cause inflammation.
All these solutions require time and money. But there is another way in which the spread of the illness can be controlled – and one that is hardly rocket science.
All experts agree that effective hand washing can help prevent the spread of C Difficile. Alcohol hand rubs are ineffective against the condition since C Difficile spores are highly resistant to chemicals. So soap and water should be used instead as thorough
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