Clostridium difficile has been in the news for a few years and is one of the leading hospital acquired diseases. Unfortunately,it has escaped from hospitals and clinics and is making itself known in the community.
C.diff as it is often referred to causes uncontrolled diarrhea that can leads to gross dehydration and coma followed by death.
There were 1646 recorded deaths in England and Wales from C.Diff in 2012, 407 fewer than in 2011. (source) Clostridium difficile accounts for upward of 14,000 deaths a year in the United States.
There is growing evidence that most of the cases in both countries are no longer hospital acquired, but passed on through community contact with other infected individuals. You can read the study here.
Clostridium difficile is a gram positive, spore forming bacterium that causes the patient to suffer uncontrollable diarrhea in some people who have taken antibiotics repeatedly.
The antibiotics wipe out the normal gut flora…the good bacteria, allowing the toxins associated with C.diff, which are present in all of us in small amounts, to take over. Bloating, abdominal pain and diarrhea follow. The volume of watery stools quickly leads to dehydration, coma and death if untreated.
Usually C.diff is treated with antibiotics, in an attempt to kill the bacterium, but in many cases this exacerbates the problem.
Clostridium difficile produces microscopic spores that have a tough outer ‘shell’ and alcohol gels available in hospitals, clinics, and increasingly in handbags across the country cannot penetrate the shell and therefore the spores remain active and infective. They can cause infection for 70 days after they have been shed. Microscopic faecal spatter is the most obvious cause of spores getting onto hard surfaces etc but the disease is most commonly spread by bad hand hygiene.
Hand hygiene is vitally important in the fight against Clostridium difficile. Hand washing mechanically removes the spores and soap and water is adequate to achieve this.
Soiled clothing and bedding should be destroyed if it cannot be boiled as low temperature washing does not kill the spores. the washing machine should be put on a hot cycle with a cup of bleach added after washing anything that may be contaminated with C.diff.
Bathrooms and other hard surfaces should be cleaned with hot water and bleach each time the patient has used the facilities.
Care should be taken with the elderly and/or infirm to make sure their hand hygiene is through.
The toxins produced by C.difficile are enterotoxin, known as toxin A and Clostridium difficile toxin which is known as toxin B. The higher the levels of these toxins the worse the condition will be. The antibiotic treatment mentioned earlier is attempted to try and allow the gut to build the ‘good bacteria’ to a level where toxin A and B are overcome and the patient starts to recover. Like many other bacteria C.diff is adapting and mutating, and the treatment often fails.
Probiotic therapy is thought by many doctors to be the way forward, there are numerous studies that support it not only as a treatment method, but as a preventative against relapse. You can read about some of them here, here and here, but there are dozens more going on across the globe.
I can vouch for this. My mother had been given just days to live, they had tried all the antibiotic therapies they could think of, and she was just getting worse. In desperation I googled ‘treatments for clostridium difficile’ and ended up at a support group who swore by probiotic home made yogurt. I went to an all night supermarket and brought some probiotic drinks which I spent hours spoon feeding to my mom, pausing only to go and buy a yogurt maker and make the stuff. I kept feeding her the probiotic shop brought stuff until the home made yogurt was ready and then we began…
A couple of weeks after mom came out of the hospital I had a call from The Queens Medical centre in Nottingham. A taxi came and took away a batch of the home made yogurt.
Not waiting for the results of the research the hospital that mom was in had the recipe off me, got their own yogurt maker and reported back that the results were astounding. I can’t say which hospital mom was in…it wasn’t exactly conventional, there was no permission from the chief executive, and we never did find out if the doctor making it had his food safety certificate! What I will tell you is that the survival and relapse rates improved within a month.
My mother had a yogurt every single day for five years. If you have no relapse in five years you are no more likely to suffer from it again than anyone in the general population. We had a bit of a party to celebrate her yogurt free future, she was never keen on yogurt even in good health and couldn’t wait to see the back of them.
Clostridium difficile is only one of many conditions that can affect the flora of the gut. Norovirus, often referred to as ‘the winter vomiting bug’ forces the closure of hospital wards and brings misery to tens of thousands each year. Maintaining good gut flora prevents the ‘bad bacteria’ from getting a hold and having probiotic foods daily, at least during the winter, and shop brought if you don’t want to make your own is a sensible move.
Studies are just beginning on a whole range of gastric conditions to see the effect that probiotics have on them. I am pretty certain what they will find, but I’ll report back when the findings are published.
In the meantime the best thing anyone can do, old and young alike is practice good hand hygiene.Good hand hygiene can make the difference between getting one of these conditions and not getting one in the first place.
Contributed by Lizzie Bennett of Underground Medic.
Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.