Clostridium difficile 2010

Clostridium difficile Infection (CDI) What is it? Modes of transmission? Environmental Sources? Control Measures?

Clostridium difficile ,[object Object],[object Object]

Clostridium difficile ,[object Object],[object Object],[object Object]

Overview: Clostridium difficile ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pseudo-membranous colitis Healthy colon

New Strain of C.difficile ,[object Object],[object Object]

States with BI/NAP1/027 strain of C. difficile (N=40), October, 2008 DC PR AK HI

Lethal hospital bug cases rocket, United Kingdom ,[object Object],[object Object],[object Object],BBC News. http://news.bbc.co.uk/2/hi/health/4186834.stm

C.difficile – On the Rise ,[object Object],[object Object],[object Object]

What are the risk factors for CDI ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Antibiotics and C. difficile? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Proton Pump Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object]

Stomach Acid-Suppressing Medications and Community-Acquired CDAD, England From Dial S, et al. JAMA. 2005;294:2989-2995 .

Severe CDAD in Populations Previously at Low Risk—Four States, 2005 CDC. MMWR. 2005;54:1201-1205 . 13 (39) 5 (50) 8 (35) Relapse 5 (15) 2 (20) 3 (13) ER visit necessary 10 (24) 4 (40) 6 (26) Hospitalization necessary 8 (24) 2 (20) 6 (26) Bloody diarrhea 24 (73) 9 (90) 15 (65) Antimicrobial exposure 25 (76) 10 (100) 15 (65) Female 11 (33) 0 (0) 11 (48) Aged < 18 years Total (N=33) Peripartum (N=10) Community (N=23) Characteristic, No. (%)

Other Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Some retail meats contain C. difficile ,[object Object],[object Object],[object Object],[object Object]

CDC - Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NEBH Cases Per New Definitions

Control Measures in August 08 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Zimek Decontamination Unit ,[object Object],[object Object],[object Object],[object Object]

20 4 3 3 10 Total 0 0 0 0 0 Sep 0 0 0 0 0 Aug 1 0 0 0 1 July 2 0 0 1 1 June 2 1 0 0 1 May 3 2 0 0 1 April 2 0 1 1 0 March 2 0 0 0 2 February 1 0 0 0 1 January 5 1 1 1 2 December 0 0 0 0 November 2 0 1 0 1 October Total Community-acquired Indeterminate Community Onset – HAI Hosp Onset Month

0.0 0.11 Rate/PtDays 0.28 Rate/PtDays 0 3 Comm Onset HA 8 Comm Onset HA 0.14 0.35 Rate/PtDays 0.45 Rate/PtDays 1 10 Hospital Onset 13 Hospital Onset 0.14 0.46 Rate/PtDays 0.73 Rate/PtDays 6911 28382 Patient Days 28914 Patient Days 1 13 Total HAI 21 Total HAI FY10 1 st Qtr FY09 FY08

A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol. 2005 Mar;26(3):273-80. ,[object Object],[object Object],[object Object],[object Object],[object Object]

A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol. 2005 Mar;26(3):273-80. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bacteria That Strikes Elderly Spreads in Canadian Hospitals August 9, 2004 ,[object Object],[object Object],[object Object],[object Object]

Clinical Manifestation ,[object Object],[object Object],[object Object]

Antidiarrheal Agents ,[object Object]

Non-Specific Colitis ,[object Object],[object Object],[object Object],[object Object]

Fulminant Colitis ,[object Object],[object Object]

How can C. difficile spores be spread?

How can C. difficile -associated disease be spread? ,[object Object],[object Object],[object Object],[object Object]

Hands and Gloved Hands as Sources for Spread ,[object Object],[object Object],[object Object],[object Object],Clinical Infectious Diseases, February 2008.

Clostridium difficile contamination of blood pressure cuffs: a call for a closer look at gloving practices in the era of universal precautions. Manian FA, et al. Infect Control Hosp Epidemiol. 1996 Mar;17(3):180-2. ,[object Object],[object Object]

[object Object],[object Object],[object Object],Transmission Factors

Transmission ,[object Object],[object Object],[object Object],[object Object]

Reservoirs for Spores ,[object Object]

Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea Samore MH, et al. Division of Infectious Diseases, New England Deaconess Hospital Am J Med. 1996 Jan;100(1):32-40. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Environmental Sources ,[object Object],[object Object],[object Object],[object Object],[object Object]

How is C. difficile -associated disease diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hand Hygiene Key Prevention Measure to Prevent Spread ,[object Object],[object Object],[object Object]

ALCOHOL-BASED HAND RUB Not Effective Against C.difficile ,[object Object],[object Object],[object Object]

SPECIAL CONTACT PRECAUTIONS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Special Contact Precautions ,[object Object],[object Object],[object Object]

Protocol to Discontinue Contact Precautions ,[object Object],[object Object]

Environmental Disinfection ,[object Object],[object Object],[object Object],[object Object],[object Object]

Consider “GloGerm” Studies ,[object Object],[object Object]

Environmental Cleaning Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Therapy for C. difficile ,[object Object],[object Object],[object Object],[object Object]

Therapy continued….. ,[object Object],[object Object],[object Object],[object Object]

Relapse of C. Difficile ,[object Object]

Relapse ,[object Object],[object Object],[object Object]

In Summary….. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clostridium difficile 2010

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Clostridium difficile 2010