Funny Lookin’

We had just isolated a patient as it seemed they had C.Diff.  How did we know before we even sent a sample?  We’re nurses and rely heavily on the “deck method.”  Y’know, if it looks like a duck, acts like a duck and quacks like a duck, it’s probably a duck.  Translating that into poop, if it looks like the Diff, smells like the Diff and the patient is developing SIRS with a white count of nearly 20, we’re gonna’ guess it’s the Diff.  Lab tests?  Who needs that?  Nurses’ noses show and unbelievable 95% sensitivity and 98% specificity with diagnosing C.Diff.  But I digress…

So in isolation we gown up in the ever-fashionable yellow splatter-proof gowns, gloves and sometimes masks with just a touch of wintergreen oil to care for the patients.  The patient who was isolation thought we were just the funniest thing since Jerry Lewis.  As we walked in she looked up and giggled, “You guys look silly!”

From the mouths our elders…

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Aerial C.Diff?

Another entry into the “Holy shit!” files of scary drugs, diseases and conditions, add aerial C.Diff.  In this article: Aerial Dissemination of Clostridium difficile spores.

Adding airborne transmission to the standard contact transmission just increases the pucker factor.  The article goes on to note that aerial spores were captured on several tests showing samples of C.Diff in wards where there had not been active cases of C.Diff for weeks.  The authors postulate that this could be an explanation for the sporadic cases of CDAD (Clostridiun difficile associated diarrhea) that spring up seemingly out of nowhere.

While not surprising, it is enough to knock you back a bit.  Operating on the idea that it is solely contact based transmission has been the basis for everything we do when treating CDAD.  From terminal cleaning of the room post occupancy of a C.Diff patient to the gown and glove isolation we practice may not be enough to combat spread around a unit.

Combine aerial transmission with the over-abudance of PPI use (which studies have shown to be a  factor in C.Diff infection due to the breaking of the gastric acid barrier protection from reduced gastic pH) in a population already at risk of CDAD and you have a poop-strewn nightmare ready to happen.  While the article does not definitively note any cases where areial transmission is the sole cause of CDAD, it raises the specter that it proably does happen and that we need to adjust the way we protect our patients.  Terminal cleaning with bleach is one step, espeically for surface cleaning, but the cleaning of air remains another aspect all together that could require extensive revamping of HVAC systems hospital wide.

It’s hard to guage the true impact of this and the fallout it may have on protocols, but it could go some way to explain a lot of cases of CDAD.  Still it scares the poop out of me!