In a perfect world, the elderly community would stay out of nursing homes and hospitals and live out their remaining years healthy and free of illnesses. However as baby boomers continue to age, the need for better healthcare continues. According to the U.S. Bureau of the Census, slightly over 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time. Long-term care facilities have major benefits, especially if you find the right one to suit your seniors’ needs. In that same perfect world, patients are supposed to leave these hospitals healthier than they arrived, and experience long-term care that has enhanced their quality of life. The reality of the situation is that these facilities pose risks to a senior’s health, with one of the biggest threats being Clostridium difficile.
Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can cause a variety of symptoms ranging from diarrhea to life threatening inflammation of the colon. According to the Mayo Clinic, illness from C. difficile most commonly affect older adults in hospitals and long-term care facilities, and typically occurs after the usage of antibiotics.
C. Diff and its Relationship to Seniors
As mentioned before, C. diff is a type of bacteria. Interestingly enough, it exists all around us. It’s in the air, soil, water, and because of that, also exists in human and animal feces. Most people have the bacteria in their intestines but never show symptoms of it making them sick. Clostridium difficile is most commonly found and spread amongst hospitals and long-term care facilities, where workers are just as exposed to coming into contact with it as the patients themselves. The Mayo Clinic reports that each year in the United States, about half a million people get sick from C. difficile, and in recent years, C. difficile infections have become more frequent, severe, and difficult to treat.
As nauseating as it may sound, coming into contact with this bacterium in fecal matter can spread C. diff and is quite common. Many times hospital employees or caregivers can inadvertently transmit C. diff if they don’t wash their hands enough and properly. Another way it can spread is if the hospital rooms have not been cleaned and disinfected adequately, especially the beds.The same can be said for nursing home rooms; tiny droplets of fecal matter can become airborne with spores living on surfaces for months at a time (for example, if the toilet is flushed with the lid up), it’s very important that nursing homes are kept clean and sanitized to reduce transmission.
With already compromised immune systems, the geriatric population has a much higher risk for experiencing the symptoms from C. diff that makes them ill. In a recent article on MDMag’s website, author Rachel Lutz examines a study done by a Hartford Hospital in Connecticut on seniors and C. diff— this population is especially vulnerable, the investigators said, and reducing the incidence is vital due to the “significant morbidity, mortality, and financial cost associated with this infection.” This study also points out that beyond advanced age, the risks associated with C. diff in the geriatric population are increased exposure to antimicrobial therapy for other infections, exposure to C. diff spores, and the host’s immune response.
Symptoms associated with a C. diff infection are:
-Watery diarrhea several times a day (often very foul smelling)
-Abdominal cramping
-Occasional blood the in stool
-Fever
-Nausea
-Loss of appetite/ weight loss
-Dehydration
-Rapid heart rate
Antibiotics and C. Diff
Antibiotics are known throughout the medical world for disrupting gut microflora, which can allow for C. diff to flourish and produce toxins. These toxins attack cells lining the intestines, leaving patches of plaque and inflammatory cells in return. An article from Pharmacy Times even suggests single doses of antibiotics for surgical prophylaxis have been associated with increased risk of C. diff. Overall, the length of which a person is on antibiotics, as well as needing multiple doses of the same medication, are two major risk factors associated with antibiotic related C. difficile diarrhea. It’s normal however, to experience mild diarrhea with most antibiotics. This diarrhea is caused from minor C. diff infection that generally stops after the antibiotics are completed. The danger lies within the episodes of diarrhea that happen multiple times a day, and continue for 2 days after medication.
Pharmacy Times indicates that the types of antibiotic classes most commonly associated with C. diff infection are: clindamycin, fluoroquinolones, cephalosporins, aztreonam, and carbapenem. Heavy research and medical data implicates that clindamycin should be avoided among patients who are at risk for C. diff infection: elderly people who are in care facilities with weakened immune systems, and who have previously been treated with multiple antibiotic prescriptions in the past. Clindamycin has even started to come with a warning label on the prescription box, pointing out its connection to possibly concerning diarrhea.
When a person develops C. diff as a result of taking antibiotics for a different infection, they may need to stop taking the antibiotics all together. For some, this isn’t a possibility, especially those who have severe infections. Although some antibiotics cause C. diff, certain others are the only option to fight off the infection. According to Medical News Today, doctors prescribe these types of antibiotics, among others, when helping fight off C. diff:
-Metronidazole: This drug is usually the first line treatment for a mild C. difficile infection. It is taken three times a day for up to 10 days.
-Vancomycin: Vancomycin is a good alternative for people who experience serious side effects, women who are pregnant, or people who are not getting better with metronidazole.
-Fidaxomicin: This is a new antibiotic that works similarly to vancomycin.
Complications
The complications that come along with C. difficile infection as provided by The Mayo Clinic are the following:
-Dehydration. Severe diarrhea can lead to a significant loss of fluids and electrolytes. This makes it difficult for your body to function normally and can cause blood pressure to drop to dangerously low levels.
-Kidney failure. In some cases, dehydration can occur so quickly that kidney function rapidly deteriorates (kidney failure).
-Toxic megacolon. In this rare condition, your colon is unable to expel gas and stool, causing it to become greatly distended (megacolon). If left untreated, your colon may rupture, causing bacteria from the colon to enter your abdominal cavity. An enlarged or ruptured colon requires emergency surgery and may be fatal.
-A hole in your large intestine (bowel perforation). This is rare and results from extensive damage to the lining of your large intestine or after toxic megacolon. A perforated bowel can spill bacteria from the intestine into your abdominal cavity, leading to a life-threatening infection (peritonitis).
-Death. Even mild to moderate C. difficile infections can quickly progress to a fatal disease if not treated promptly.
Prevention and Treatment
If you are a caregiver, it is very important to follow a strict hand-washing regimen throughout your time spent with the senior. This isn’t just for their safety, but to protect you from coming into contact with the bacteria as well. It is wise to suggest that family members take a break from visiting their senior loved ones in hospitals to avoid contracting C. diff as well. C. diff spores are not effectively killed by certain alcohol-based products such as hand sanitizer. Disinfecting surfaces in or around a sick patients space is crucial to controlling the spread of the bacteria, and it’s very important that chlorine bleach-based cleaning products are used to do so.
Unfortunately the cleanliness of hospitals and long-term care facilities can differ greatly between each other, and its something to consider when picking the right home for the senior you care for. If possible, tour the nursing home or rehabilitation center where your loved one will be spending their time, and look for any signs of
nursing home negligence. Any detail causing you to worry or feel uncomfortable about leaving your senior family member in a certain place based on the cleanliness, friendliness and presence of employees, or research you may have done, should be a red flag to look elsewhere. The employees at long-term care facilities are the ones in charge of cleaning up after a sick senior experiences diarrhea. If C. diff is the cause, you want to know and trust the facility to make sure they’re clean, comfortable, and that the area has been sanitized properly.