Can I please have some advice about dealing with C Diff ?

[travellingwilbury]

I work as a carer for social services and at the moment I am helping to care for someone who has got C Diff . I have been given next to no information about it apart from using barrier care at all times . But I have also been told that as it is air borne that the barrier care although effective to a point is in no way 100 % .

I am not by nature someone who is a drama queen about this sort of thing but a couple of nurses I have spoken have told me "off the record" that if they had small children at home that they would seriously think about pulling out and not going into this person .

So I am in a quandry . On the one hand I don't want to make a big fuss over something which can be prevented but I also don't want to put my children at risk .

Any clever people out there that no more about this than I do ? I don't really want to Google as I am sure I will end up just reading horror stories .

TIA

[BionicleBill]

Ok, yes I think I can remember some stuff - firstly you want to have a look for the c diff support forums. It's a good site but please don't mention you're a nurse, if you post, as you'll be the target of people#s anger against the lack of education in the NHS - it's seriously a bit issue for most posters as they have often lost a loved one due to poor hospital management of the condition, so are justifiably annoyed at anyone in the service who doesn't know the basics.

Good on you for wanting to find out though.

Right. Young children are usually NOT seriously affected - it is mainly those who are already suffering from lowered immunity, physically weak etc and elderly who will be likely to be seriously ill or die from c diff.
Everyone else might get quite unwell but will usually recover.

It is not easy to catch. Have you or your children taken antibiotics recently? That is the main risk - you need two things to catch c diff - exposure to the spores PLUS a very unbalanced gut flora, meaning you've taken something that kills off the good bacteria in your intestines. This allows the c diff to take hold and start producing bacteria that attack the gut, you'll then get diarrhoea and discomfort and pain. It can progress into colitis which although quite rare can be serious and kill you.

The next thing you need to know is that nothing kills the spores/bacteria apart from bleach, so you'll need to use a cleaning agent containing 5-10% bleach in order to make sure everything is clean - for your hands, don't bother with alcohol gels, they don't work on c diff (most people don't know this) - you need to scrub your hands for several minutes, using hot water and soap, this basically dislodges any bacteria etc sticking to your hands. It washes them down the sink - it doesn't kill them.

Wash your hands before and after touching the patient or any of their things.
Operate isolation nursing if you can.

It is airborne but only in the sense that spores can travel in the bathroom etc, not by breathing. So the whole bathroom will want bleach cleaning regularly - after every episode of diarrhoea, clean the loo with bleach and flush with the lid down. Clean all taps and handles with bleach too and make sure the patient washes hands thoroughly. Wash everything on 60.

most babies carry c diff in a asymptomaic way until around 18mo, for some reason. Usually children are only mildly affected if they do suffer any symptoms, although it can be serious occasionally.

If you ahev not been on antibiotics then you are at low risk of catching it. But do be careful with the cleaning and washing.

The ignorance within the health service is astounding and has led to deaths, so please try to educate your colleagues as well.

HTH x

[BionicleBill]

Btw I had it - without diarrhoea, which helped, I just had a lot of cramps and some bleeding - after taking certain antibiotics. It was treatable but very persistent so not pleasant. My mother and friends and children did NOT catch it, despite being very much around - as they had not taken antibiotics and we were all careful about washing hands etc. People can live with someone who has it chronically for years and not become infected.

Education is the main thing.

[travellingwilbury]

Thank you very much , sorry I went to work and have just come back for a break . I had been told about the alcohol gels being useless and we are all washing our hands madly .

None of us have had any antibiotics for a long time so that is not an issue thankfully . I don't respond very quickly to antibiotics and I always need a lot higher dose than is usual (I was on a lot when I was younger due to spontaneous osteomyalitis )

You have helped me to feel calmer about this and also the airborne risk which is the one thing I was most worried about seems to be less of an issue than I feared .

Thanks for your help , I am feeling more confident that it is a balanced risk now rather than a irresponsible risk .

[nellie12]

Please dont worry. I have worked in nhs for years and cared for patients with all sorts. we have young children and neither dh or I have had c.diff or passed it to kids. (hopefully haven't passed it to anyone else either..)

The important thing is to wear aprons and gloves proper handwashing and moisturising between tasks/ patients. you can still use alcohol gel after you've washed your hands. use paper towels to dry your hands not cloth ones.

I always change out of uniform before holding kids and wash it at 60. Dont forget you can always ring the infection control team in community for advice. they're usually happy to help. hth

[travellingwilbury]

Thank you Nellie , we are all using aprons and gloves and I do try and always take my uniform off when I come in from work so I think that we are all probably as safe as we can be .

Because I work in social care rather than health I am not used to dealing with things like c diff and what I had heard about it had made me feel twitchy . The health teams don't think we have a need to know either which doesn't help anyone . But the inter agency debate is a whole other thread .

[nellie12]

Point out to the health teams that you do need to know how to prevent cross infection as you all deal with other vulnerable patients. Ask your ,manager to contact the community infection control team who should be able to provide training/info. It is very difficult getting people to take the training lead when several agencies are involved but remind them that you are not asking for confidential information about the patients illness but for infection control strategies as you have a duty of care to your other clients too. and good luck

[BionicleBill]

Oh that's good - someone who works in the field, glad you came along Nellie!

TW - although I do think the risk to you is not huge as Nellie says, do be aware that you could potentially pass it on to other patients who are vulnerable.

Also the spores do live for up to a year on surfaces so if you were to need antibiotics at some point in the near future, and if the situation remains ongoing with this patient then you would be wise immediately to stop contact.

Best of luck - if they are not already taking Saccharomyces Boullardii then they ought to - it's a yeast based probiotic that works alongside conventional treatments (metronidazole, flagyl, vancomycin) and helps recovery/ reduces recurrence which is the major problem with this superbug.

[travellingwilbury]

Nelli ,Thank you , I will get in touch with someone about getting some more information out there .Hopefully just a little bit more written information would be enough . I know I would make myself really popular by suggesting a training course . We seem to get through our fair share of those already . I think it would help to just minimise peoples worries about this . I do worry about passing this on to other people in our care as well but I suppose all we can do is make sure we are following all the guidelines and protecting ourselves and others .

BB ,I will check up about the things they are taking but I do know they are having a prescribed probiotic 3 times a day so hopefully that is the one you mentioned .

Looks like we will be getting through a lot of bleach and hot washes for while

[mears]

travellingwilbury - be very careful about your hand hygiene. My Dad has lovely carers who come in 4 times a day but I get frustrated at the lack of knowledge about hand hygiene.
The girls put on gloves the minute they come into the house, without washing their hands. They are vinyl gloves that don't actually protect against anything. The gloves get caught in the spring clips for the hoist and just slow them up I think.I personally do not see the need to put on gloves until they need to wash him in any soiled areas.

What I find that they do is wash him when he is soiled and then get him dressed still wearing the same gloves. They should be changed when they are contaminated.

I just wanted to mention this because sometimes you do not think about what you are actually doing, thiking that gloves are protection against all things. When I am around I do chat to the girls about it. Dad does not have any infection.

Because they put on gloves the minute they come in, they are not thinking about what they are touching.

Are the gloves you are being provided with by the way, suitable for the job?

[travellingwilbury]

Thanks Mears , we do have suitable gloves which in normal circumstances are only worn when needed . Certainly not when we first walk into a house because as you say you are then just spreading things around , and also giving the impression that you think the person you are visiting is dirty

We are all obsessive hand washers anyway , when we first come in , after the gloves have been removed and before touching anything else . So that isn't really an issue . It was the air borne aspect of this that I was worried about , but I do see what you mean and I think you are right to say something . We always carry a few pairs with us and we can get through 3 or 4 pairs in one house depending on what we are doing .

[mears]

That's good TW. Sounds as though your training is better than the company our cares come from. When I discuss it with the carers, they say that they are taught to wear gloves all the time. They have got better at handwashing though and it really seems to be when someone new starts we have this all over again.

[BionicleBill]

Mears I am glad your Dad has managed not to catch anything awful - remember talking about this with you last year! (tis me FA btw)

[travellingwilbury]

Mears , that is not good to hear . I think that because I work directly for social services rather than a private agency the training and certainly staff turnover rates are a lot better .

I know not all agencies are rubbish but in this area , agency care leaves a lot to be desired .

Well done for perservering , not everyone is as lucky as your dad to have someone who is on their side .

[mears]

The caring company is contracted by social services. Originally it was the council's own carers however, they could not provide the care he needed when he came home from hospital last year.
I would say that the carers are overworked sometimes, with little managerial support. Their phones are contantly going to ask them to change shifts.
Dad is the most dependent client that they have at the moment. Apart from the glove issue, they are very good with him.