http://www.wechealthunit.org daily 1 2007-05-08T21:19:14Z http://www.wechealthunit.org/diseases-conditions/glossary/ploneglossarydefinition.2008-04-03.6852846505 What is C. difficile? C. difficile is a spore bacterium that is naturally found in the feces (stool). What is C. difficile disease? Good bacteria kill C. difficile in the bowel. When certain antibiotics are used for illnesses the good bacteria can be killed as well. When the good bacteria are killed C. difficile is able to grow and produce toxins. The toxins can damage the bowel and cause diarrhea. C. difficile disease is usually mild but it can cause serious illness. In severe cases surgery may be needed. Death can occur in extreme cases of C. difficile disease. C. difficile is the most common cause of infectious diarrhea in hospitals and long-term care facilities. What are the symptoms of C. difficile disease? • Watery diarrhea, more than 3 bowel movements in a 24 hour period, or anything that is unusual for that particular person • Fever • Abdominal pain or tenderness • Loss of appetite • Nausea Who gets C. difficile disease? C. difficile usually occurs after antibiotic use. The elderly, those who are immunocompromised, anyone undergoing chemotherapy, and those who have other serious illnesses are at increased risk. A lengthy stay in a healthcare setting and bowel surgery can also increase the risk of C. difficile disease. How is C. difficile disease diagnosed? If you have symptoms of C. difficile a sample will be taken of the watery stool. A laboratory test will be performed to see if C. difficile toxins are present. What is the treatment for C. difficile disease? Treatment depends on how sick you are. People with mild symptoms may not need any treatment other than drinking plenty of fluids to prevent dehydration and a fever reducer containing acetaminophen. For more severe disease antibiotics designed to kill C. difficile are required. It is very important to take all medication as prescribed by your doctor. Never use over-the-counter medication to stop the diarrhea. This can make the illness worse. Contact your doctor if diarrhea does not go away or comes back. How does C. difficile spread? Surfaces such as: toilets, doorknobs and handles, bedpans, and shared commode chairs can become contaminated with C. difficile bacteria. This bacterium is not seen with the naked eye but our hands can become infected by touching one of these surfaces. If we touch our mouth without washing our hands, we can become infected. Our soiled hands can also spread the bacterium to other surfaces or people. Preventing the spread of C. difficile in a healthcare setting 1. Wash your hands regularly for 20 seconds with soap and warm water. 2. Wash your hands often if you work in, or are visiting someone in a long-term care facility or hospital, especially after using the toilet. 3. Use hand sanitizers at the entrance of hospitals and long-term care facilities when available. 4. Patients in hospital who are infected with C. difficile disease may be restricted to their room. 5. All staff entering a C. difficile patient’s room should wear a gown and gloves. 6. The surfaces and equipment in a C. difficile patient’s room should be cleaned thoroughly. Preventing the spread at home Healthy people who are not taking antibiotics are at very low risk for C. difficile disease.Certain hygiene practices should be followed to prevent the spread of any illness: 1. Wash your hands after using the toilet or touching dirty surfaces and before preparing meals or eating. 2. Clean your house with an all-purpose household cleaner. Follow directions on the label. 3. Wet surfaces with cleaner, scrub well and let air dry. 4. When cleaning, pay special attention to areas that may be soiled with feces such as the toilet and sink. Remove visible feces and clean as described above. 5. Wash clothes and other fabrics separately if they are heavily soiled with feces. Rinse off feces, clean in hot water with soap, and dry in the dryer on high heat if possible. Dry clean when appropriate to do so. 6. Clean dishes in the dishwasher or sink. If washing dishes in the dishwasher, no extra disinfection is needed. When using the sink, wash dishes with soap and hot water. Then rinse dishes in another sink using a bleach solution of 5 ml (1 teaspoon) of bleach per 495 ml (2 cups) of water. Let dishes air dry. Do not wipe with a towel. pdf version of this fact sheet For more information visit It's Your Health: Clostridium difficile Health Canada Clostridium difficile Fact Sheet Ontario Ministry of Health and Long-Term Care Clostridium difficile (C. difficile): Questions and Answers Public Health Agency of Canada No publisher mkingsley 2008-04-03T20:03:43Z Glossary definition http://www.wechealthunit.org/workplace-health/initiatives/promotional-activities-for-workplaces/employee-contest-infection-protection-initiative As part of our Infection Protection initiative for October - December 2006, we have developed a contest called, "Match the Facts". The aim is for employees to identify how germs are spread and what can be done to reduce the risk of infection. No publisher kmorse 2007-05-07T20:52:12Z Article http://www.wechealthunit.org/diseases-conditions/glossary/ploneglossarydefinition.2008-04-23.9105306785 What are enterobacter? Enterobacter are gram-negative bacteria found in the environment, on human skin, and in our intestinal tract. While many are harmless, several species are opportunistic pathogens present in hospital settings. The most common pathogenic species are E. cloacae and E. aerogenes. Although enterobacter rarely infect healthy people, they can cause significant morbidity and mortality in immunocompromised patients. Enterobacter, similar to other gram-negative bacteria like salmonella and E. coli, produce an endotoxin that causes inflammation. The best and most effective infection control measure is simple and easy to do. Wash your hands thoroughly, regularly, and often. Why are enterobacter a concern? Infections caused by enterobacter bacteria are a concern because they are increasingly common and are often caused by antibiotic resistant strains. Between 5% and 15% of hospital in-patients develop an infection during their admission and patients in an intensive care unit (ICU) are 5 to 10 times more likely to get a hospital acquired infection than those in general wards (Lim and Webb, 2005). Of these infections, enterobacter represent 6% of all hospital-acquired isolates and 11% of all pneumonia isolates. They are the most frequently isolated gram-negative organisms in intensive care unit (ICU) bloodstream infections and they are the third most common pathogen isolated in cases of ICU pneumonias. Because of their prevalence and pathogenisis, antibiotic resistance in this bacterium is particularly alarming. Recent studies have found that 35 - 50% of Enterobacter involved in nosocomial infections are resistant to second and third generation cephalosporins and broad spectrum penicillins. The rates are much lower for fourth generation cephalosporins and carbapenems, but are increasing (Goossens, 2005). These rates are significant because infections caused by resistant organisms are thought to result in higher morbidity and mortality, prolonged hospitalization, and increased costs compared with infections caused by sensitive strains. What are the symptoms? Symptoms of enterobacter infections are not specific to the bacteria and present as other gram-negative bacilli infections. The urinary and respiratory tracts are the most common sites of enterobacter infection. However, these bacteria can cause infections at many different sites, such as: - The lower respiratory tract - Urinary tract - Joint - Skin - Heart - Intra-abdomen - Soft tissue - Bone - How is an enterobacter infection treated? Antimicrobial therapy is indicated in virtually all infections caused by enterobacter. However, there is concern over the levels of resistance of these bacteria to a number of antibiotics. Second and third generation cephalosporins and broad spectrum penicillins shouldn’t be used to treat confirmed enterobacter infection, regardless of the apparent in-vitro susceptibility. Carbapenems are therefore the current antibiotics of choice to treat enterobacter infections. Who is at risk? Patients are most susceptible to enterobacter infections if they stay in the hospital, especially the ICU, for extended periods. Patients under the age of 2 and over the age of 65 are especially susceptible to infection. Other risk factors include: • Prior use of antimicrobial agents. • Underlying diseases. • Ulcers of the upper gastrointestinal tract. • Presence of intravenous catheters. • Serious conditions such as burns or mechanical ventilation. • Immunosuppression. FYI Catheters and other invasive devices are the # 1 exogenous cause of hospital-onset infections. What you can do: • Use catheters only when essential. • Make sure the right catheter is used. • Follow proper insertion and catheter-care protocols. • Remove catheters when no longer essential. How are enterobacter infections spread? Enterobacter are spread like other gram-negative bacteria, such as salmonella. This means that they spread through contact with the bacteria on patients, contaminated surfaces, and medical equipment. Once a health care worker gets the bacteria on his/her hands, it then spreads to patients and other contact items. The spread of pathogenic bacteria in health care facilities can be stopped. It’s every health care worker’s responsibility to always follow basic infection control procedures. This should be done with all patients at all times, regardless of diagnosis or infectious status.   What can I do to stop the spread? Infection control procedures are critical to control the spread of pathogenic bacteria. These procedures must be followed at all times and are essential to provide a high level of protection to patients, health care workers, and visitors. Standard infection control measures: • Wash your hands and use hand-sanitizers thoroughly, regularly, and often. • Practice good hand hygiene. • Use personal protective equipment when handling blood, body substances, excretions, and secretions. • Handle patient care equipment and soiled linen with care in order to prevent exposure to skin, clothing, and other objects. • Always handle waste appropriately. • Know and follow infection control guidelines of your facility. • Move and transport patients only for essential purposes. For more information For a detailed description of infection control procedures check with your infection control specialist and the World Health Organization guidelines for infection control in health care facilities. References: Conly, J. (2002). Antimicrobial resistance in Canada. Canadian Medical Association Journal, 167, 885-91. Goossens, H. (2005). European status of resistance in nosocomial infections. Chemotherapy 26, 177–181. Health Canada. (2001). Office of laboratory security data sheet - infectious substances: Enterobacter spp. Retrieved on March 11, 2008 from http://www.phac-aspc.gc.ca/msds-ftss/msds59e.html Lim, SM, Webb, SA. (2005). Nosocomial bacterial infections in Intensive Care Units I: organisms and mechanisms of antibiotic resistance. Anaesthesia, 60,887–902. No publisher mkingsley 2008-04-23T17:08:38Z Glossary definition http://www.wechealthunit.org/a-to-z-topic/e-h/hand-sanitizers No publisher root 2007-05-16T14:11:45Z Smart Folder http://www.wechealthunit.org/inspect/emergency-preparedness/pandemic-flu/frequently-asked-questions-on-pandemic-influenza/how-do-i-use-hand-sanitizers-properly Frequently Asked Questions on Pandemic Influenza No publisher acsuser 2006-09-12T21:33:56Z Question http://www.wechealthunit.org/inspect/infection-protection/fact-sheets/pandemic_influenza_factsheet15_may2006.pdf This Pandemic Influenza factsheet provides information on using hand sanitizers. No publisher mjanisse 2006-09-12T21:16:28Z File http://www.wechealthunit.org/workplace-health/initiatives/brochures/washyourhands_fall2006_generic.pdf This employee wellness brochure highlights the importane of washing hands frequently and correctly as an important way of reducing the spread of disease-causing germs. A review is provided on how to wash hands and use hand sanitizers effectively. No publisher hlangille 2007-05-04T19:35:08Z File http://www.wechealthunit.org/workplace-health/health-topics/infection-protection-fall-06/copy_of_washing-your-hands-of-germs No publisher mkingsley 2006-10-25T19:35:59Z Page