TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE — PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED:
In September, researchers, health care workers, and industry and patient advocates convened for the 4th Annual International Raising C. diff Awareness Conference and Health Expo in Atlanta.
Clifford McDonald, MD, Associate Director for Science in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), chaired the conference. In his role at the CDC, McDonald’s at the forefront of efforts to prevent and treat the infection – one the CDC has declared among the most urgent drug-resistant threats that we currently face.
“It’s my firm belief that we are on the threshold of a new era in better diagnosis, treatment, and prevention approaches. At the CDC, we deal with statistics, but there are faces behind those numbers. At the heart of every infection is a patient who deserves our competence, our empathy, and our passion,” said McDonald.
One of those faces, Roy Poole, is a volunteer patient advocate for the C Diff Foundation. After retiring from a career in the Air Force, Poole led a healthy, active lifestyle as an avid outdoors-man in Colorado before antibiotics prescribed for a routine dental procedure set the stage for CDI. In the medical community, his symptoms were met with disbelief and inappropriate treatment.
“Three weeks after leaving the hospital, I walked into my (previous) primary care physician, and asked for an order to have a stool sample taken to determine if Toxins A or B were present. His response was, ‘Are you still having problems with that?’ Clearly, there is a need for more education about C. diff among physicians,” said Poole.
CDI is a formidable opponent. However, with the newly focused attention on discovering ways to disable the bacteria and cohesive public health approaches aimed at prevention, presenters from government, academia and industry offered five key reasons we can win the battle against C. diff:
Antibiotic stewardship efforts are gaining a foothold.
Statistics present a chilling picture: 453,000 new cases and an estimated 30,000 deaths each year. It’s likely that those numbers grossly underestimate the true impact of CDI, since it’s what we know from death certificate reporting.
However, we are seeing that rates may have peaked after a long plateau. Mark Wilcox, MD, Head of Microbiology at Leeds Teaching Hospital, Professor of Medical Microbiology at University of Leeds, and the lead on Clostridium difficile for Public Health England in the United Kingdom, has demonstrated a 70% reduction in cases in England in just 7 years. This was after a concerted effort that Wilcox spearheaded surrounding antibiotic stewardship, specifically addressing a reduction in unnecessary prescribing of fluoroquinolones and cephalosporin antibiotics.
Commonly prescribed antibiotics disrupt the protective microbiota (the normal bacteria of the gut) and leave it vulnerable for C. diff colonization. “There was a concerted effort that went beyond lip service and truly embraced the principles of improved surveillance, more accurate diagnostics, enhanced infection prevention measures to use antibiotics more wisely and to limit transmission and careful treatment,” said Wilcox.
High rates of CDI are always associated with the use of certain antibiotics: clindamycin, cephalosporin, and fluoroquinolones. Research has shown that lower respiratory tract infections and urinary tract infections account for more than 50% of all in-patient antibiotics use. But are these really necessary?
“We know that antibiotics are overused and misused across every healthcare setting. At least 30% of antibiotic prescriptions are unnecessary – and this equates to 47 million unnecessary antibiotic prescriptions per year written in doctors’ offices, hospital outpatient departments, and emergency departments. We have a lot of work to do, and CDC is actively working to reduce unnecessary antibiotic use,” said Arjun Srinivasan, MD at the CDC. “Stopping unnecessary antibiotics is the single most effective thing we can do to curb C. diff infections in the United States. This is something that we can do today.”
Srinivasan acknowledged that telling patients that they can’t have a prescription for an antibiotic might result in some pushback. “Patient satisfaction scores are a very real concern. When someone is sick and takes a day off work, they’re not leaving without a prescription – especially when the last provider wrote one for their same symptoms,” he said. “But this is a new day, and it’s up to the physician to educate their patients and stay strong.”
Hospitalists have access to accurate, inexpensive and quick diagnostic tests that can lead to targeted, effective treatment. This can arm the treating physician and patient with information that can put patients on a path to recovery without feeling like they are being dismissed.
Emerging guidance reflects important advances in research and development.
Most recently published in 2010, the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for C. diff are currently under review. This is critical because of the number of physicians still treating with metronidazole first, despite the fact that the largest randomized controlled clinical trial has shown that vancomycin is more effective.
“Since 2010, the landscape has changed dramatically,” said Stuart B. Johnson, MD, Professor, Department of Medicine, Loyola University, and Researcher at the Hines VA Hospital in Chicago.
“The past few years have ushered in a new age of understanding how and where C. diff colonizes, and the damaging toxins A and B that it produces.”
Considering that 25-30% of patients experience a CDI recurrence, it’s evident that metronidazole unnecessarily contributes to the failed treatment outcomes for patients. Metronidazole is less expensive, but has more side effects than oral vancomycin and is less effective in treating CDI.
Johnson provided an overview of the dramatic advances this space has seen in just the past few years.
Limitations of current guidelines include:
• No mention of fidaxomicin, a narrow-spectrum antibiotic, which in 2011 was the first medication approved in 25 years for the treatment of C. diff associated diarrhea
• Limited evidence for recommendations to treat severe, complicated CDI
• Limited evidence for recommendations on recurrent CDI
• Little mention of Fecal Microbiota Transplant (FMT)
5. Patient advocacy and awareness efforts can alter the course of CDI.
CDI survivors shared their experiences along their emotional journey – fear, disbelief, isolation, and depression. They also expressed gratitude at the validation, information and support they received from the patient advocacy community. Perhaps the greatest gift they have received is the empowerment to question their physicians about the necessity of antibiotics they have been prescribed in terms of risk of CDI.
“The hospital where I was treated initially seemed eager to have me leave. They offered no additional help. The C diff Foundation has been my greatest source of help. In turn, I feel I help myself cope best, when I help others to cope with the disease,” said Poole.
TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE
PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED —- THANK YOU
Dale Gerding, MD, FACP, FIDSA, is Professor of Medicine at Loyola University Chicago, Research Physician at the Edward Hines Jr. VA Hospital. Additionally, Gerding is an infectious disease specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair of the antibiotic resistance committee of SHEA. He is a fellow of the Infectious Diseases Society of America and past chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. His research interests include the epidemiology and prevention of Clostridium difficile, antimicrobial resistance, and antimicrobial distribution and kinetics.
The paper, “Burden of Clostridium difficile Infection in the United States,” was published in the New England Journal of Medicine.
The study, “Changing epidemiology of Clostridium difficile infection following the intriduction of a national ribotyping-based surveillance scheme in England,” was published in the journal Clinical Infectious Diseases.
The study, “Prevalence of antimicrobial use in US acute care hospitals,” was published in JAMA.
The paper, “Vancomycin, metronidazole, or toleyamer for Clostridium difficile infection: results from two multinaionalm randomized, controlled trials,” was published in Clinical Infectious Diseases.
The study, “A Randomized Placebo-controlled Trial of Saccharomyces boulardii in Combination with Standard Antibiotics for Clostridium difficile disease,” was published in JAMA.
Giving Tuesday Is a global day dedicated to giving back.
On Tuesday, November 29th , 2016 Charities, Families, Businesses, Community centers, and Students around the world will come together for one common purpose: to celebrate generosity and to give.
#GivingTuesday was founded in 2012 by New York’s 92nd Street Y in partnership with the United Nations Foundation. Together, with a team of influential and founding partners together launched a global movement that has engaged over 10,000 organizations worldwide.
Remember the C Diff Foundation in your Giving Tuesday efforts. Your gift is tax deductible and it will support patients touched by the life-threatening C. diffiicle infection, their families, communities and the many programs dedicated in Raising C. diff. Awareness™ by providing information and support — from villages to cities — worldwide.
We appreciate you and all that you do for the good of others.
To Donate please visit the C Diff Foundation Website www.cdifffoundation.org
and choose the tab at the top of the page —
Thank you for your continued support and we are grateful for your generosity.
Shop Amazon to support the many programs and educational workshops provided by the C Diff Foundation worldwide —
It’s a pleasure to share the new way to give to the C Diff Foundation. Amazon will share a portion of the proceeds from your purchases with the C Diff Foundation. While you are shopping on-line you are also donating, and we are grateful.
Here is how it works:
* Shop Amazon through AmazonSmile C Diff Foundation
Click on the link below to access the site
The Global C. difficile Congress FREE Webinar will take place on November 11th at 8:00 a.m. Eastern Time will broaden existing knowledge surrounding C. difficile infection (CDI) prevention, treatments, and environmental safety worldwide. The drive and passion takes us forward in promoting the practical and technical advancements taking place across the globe. Healthcare Professionals from every area of expertise, will discuss the control and treatment options, the healthcare perspectives, antibiotic-resistance stewardship programs, and much more to raise awareness and share successful implementations and guidelines.
The Global C. difficile Congress will be eight sessions presented by topic experts – in four hours – in one day – with goals to change the C. difficile world with a common focus; To
improve C. diff. infection prevention, treatments, and environmental safety in the healthcare communities worldwide.
Twitter chats and tweets take place in honor of the
Global C. diff. Awareness Campaign From November 1st throughout the month.
There will be a #CdiffTwitterChat
Join Us on NOVEMBER 18TH at 3:30 p.m. Eastern Time with International Infectious Disease Expert, Dr. Hudson Garrett Jr. for a real-time Question and Answer Twitter Chat about Clostridium difficile infection and disease. Questions are welcomed from both patients and healthcare providers. Registration is complimentary to all those interested. Click on the link below for more information:
VOLUNTEER PATIENT ADVOCATES:
We applaud our Volunteer Patient Advocates around the globe who continue sharing life-saving information from villages to cities organizing meetings during the month of November to reach a little higher, speak a little louder and elevate C. difficile infection awareness, prevention, treatments, and environmental safety for everyone to witness a decrease in C. diff. infections worldwide. Each Volunteer is a special leaf, on each branch of the growing C Diff Foundation tree. Our sincere gratitude to each of our Volunteers worldwide!
Follow the C Diff Foundation on
Pinetrest, and LinkedIn and join the fight and save lives.
Thank you for your support that helps our mission continue moving forward.
Educating and advocating for C. difficile infection prevention, treatments, environmental safety and support worldwide.
Be sure to check back as new events will be added weekly.
We are pleased to welcome Ron Romano, RN to the C Diff Foundation Global Network.
Ron Romano, RN presides as Infection Prevention Advocate.
Ron has certifications from the following organizations :
- American Association for LTC Nursing – Co-founder Past President – 2007- 2015
- American Association for Safe Patient Handling – Board Member 2010-2012
- Association for Professionals in Infection Control & Epidemiology – Current Member
- Safety Specialist LTC – Certification – Current
C. difficile Infections are no stranger to Ron as his family members have also been touched by this infection. His background in healthcare and passion for Infection Prevention and Epidemiology is an asset to many. Ron is the Owner, President and CEO of Safety Net LLC in Cincinnati, Ohio.
Safety Net is a national healthcare safety consulting and distribution company providing unique product solutions to mitigate risk associated to infections. We serve acute care hospitals, post-acute and home-care. Our solutions protect our healthcare workers and those under their care.
Ron has also been the Past-President in the following organizations:
American Association for LTC Nursing (AALTCN) 07-15 The AALTCN is a professional organization that supports all levels of caregivers providing career ladder with supporting education, certifications and resources. AALTCN has recently merged with the American Association for Nurse Assessment Coordinators to form the largest professional nursing organization in long term care.
Health Education Network – 07-15, Co-owner – President
Health Education Network is a medical publication company that provides Nursing education for all levels of caregivers on a variety of topics for LTC. Certificate programs are available for Staff Development Coordinators, Nurse Assessment Coordinators, Director of Nursing in LTC, RN and LPN in LTC.
National Association Director of Nursing Administration (NADONA/LTC) Cincinnati, Ohio 01-07
NADONA/LTC is a professional organization representing Directors of Nursing, Assistant Directors of Nursing and Clinical Managers in long-term care. NADONA/LTC has 38 state chapters nationally and internationally in Canada.
We welcome Ron to the C Diff Foundation and appreciate his healthcare background to join us in promoting Infection prevention and C. diff. Awareness worldwide with fellow members
The C Diff Foundation Volunteer Patient Advocates; Heather Clark and
her sister, Kimberly Reilly participated at local events over the summer season to educate and advocate
for C. diff. infection prevention, treatments, and environmental safety within the local communities raising C. diff. awareness and saving lives.
On behalf of the C Diff Foundation , we sincerely thank you Heather and Kimberly for your dedication, your time, and for joining the
C Diff Foundation partnering and sharing our global mission.
We are truly grateful to the many special Volunteer Patient Advocates, the special individuals donating their time in “Raising C. diff. Awareness within their communities” around the globe. Thank You!
Heather and Kimberly lost their dear Father from C.diff. involvement. Shortly after his passing, Heather and Kimberly took a stand with the C Diff Foundation and dedicated their time and efforts in “Raising C. diff. Awareness” to help educate, and advocate for this life-threatening infection that played a big part in their Father’s passing.
To listen to Heather’s journey, with fellow C. diff. survivors, – please click on the podcast link below:
“What is C. diff.?”
Clostridium difficile (C.diff.) is gram-positive, anaerobic, and a spore, rod/spindle-shape,
a common bacterium of the human intestine in 2 – 5%. C diff. becomes a serious gastrointestinal infection when individuals have been exposed to antibiotic therapy, and/or have experienced a long-term hospitalization, and/or have had an extended stay in a long-term care facility. However; the risk of acquiring a C diff. infection (CDI) has increased as it is in the community (Community Acquired CDI) and found in outpatient settings.
There are significant risk factors in patients who are immunosuppressant, ones who have been on antibiotic therapy, and the elderly population.
How do Antibiotics cause C diff.? The antibiotics cause a disruption in the normal intestinal flora which leads to an over growth of C difficile bacteria in the colon. The leading antibiotics known to disrupt the normal intestinal flora, yet not limited to, are Ampicillin, Amoxicillin, Cephalosporins, Clindamycin, and the broad spectrum antibiotics.
Since November 2012 the CDC has shared public announcements regarding antibiotic use: Colds and many ear and sinus infections are caused by viruses, not bacteria. Taking antibiotics to treat a “virus” can make those drugs less effective when you and your family really need them. Limiting the usage of antibiotics will also help limit new cases of CDI.
*Always discuss the symptoms and medications with the treating Physician.
What are C.diff. Symptoms? Symptoms of Clostridium difficile (C.diff.)
C.diff. strains produce several toxins; the most popular are enterotoxin – Clostridium difficile toxin A and cytotoxin – Clostridium difficile toxin B. Both strains are responsible for the symptoms of diarrhea, abdominal pain, fever, fatigue, and can advance to a complication of a severe inflammation of the colon; pseudomembranous colitis, which can also lead to further complications of toxic megacolon.
How is C.diff. Transmitted? Mode of transmission of CDI can be either directly or indirectly, hospital acquired (nosocomial) or community – acquired; Ingesting C.diff spores transmitted from others and patients by hands, or altered normal intestinal flora by antibiotic therapy allowing proliferation of C.diff. in the colon. Coming in contact with surfaces, devices, or material with Clostridium difficile spores can easily be transferred to individuals by hands that have touched a contaminated surface or item. Examples of surfaces, devices, and materials contaminated with C.diff. spores in hospital and community/outpatient settings: commodes, bath tubs, showers, hand rails, bed rails, counter tops, handles, clothing, medical equipment, and electronic rectal thermometers.
The C Diff Foundation provide a wide range of programs, such as education, and advocacy for C. diff. infection prevention, treatments, support, and environmental safety worldwide, training of volunteer patient advocates (VPA’s) across the globe to provide educational workshops, supplying life-saving medications for those afflicted with this infection from young children to seniors, building satellite branches across the globe, presenting educational workshops in educational programs, improving and expanding the C. difficile infection awareness, providing global tele-conferencing support sessions in mental health counseling, long-term illnesses, the prevention, treatments, environmental safety with nutritional education for patients, and families suffering through a C. difficile infection
and so much more.
We are working together and dedicated at raising C. diff. awareness to witness a decrease in newly diagnosed C. difficile infections worldwide and through dedication and efforts of the
C Diff Foundation Volunteers – we will meet our goals.
Treatments For CDI? Treating C diff is becoming more challenging to physicians, frustrating to patients, and costly to the health care industry. To date there are three antibiotics effective at treating C diff: Metronidazole is prescribed to treat mild to moderate symptoms and is cost effective (8). Vancomycin is prescribed for moderate to severe symptoms via: oral route as intravenous administration does not achieve gut lumen therapeutic levels. Vancomycin is prescribed to patients with unsuccessful results from the Metronidazole, or the patient is allergic, or pregnant, breastfeeding, or younger than ten years of age.
The most recent antibiotic, Dificid (fidaxomicin) http://www.dificid.com is the first medication approved by FDA to treat C diff. Associated-Diarrhea CDAD in over twenty five years with superiority in sustained clinical response (5) Loperamide, diphenoxylate and bismuth medications are contraindicated as they slow the fecal transit time which extends the toxins in the gastrointestinal system.
The use of Cholestyramine has demonstrated positive results as toxins A and B bind to the resin as it passes through the intestines aiding in slowing bowel motility and assists in decreasing dehydration (9).
C.diff. spores are able to live outside of the body for a very long period of time and are resistant to most routine cleaning agents. It has also been proven that alcohol based hand sanitizers remain ineffective in eradicating C. diff. spores. In 2009 Clorox Commercial Solutions Ultra Clorox Germicidal Bleach ® was named the first and only product to obtain Federal EPA registration for killing C. diff. spores on hard, non porous surfaces when used as directed (1).
Please visit the following Page for additional information:
The CDC also recommends a 1:10 ( 1 cup bleach to 9 cups of water) dilution of bleach and water for cleaning hard non-porous surfaces keeping areas covered with solution for 10 minutes and the solution is to be mixed fresh daily.
Hand hygiene following the guidelines in HAND WASING; it is important to wash hands before entering and exiting a patient’s room (4). The spores are difficult to remove from hands; Universal Contact Precautions remain best practice for healthcare personnel and Contact Precautions for patients with a confirmed diagnosis of CDI. Prevention through education about CDI has proven effective and beneficial to environmental housekeeping departments, health care professionals, administration, patients, and their families (2)
To Join The C Diff Foundation Volunteer Patient Advocate Program, please contact us by email email@example.com or call us toll-free 1-844-FOR-CDIF
(1) Clorox registered EPA
(2) Clostridium difficile (CDI) Infections thttp://www.cdc.gov/hai/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf
(3) Lab Tests and Diagnosis Mayo Clinichttp://www.mayoclinic.com/health/c-difficile/DS00736/DSECTION=tests-and-diagnosis
(4) CDC Hand washing
(5) FDA announcement Dificid
(6) Probiotics in the prevention of antibiotic-associated diarrhea
(6) Danimals PRNewswire8/Jan2012;
(7) Get smart antibiotics week CDC
It is with great pride and certainty in the power of the healthcare community to present the 4th Annual International Raising. C. diff. Awareness Conference and Health Expo
being hosted at the
DoubleTree by Hilton — Atlanta Airport
3400 Norman Berry Drive
Atlanta,Georgia 30344 USA (Hotel Phone: 1-404-763-1600)
Doors open at 7:15 a.m — Sign In and Continental Breakfast
Conference begins at: 7:30 a.m. – 5:00 p.m.
Raising C. difficile awareness is essential to build upon and advance existing knowledge and necessary for overcoming the challenges our healthcare communities are faced with today.
“None of us can do this alone — All of us can do this together”
Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released February 25, 2015 by the Centers for Disease Control and Prevention (CDC). C. diff. is a leading cause of infectious disease death worldwide; 29,000 died within 30 days of the initial diagnosis in the USA. Previous studies indicate that C. diff. has become the most common microbial cause of healthcare-associated infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone.
Clinical professionals gather for one day to present up-to-date data to expand on the existing knowledge and raise awareness of the urgency focused on a Clostridium difficile infection (CDI) —
- Environmental Safety
- Clinical trials and studies
- Microbiome research, studies
- Infection Prevention
- Fecal Microbiota Restoration and Transplants for Adults & Pediatrics
- A Panel Of C. diff. Infection Survivors
- Antibiotic Stewardship
- Healthcare EXPO
……………………and much more.
You won’t want to miss out on this opportunity to learn from
International topic experts delivering data directed at evidence-based
prevention, treatments, and environmental safety in the C. diff.
and healthcare community.
Gain insights on September 20th that will not be available anywhere else with an opportunity to receive up-to-date data on major topics in this program being presented in one day.
5 Leading reasons to attend this dynamic conference:
- Learn from leading healthcare professionals, clinicians, researchers, and industry.
- Networking opportunities with new and reconnect with those in the healthcare community with similar interests.
- Gain breakthrough results through research in progress and gaining positive results. Programs focused on Antibiotic-resistance such as the Antibiotic Stewardship making a difference. Front line developments in progress focused on C. diff. infection prevention, treatments, environmental safety.
- Implement and share the knowledge well after the conference ends. Every attendee receives a booklet with guest speakers information, media to review audio programs, and Health Expo Sponsor information focused on the important agenda topics.
- Embrace the opportunity, with all of the topic experts presenting, and hold the conference in the highest priority from the participation in this conference to an audience of medical students, and fellow healthcare professionals, who will benefit the most from the data and gain tools to overcome the barriers facing healthcare each day.
“The information and up-to-date studies shared at the 2015 conference added to an existing knowledge base that helps us to continue delivering quality care in the medical community.” Linda Davis, RN,BSN
$75.00 — Conference Registration
$30.00 — Student Conference Registration (Student ID To Be Presented At the Door)
TO REGISTER Click on the “Raising C. diff. Awareness” Ribbon below
Room accommodations are available — Complete and Confirm
by August 19th to reserve your hotel reservations.
To create a reservation please click on the DoubleTree By Hilton Logo below – – – – – –
A suggested travel coordinator, for your convenience
For Additional Information visit the C Diff Foundation Website:
And Click on the 2016 September Conference Tab
Follow us on Twitter