C difficile: Guidelines to Diagnose, Treat, and Prevent
The final issue is about the hygiene of these patients. The guidelines spend a lot of time talking about the in-room hygiene of the hospitalized patient. What is lacking is talk about home hygiene. When these patients are discharged from the hospital or if they are outpatients, they are at home. They need to vigorously clean their bathrooms. All surface areas need to be cleaned with bleach or an equivalent agent. C difficile can live on surface areas for weeks. What happens is that these patients are defecating in the commode at home, and when they flush the commode there is aerosolization of these products. This is something called "toothbrush microbiology." Studies have actually demonstrated fecal organisms on toothbrushes. I have my patients clean their bathrooms exquisitely to all surface areas. I also have them throw away their toothbrush. I think this is important when you are talking about preventing recurrent disease.
The diagnosis, treatment, and prevention of C difficile is a complicated process. We have lots of new information. I think the American College of Gastroenterology Guidelines are exquisitely specific as far as giving us guidance. All their recommendations are evidence-graded, so they talk about the weight of evidence and the strength of evidence supporting that recommendation. I encourage each and every one of you to give this a healthy review as you look at your treatment plan and diagnostic strategy for C difficile.
Hopefully this has been helpful to you. I look forward to discussing future topics with you. Thanks again for listening.
Hygiene and Prevention
The final issue is about the hygiene of these patients. The guidelines spend a lot of time talking about the in-room hygiene of the hospitalized patient. What is lacking is talk about home hygiene. When these patients are discharged from the hospital or if they are outpatients, they are at home. They need to vigorously clean their bathrooms. All surface areas need to be cleaned with bleach or an equivalent agent. C difficile can live on surface areas for weeks. What happens is that these patients are defecating in the commode at home, and when they flush the commode there is aerosolization of these products. This is something called "toothbrush microbiology." Studies have actually demonstrated fecal organisms on toothbrushes. I have my patients clean their bathrooms exquisitely to all surface areas. I also have them throw away their toothbrush. I think this is important when you are talking about preventing recurrent disease.
Closing Remarks
The diagnosis, treatment, and prevention of C difficile is a complicated process. We have lots of new information. I think the American College of Gastroenterology Guidelines are exquisitely specific as far as giving us guidance. All their recommendations are evidence-graded, so they talk about the weight of evidence and the strength of evidence supporting that recommendation. I encourage each and every one of you to give this a healthy review as you look at your treatment plan and diagnostic strategy for C difficile.
Hopefully this has been helpful to you. I look forward to discussing future topics with you. Thanks again for listening.
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