Recurrent C.Diff and Prevention Behaviors | News | Loyola Medicine

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Friday, November 3, 2017

After Repeated C. diff Infections, People Change Their Behaviors

Washing Hands

MAYWOOD, IL –  After suffering repeated bouts of debilitating Clostridium difficile infections, many patients significantly change their behaviors, but some precautions may do little to prevent future infections, according to a first-of-its-kind study.

Many patients reported they wash their hands (46.7 percent) and use soap and water for washing and bathing (44.9 percent) much more often. But there is little or no evidence to support some other behavior changes, including avoiding or adding certain foods (reported by 31.4 percent of patients), increasing the use of probiotic supplements (26.3 percent) and avoiding shared places such as public bathrooms or restaurant buffets (26.3 percent).

The study, led by Loyola University Chicago and Hines VA Hospital researcher Frances M. Weaver, PhD, is published in the journal Infection Control and Hospital Epidemiology. Weaver is a professor in Loyola's Department of Public Health Sciences and director of Hines' Center of Innovation for Complex Chronic Healthcare.

"While some behaviors are appropriate (e.g. handwashing) others are not supported by evidence of decreased risk and may negatively impact patient quality of life," Dr. Weaver and colleagues wrote.

Infection by the bacterium Clostridium difficile, or C. diff, can cause diarrhea, abdominal pain, fatigue, headache, fever, light-headedness, nausea and weight loss. In 2011, there were an estimated 453,000 C. diff cases in the United States, and approximately 6.5 percent of these patients died.

Researchers surveyed 119 patients who had suffered recurrent C. diff infections, to better understand how their illness affected their behaviors. (Recurrent infection was defined as a second episode of C. diff within 15 to 56 days of an initial episode.) Patients were treated at seven Chicago area hospitals that belong to the Chicago Area Patient Reported Outcomes Research Network (CAPriCORN).

Survey respondents' average age was 57. Fifty percent said they had been hospitalized with C. diff or a diarrhea-related illness in the past three years; 58.5 percent rated their diarrhea as severe; 30.7 percent reported severe exhaustion; 29.1 percent reported severe abdominal pain; 55.6 percent said they were worried about getting sick again and 37.3 percent were worried about being contagious.

Increased hand washing and use of soap and water for cleaning have been shown to significantly reduce the likelihood of acquiring and transmitting infections.

But there is little evidence to suggest that changes in diet reduce the risk of contracting C. diff. The use of probiotics (yogurt and other microorganism-based products) have received extensive media coverage, but using probiotics to prevent C. diff  "is still controversial because of the conflicting findings across studies," researchers wrote.

Respondents who said they eat out less and/or avoid shared and public places "may be adversely impacting their quality of life without changing their risk of future illness," researchers wrote.

Certain medications, including antibiotics and proton pump inhibitors to treat heartburn, increase the risk of C. diff infections. But 46.6 percent of respondents did not avoid such medications.

Researchers concluded that doctors should provide pamphlets, waiting-room videos and other information about how to prevent C. diff. Doctors also should explain that other behaviors, such as eating out less, "will not affect their risk of future illness but could negatively affect their quality of life."

The study is titled, "The impact of recurrent Clostridium difficile infection on patients' prevention behaviors."

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.