A new study confirms that C. Diff is indeed a condition that medical staff need pay attention to and identify it as soon as the condition manifest itself-- in order to save patient lives.  

After evaluating 254 patients with Clostridium Difficile at Winthrop University Hospital in New York, researched determined that patients who acquired the disease in a nursing home were more substantially more likely (three times more) to die from resulting complications than those who acquired the condition in the 'general community'.

As the ears and eyes of treating physicians, nurses in medical facilities need to be educated on symptoms associated with C. Diff and how the condition differs from an ordinary 'stomach ache' in order to give patients the best chance of a full recovery.  Common symptoms of C. Diff may include:

• Severe stomach pain and cramping following use of antibiotics
• Particularly foul smelling bowel movements
• Frequent diarrhea
• Dehydration
• Fever
• Distended stomach

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The family of a deceased Mississippi nursing home patient that died from complications related to Clostridium Difficile (C. Diff) has settled a claim with the nursing home where she contracted the infection. WREG reported that the family of Virgina Valentine settled their wrongful death claim with Trinity Mission Health & Rehab for an undisclosed amount of money due to the alleged C. Diff infection of their loved one.

Shortly after her admission to Trinity Mission, Ms. Valentine became weakened to the point that she was taken to a nearby hospital.  While at the hospital, doctors diagnosed her with C. Diff and began administering antibiotics to kill the infection.  Despite the medical intervention, Ms. Valentine was unable to fight off the C. Diff and passed from complications.

Even though Ms. Valentine had executed an Alternative Dispute Resolution Agreement at the time of her admission to Trinity Mission, which called for all disputes to be resolved via arbitration, her family was successful in invalidating the agreement based upon multiple errors on the part of the facility.  Read more about the settlement of this nursing home claim here.

C. Diff In Nursing Homes

In the course of the past few years, C. Diff has received much attention due to an increasingly aware medical community that has become more attuned the risks associated with this infection-- particularly among the elderly.

C. Diff is a bacterial infection can cause diarrhea and more serious intestinal conditions, such as colitis. C. Diff bacteria are found in the feces of an infected person. The bacteria is primarily spread when caregivers come in contact with the feces of an infected patient and fail to wash their hands before treating another patient.

Many elderly in nursing homes and hospitals are at a heightened risk for contracting C. Diff due to the fact that they may be taking antibiotics for other.  The influx of antibiotics is believed to weaken their bodies ability to fight off the C. Diff bacteria. 

When diagnosed early on, C. Diff may be treated with a course of specialized antibiotics.  However, the effectiveness of the antibiotics becomes compromised when a diagnosis is delayed.  Advanced cases of C. Diff may require surgery in the bowel or colon and may deadly.

Related:

Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

C-Diff Infection Alleged To Blame For Death Of Nursing Home Patient

The lawsuit alleges two short-term stays at Helia Healthcare facilities (Helia Healthcare of Energy and Helia Healthcare of Benton) are to responsible for the man's C. Diff infection and development of decubitus ulcers.  It is further alleged that these medical complications contributed to the man's death.

Despite the fact that the man had a prior episode of C. Diff, and was at an increased risk for return of the infection, the nursing homes failed to recognize tell-tale signs of the infection including:

• Poor appetite
• Poor fluid intake
• Diarrhea

It wasn't until the man had long been struggling with signs of the infection did the facility send him to the hospital for treatment. Read more about this wrongful death lawsuit here.

C. Diff and Nursing Homes

C. Diff s a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon) and even death.  Though contracting C. Diff may be a relatively common occurrence (there are an estimated 3 million cases reported annually), C. Diff involving nursing home patients is especially problematic due to the fact that many elderly patients have compromised immune systems and are already in a weakened state.

C. Diff bacteria are are contagious and can be passed through the feces of an infected person and can spread to food, surfaces, and objects when infected patients and other nursing home staff do not wash their hands thoroughly.  Proper sanitation techniques such as thorough cleaning and hand washing is crucial in order to prevent the bacteria from getting spread to other patients.  Spores of C. Diff can survive for months unless facilities to a proper job sanitizing patient rooms and common areas such as bathrooms and cafeterias.

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Here are some of the medical conditions we have discussed over the past year:

Clostridium Difficile / C. Diff

Clostridium difficile (also called C. difficile or C. diff) associated disease (“CDAD”) is a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon). CDAD is responsible for about three million cases of diarrhea and colitis annually in the United States.

Stevens Johnson Syndrome

Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction. SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Legionnaires Disease

Legionnaires disease is an infectious disease caused by the Legionella bacteria. There are two types of Legionnaires disease: Legion fever (where people generally develop pneumonia) and Pontiac Fever (symptoms similar to the flu).

Legionnaires disease got its name when a group from the American Legion conference all developed pneumonia. When scientists analyzed the group, they noticed that they all had the same bacterium called Legionella.

Subdural Hematoma

A subdural hematoma is a type of intracranial bleeding (hemorrhage), caused by head injury. Subdural hematomas occur when blood vessels burst in the space between the brain and the outermost membrane that covers the brain (dura mater). The collection of blood forms a hematoma, which puts pressure on the brain tissue.

There are three types of subdural hematomas: acute, sub-acute, and chronic. Acute subdural hematomas are the most dangerous and are usually caused by a severe head injury. With sub-acute hematomas, the signs and symptoms take longer to appear (days or weeks). Chronic hematomas can be caused by less severe head injuries, and symptoms can take weeks to appear because of slower bleeding.

Hypotension

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low.

Sepsis

'Sepsis' is a bacterial infection in the bloodstream or body tissues, frequently found in patients with severe bed sores. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.' Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis. People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Amyloidosis

Elderly nursing home residents, especially those suffering from other diseases such as bed sores, have a higher risk of developing amyloidosis, a disease which can damage various tissues and organs. This can cause dangerous complications in residents who are already weak from advanced age or underlying disease.

Amyloidosis is a group of diseases caused by abnormal deposits of amyloid protein (usually produced by cells in bone marrow) in the body’s tissues and organs. The disease frequently affects the heart, kidneys, liver, spleen, nervous system, and gastrointestinal tract. The amyloid protein can deposit in a localized area (localized amyloidosis) or affect tissues throughout the body (systemic amyloidosis). Amyloidosis is diagnosed for testing for the amyloid protein in a biopsy of involved tissue.

Impacted Bowel

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

C. difficile is naturally found in the environment and even in a small number (fewer than 3%) of healthy people’s large intestine. Most people in good health do not usually get sick from C. difficile because of the millions of intestinal bacteria that help protect the body from infection.

When people-- particularly the elderly-- take antibiotics to treat infections (such as floroquinolones, cephalosporins, clindamycin, and penicillins), the antibiotics can kill some of the healthy bacteria along with the bacteria causing the infection. This allows C. difficile to grow out of control leading to a C. difficile infection. 

After a C. difficile infection sets in, it can produce toxins that attack the lining of the intestine, killing cells and causing patches or plaques of inflammatory cells. The toxins can also decay cellular debris inside the colon. 

A more recent strain of C. difficile is even more aggressive, producing much more of the harmful toxins than previous strains. This new strain is also more resistant to medications and has even affected people who have not spent time in the hospital or taken antibiotics. 

Signs and symptoms of mild to moderate CDAD cases:

• Watery diarrhea three or more times a day for two or more days
• Mild abdominal cramping and tenderness
• Low-grade fever

More severe cases of CDAD can cause the colon to become inflamed (colitis) or form patches of raw tissue that can bleed or pus (pseudomembranous colitis). Signs and symptoms of more severe C. difficile cases:

• Watery diarrhea ten to fifteen times a day
• Severe abdominal pain and tenderness
• High fever
• Blood or pus in stool
• Nausea
• Dehydration
• Loss of appetite
• Weight loss

CDAD incidence has doubled in recent years and is responsible for about three million cases of diarrhea and colitis annually in the United States. A much higher percentage of people carry the bacteria in nursing homes, hospitals and other healthcare facilities. 

The bacteria are passed through the feces of an infected person and can spread to food, surfaces, and objects when infected people do not wash their hands thoroughly. The bacteria creates spores (nonactive form of the bacteria) can live in a room for weeks or even months; when ingested, they transform into the active, infectious form of the bacteria. 

Most cases occur in healthcare settings because germs are spread easily, there is increased use of antibiotics, and there are people more vulnerable to infection. CDAD commonly affects the elderly, with persons 65 years of age or older being ten times more likely to become infected with C. difficile than younger people. Infections are also more common after antibiotic use.

There are several risk factors for C. difficile infections:

• Currently taking or having recently taken antibiotics (C. difficile accounts for 15-20% of antibiotic-related diarrhea and most cases of pseudomembranous colitis)
• Advanced age (65 years of age and older)
• Recent hospitalization, especially for an extended period of time (10% of hospital patients will develop an infection after a stay of only two days)
• Living in a nursing home or long-term care facility
• Serious underlying illness or weakened immune system
• Abdominal surgery or gastrointestinal procedure
• Colon disease (IBS or colorectal cancer)
• Previous C. difficile infections

Dangerous complications can occur with C. difficile infections. These include:

• Dehydration and electrolyte deficiencies
• Kidney failure
• Bowel perforation (hole in the large intestine)
• Toxic megacolon (colon becomes very distended and can even rupture)
• Death (mortality rate is 1 to 2.5 percent and is higher in older adults)

There are several tests that can be performed to determine if a person has a C. difficile infection:

• Stool tests (enzyme immunoassay, PCR, tissue culture assay)
• Colon examination (flexible sigmoidscopy)
• Imaging tests (CT scan)

While mild illness caused by CDAD may improve after stopping antibiotics (requiring only correction of dehydration and electrolyte deficiencies), more severe symptoms might require treatment with a different antibiotic (metronidazole for mild to moderate illness and vancomycin for more severe symptoms). Probiotics (organisms such as bacteria and yeast) can be used to help prevent recurrent C. difficile infections. 

In severe cases, surgery might be necessary to remove diseased portions of the colon. Recurrent C. difficile infections occur in about twenty-five percent of people with C. difficile infections. Treatment for recurrent infection includes: antibiotics, Probiotics, and stool transplants to help restore healthy intestinal bacteria. A doctor should be consulted if a person has symptoms lasting more than three days, a fever, severe pain or cramping, blood in the stool, or more than three bowel movements a day. 

C. difficile is considered the most common cause of diarrhea in nursing homes. Because many elderly nursing home patients are more susceptible to C. difficile infections and its accompanying complications, nursing home staff must closely monitor the bowel movements of residents in order to quickly diagnose a possible C. difficile infection. 

Many nursing home residents are already weak or suffer from other illnesses; therefore, it is important that nursing home staff provide proper treatment for diarrhea (fluids and good nutrition) in order to maintain resident health. 

In addition, nursing homes should take extra precautions to prevent the spread of C. difficile through: thorough hand washing, contact precautions (keeping residents with infections separate from healthy residents), thorough cleaning of all surfaces and equipment, and avoiding unnecessary use of antibiotics. 

We have successfully prosecuted cases involving individuals who died due to untreated or undiagnosed C. difficile.  We always welcome the opportunity to speak with you regarding a potential cause of action against a nursing home or hospital.  Our services are always free if there is no recovery for you.  (888) 424-5757

Special thanks to Heather Keil, J.D. for her diligent work researching this important topic.

Sources:

Mayo Clinic: C. difficile

CDC: Clostridium difficile

Geriatric Nursing: Clostridium difficile: An emerging epidemic in nursing homes