Exposure question

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Pippa
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Exposure question

Postby Pippa » Sat Apr 27, 2019 8:51 pm

I am a 60 year old woman who was just exposed to C diff. I was visiting my 89 year old mother in law in a rehabilitation facility. Her first test for C diff came back positive today. The day prior to her being diagnosed, I used a cloth towel to dry my hands in the restroom of her room since the facility does not supply paper towels. My mother in law took a shower in that bathroom earlier that day. She has a colostomy bag, making fecal transmission a lot higher than normal. I have done a lot of research online about C diff. But, I cannot find out what risk I am at for getting it. I have not been on antibiotics in probably two years. I am heathy. I read where the spores can remain active for up to 5 months on a hard surface.
I also cannot determine what risk I am at for being a carrier of C diff. I have a two week old grandson and my daughter desperately needs my help with him because she also has a two year old.
As desperate as we are for me to help with my grandson, we are not planning on my entering her home until I am cleared for having C diff.
I cannot get straight answers from medical professionals so far. I just get, "don't worry about it unless you get symptoms".
*What risk am I at for getting C diff?
*How soon can I be tested?

AllisS
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Re: Exposure question

Postby AllisS » Sun Apr 28, 2019 12:17 am

Hi Pippa, welcome to the site. The advice that you need not be concerned unless you have symptoms is correct. Testing should be done only in the event of symptoms. Your risk of having contracted C. diff simply by having used a cloth towel in your mother's bathroom is almost nil; the sole route of transmission of C. diff is fecal-to-oral. In other words, someone who actually has C. diff would have to have used the towel and deposited spores on it, then a subsequent, C. diff-vulnerable person using the towel would have had to have "ingested" the spores, e.g., from hand to mouth or nose. None of these circumstances were present in the scenario that you describe.

That said, the fact that the rehab facility doesn't provide paper towels is cause for concern. I suggest you raise this issue with the facility and point out (though they should know this, themselves!) that it's unhygienic and an infection risk for residents to be reusing the same cloth towel repeatedly. If they aren't responsive, perhaps you could bring a roll of paper towels for the restroom. Also, you and other visitors to the room should avoid using the room's bathroom. Use a bathroom available for visitors instead.
If your illness was preceded by use of a medication, e.g., an antibiotic, please fill out an FDA Adverse Event Report at http://www.fda.gov/Safety/MedWatch/default.htm

Pippa
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Re: Exposure question

Postby Pippa » Sun Apr 28, 2019 1:04 am

Thanks so much AllisS.
My concern is that my mother in law absolutely used that cloth towel prior to my using it. She has a high likelihood of having fecal matter on her hands because she uses a colostomy bag. It always has an odor because it often leaks.
From what I have read online (don’t know if it is true), if a towel is in the same bathroom as a person who has C diff while using the restroom, spores from the fecal matter escape and drift everywhere in the restroom, most likely landing on a nearby absorbent towel.
*Do the spores remain in the fecal matter or get lose and drift all over a small room?
Until I am tested and the results are negative, I will not be allowed to get physically near my grandsons.
*Are doctors the only people who can arrange testing? I am hoping an independent lab can test me. From what I can find, the incubation period is 5-10 days. (I have used an independent lab previously to test for lead in my blood. But, I see nothing about C diff for them online.

beth22
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Re: Exposure question

Postby beth22 » Sun Apr 28, 2019 2:02 am

I agree with Allison that your chances of getting c diff from that towel are pretty slim. You would have to have ingested the spores. So unless you ate something without washing your hands or put your finger in your mouth, there is little chance. Having said that, I have to tell you that I got c diff from visiting my mother at a rehab facility. I never used her bathroom, but I did touch surfaces in the room and I think I ate in her room before we knew she had c difficile. There were many other patients there who also had it, but the facility was pretty lax in letting people know to take precautions. I did not develop symptoms until I took antibiotics much later though.

If your daughter insists that you test, then I would call your doctor and explain that you can't see your grandson unless you have this test and maybe the doctor will give you an order for one. Many babies have c difficile in their GI tract anyway and it does not cause them harm. I understand how you feel though. I was very cautious when I went around my grandson when he was born last year as well.

roy
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Re: Exposure question

Postby roy » Sun Apr 28, 2019 4:13 am

You are getting bad advice from someone!
C.diff is a common bacteria that is everywhere, its NOT a deadly bacteria that is eminating from your mother in law!
1 in 20 healthy people carry it in their gut, 1 in 4 pairs of shoes and house door steps carry.
It's on the bus and its in the supermarket.
As for the new baby 3 out of 4 carry it naturally in their gut!
Babies are a huge source of c.diff in the elderly (already sick) adult population.
It's very common and not a plague!
It causes problems if a sick person comes into contact with it and it MIGHT (but not always) then cause a disease called clostridium difficile colitis.
It's common to have the bacteria and test positive but NOT have that disease and theres a huge differance between having the bug and being sick because of it.
To catch c.diff you have to swallow the spores (breathing them in through the nose is harmless) you swallow spores dozens of times a year without knowing it and your body just deals with it!
The same way it deals with 300 viruses and bacteria that you suck in with every single breath you take!
A healthy person could eat c.diff infected poop spread on toast and would not become infected! (dont recomend it though:-).
If your already sick or your on antibiotics the c.diff spores might multiply out of control and cause colitis.
One final comment
A cloth towel in a health facility has a LOT more than c.diff on it.

Pippa
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Re: Exposure question

Postby Pippa » Sun Apr 28, 2019 8:38 am

Wow Roy,
That is so opposite of the information that I have read online. It sounded to me that C diff is THE super bug that is the result of overuse of antibiotics.
I am not that worried about getting it myself. But, I need 100% proof that I neither have an active case nor am carrying it in order for my daughter to allow me to ever get near my daughter or grandchildren again. She has access to medical journals and will research C diff very thoroughly once I tell her that her grandmother has it. But, what I find is that the medical journals have so much scientific and detailed data that it is very difficult to sift through it all. She may conclude that the risk is just not worth my seeing her or my grandchildren ever again. (I am adopted and my only biological relatives are my daughter and grandchildren. My adoptive family are all deceased.)
I have to find a way to be tested for C diff. I was hoping that a private lab would do it without a doctor’s orders. I have had tests done through private labs previously. However, it does not appear that they test for C diff. From what I find, testing is recommended 5-10 days after exposure. So, I have to convince my doctor to order the lab test for it. If it comes back positive, I will never see my daughter or grandchildren again. My daughter loves her grandmother dearly, but has not been in her house for years afraid that she might be carrying C diff. With her diagnosis, my daughter won’t even go to her funeral when she dies. Her grandmother is very frail and 89. So, that is around the corner. I understand what you are saying, but there is way too much information online that indicates the opposite. My daughter and son in law both have extreme anxiety regarding sicknesses and diseases.

Ril
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Re: Exposure question

Postby Ril » Sun Apr 28, 2019 11:08 am

Unfortunately they are misinterpreting the information they are reading so I am not sure you will ever convince them of the truth.
Do they understand that even if you are tested and test positive for the presence of c diff but are negative for toxins that means you are negative for disease? That is a very important distinction.

And do they understand with all their research that it is not airborne so they can be in the same room with Grandam? Is there a trusted dr they can speak with?

This is a very sad situation for your family that I am afraid we can’t solve.

Pippa
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Re: Exposure question

Postby Pippa » Sun Apr 28, 2019 12:25 pm

I had no idea about that distinction myself. My daughter has chronic health issues, as does her grandma. I constantly have to intervene for both with medical staff. My daughter and I often have to inform doctors about medical research that they are unaware of. So, we trust few doctors. I just caught her grandmother’s nurse in rehab lying to me this morning about medication for C diff. He said she got it yesterday. I confirmed that it was not given until just now with another phone call from me.
We have one PCP that is trustworthy. But, he cannot be reached without making an appointment to see him. His earliest appointments are in three months and you have to have a medical exam scheduled or a chronic illness being treated by him in order to make an appointment. My mom in law has a great cardiologist who just intervened in regard to an angioplasty a vein doctor wanted to do. The cardiologist asked me “What does the vein doctor want to do, kill her?” He arranged for it to be done in a hospital. Sadly, the hospitalist doctor nearly killed her, overdosing her on a blood thinner. The cardiologist had no idea until I informed him. He believed she had been discharged. He was livid with the hospitalist. The hospital was so neglectful that she ended up in the rehab facility.
But, the cardiologist will not treat C diff. She has a gastroenterologist, but he is abysmal. My only hope is the nurse practitioner at our PCP’s office. She is great and we trust her a lot. I am just not sure how much she knows about C diff.
My daughter’s concern is not only that a family member will get the disease now, but also that I am carrying it and will give it to family members. When that person is in a weakened state, maybe 20 years from now, they will get the active disease. Also, her newborn son has received two rounds of antibiotics in 16 days. My daughter tested positive for Step B with IV antibiotic during labor. Then, she got an serious infection after giving birth that required a different antibiotic and she is nursing. So, he got that as well. (Okay’d by his pediatrician.) So, my 16 day old grandson has his gut bacteria in a bad way from all of that antibiotic. I certainly do not want to take a risk with my being around him for a while. Also, my daughter’s gut bacteria is bad with all of those antibiotics.
I have repeatedly read that it is totally airborne via the spores. I assume that the spores fly out of fecal matter.
From what I can tell, you can give it to others without having an active case (disease) of it.
*Is that true?

roy
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Re: Exposure question

Postby roy » Sun Apr 28, 2019 5:47 pm

C.diff is not transmitted through the air.
It lives in soil, not in the air.
Because it is a microbe it can be transported on a slight breeze, in fact in a still atmosphere it still takes several hours for it to fall and settle on a surface and then it can be picked up on the hands.
It can not multiply if it's in contact with oxygen and spores die if they go into your respiratory system.
Airborne possibly but only in the sense that it can be blown around or wafted into the air.
Your family would be horrified at the potentialy deadly bugs we ALL carry!
Staph, strep, E.coli etc are all normal and very common gut bacteria, if the person carrying them does not have a "host response" theres no disease.
Testing for a bacteria if you dont have symptoms is wrong.
We all have 100s of types of bacteria on and inside us.
Some good, some bad.
Trying to change that mix is what causes diseases like c.diff!

As for your 20 year comment.
During that time someone probably ingests and eliminates c.diff spores hundreds of times, that's normal nature in action!

Pippa
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Re: Exposure question

Postby Pippa » Mon Apr 29, 2019 2:00 am

I have never come across the concept of “host response”. That is interesting. Right now, I am waiting to see if I get any symptoms. If I get them, I will immediately attempt to get an appointment ASAP with the nurse practitioner at my PCP. I will have to see what she says. But, I will not be allowed any physical contact with my daughter or grandchildren ever again unless the nurse practitioner can assure my daughter that there is zero chance of my transmitting C diff to her or her children. Since she already carries Strep B and has to be very careful to not give it to her husband or children, the last thing she wants is to have to have additional precautions for C diff. She has done a lot of research on all the bacteria just mentioned. Years ago, she was part of a project to detect levels of those bacteria and how long they remained virulent in a variety of environments and surfaces. She can quote the levels of those bacteria in different environments. So, she knows the level of risk for each bacteria, depending on the environment, and takes precautions based on the risk. Often, it is zero. But. C diff is her least researched bacteria. I am doing the research for her. The idea of host response is intriguing and makes sense. I have not come across it previously. Hopefully, it will solve the issue for us. I do not expect to get sick from C diff. I think the consensus is that if I get no symptoms, either I did not ingest it or I did and my body has rid itself of C diff like it does many other bacteria.
***However, what is the likelihood of dormancy? Apparently, this is not uncommon.
By the way, the rehab increased the level of isolation for my mother in law today. No one is allowed in her room unless heavily gowned, etc. Yesterday, staff came in without a gown, gloves and mask even though visitors had to be suited up. She warned them to leave and they ignored her. They must have been uneducated. Now, there is a huge red sign on her door to stop and talk with a nurse before entering. It is a sad situation. She is so depressed and terrified of the diarrhea returning that she has virtually quit eating. The facility is making no attempt to get her to eat. No one wants to get near her. She was originally scheduled to be discharged today. I made a formal appeal to her insurance company based on her having C diff. As of 1 am, the appeal has not been addressed. She is still scheduled to be discharged in 11 hours. Surely, the appeal will be granted prior to that.
**In general, how long will she be on antibiotics before she is no longer considered to be contagious?

roy
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Re: Exposure question

Postby roy » Mon Apr 29, 2019 3:22 am

Does your daughter know that theres at least a 75% certainty that her baby is already carrying c.diff?
3 out of 4 newborns pick it up during or shortly after birth. (before birth a babys gut is sterile and has no bacteria).
They would all test positive so the guidlines are that a baby is never tested for c.diff.
C.diff does not cause a disease in babies, it's a "normal" gut inhabitant.
A babys immature colon does not yet have the receptors that induce a "host response" to the toxins.
During the first 2 years of life a babies gut bacteria grows and matures to resemble close to the mix that they are going to have for the rest of their life and kicks out the c.diff.
Colonised babies may even develop a degree of immunity that lasts for life.
If your daughter is on antibiotics theres a chance she might pick it up from her baby and a higher chance it might become a disease.
Junior is a MUCH higher infection risk than your mother in law but does not need testing.

hospital and facility guidlines are that c.diff patients are no longer required to be isolated 48 hours after the first solid stool.

Slightly concerning is that your family are worried about your relation transmitting c.diff and theres no mention in your posts about the best treatment for her.
It's your mother in law that needs support, not your family!
She has an infection that's very deadly in a sick elderly person.
What treatment is she on?

Pippa
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Re: Exposure question

Postby Pippa » Mon Apr 29, 2019 2:34 pm

You are so right about my mother in law’s treatment. She received no treatment until I demanded it. She is now getting Vancomycin twice a day. She also is barely fed. She is only being provided heavy meals that she cannot eat. I call and beg them to bring her soup. She gets soup once a day now. The facility social worker just got involved and said the nurses never informed the kitchen.
She has a colostomy bag. So, she never has a solid stool. Because of that, she will remain in isolation until she is discharged. She is due to be discharged today because Medicare will not pay after today. There is an appeal, but it has not been complete by Medicare. But, since her daughter insists on taking her to her home in another city (with no access to her mom’s doctors) and was not notified in time that the appeal has not come through (she assumed that it would be approved), there is no family member to take her out of the facility. The facility may have to “eat” the cost. That is fine with me. She needs care, but also food. Hopefully, the social worker is rectifying that.
My daughter is very aware of the sterile gut and colonization via a normal vaginal birth. However, she did not have a normal vaginal birth. She had Strep B. That required a massive dosage of an IV antibiotic. That wiped out the gut colonization of her infant. It may have slowly started when he was 2 days old. But, she got an infection and was given a different antibiotic. She is nursing. So again, my grandson has no gut colonization of good and bad bacteria. He is two weeks old now and one week off of the second antibiotic via nursing.
If I bring him only C diff without good bacteria to balance it, I do not know what the result would be.
*Does anybody here know?
Perhaps he should be given a probiotic.

AllisS
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Re: Exposure question

Postby AllisS » Mon Apr 29, 2019 3:25 pm

I wouldn't want to rely on a PCP or NP for such a complicated scenario. See if you can get a consult with an infectious-disease doctor who could help to sort things out.
If your illness was preceded by use of a medication, e.g., an antibiotic, please fill out an FDA Adverse Event Report at http://www.fda.gov/Safety/MedWatch/default.htm

roy
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Re: Exposure question

Postby roy » Mon Apr 29, 2019 4:40 pm

I agree with Allis, you need an expert Drs input.
I assume her colon has been removed?
If that's correct the facility are treating her for a disease of the colon despite her not actually having a colon!


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