{"id":267,"date":"2012-12-18T11:56:03","date_gmt":"2012-12-18T19:56:03","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=267"},"modified":"2014-02-19T13:37:02","modified_gmt":"2014-02-19T21:37:02","slug":"i-dont-want-to-hold-your-hand-c-s-lewis-i-want-to-hold-your-hand-the-beatles","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=267","title":{"rendered":"\u201cI don\u2019t want to hold your hand.\u201d \u2013 C.S.Lewis. \u201cI want to hold your hand.\u201d \u2013 The Beatles"},"content":{"rendered":"<p>A recent survey of multiple large, national databases in the US has reported that Clostridium difficile (C.diff) colitis is now the 9<sup>th<\/sup> leading cause of gastrointestinal and liver related deaths. Way out of line with my own perception of GI-related mortality, <!--more-->this places C.diff colitis <em>ahead<\/em> of deaths due to GI hemorrhage, chronic hepatitis C, acute pancreatitis, diverticular disease, and cholecystitis. From 2002 to 2009 the number of deaths attributable to C.diff infection rose a whopping 230%!<\/p>\n<p>The most widely recognized risk factor for the development of C.diff colitis is antibiotic use. Other factors include hospitalization, advanced age, and severe illness. Antibiotics not only disrupt the intestinal flora allowing for the overgrowth of C.diff.\u00a0By contributing to\u00a0the development of resistance to either clindamycin or fluoroquinolones, antibiotics\u00a0can also make the organism\u00a0more virulent.<\/p>\n<p>C.diff is highly transmissible and spreads faster than a bad photo on Facebook. 20 to 50% of adults in hospitals and LTC facilities are carriers (versus 2-3% in the general healthy population). About 20% of patients entering a hospital negative come out with infection. It can be cultured from objects in patients\u2019 rooms, hands, clothing, and\u2026 stethoscopes.<\/p>\n<p>Needless to say, our friends in hospital infection control are all over this. On a personal level there are 10 factors to which we should pay attention and they are all at the ends of our two arms. Hand washing remains next to Godliness. In the convenience vs. effectiveness conundrum, the alcohol-based hand cleansers so readily available and easy-to-use do not eliminate the C.diff spores, and the CDC recommends good ol\u2019 soap and water. By the way, the CDC also recommends disinfecting stethoscopes between patients.<\/p>\n<p>Practice-wide stewardship and insuring appropriate antibiotic utilization is a professional obligation. We should not have a hand (hmmm) in the further rise of C.diff\u2019s ranking.<\/p>\n<p>Marshall Kubota, MD<\/p>\n<p>Peery AF et al. <em>Gastroenterology<\/em> 2012 Nov 143:1179<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recent survey of multiple large, national databases in the US has reported that Clostridium difficile (C.diff) colitis is now the 9th leading cause of gastrointestinal and liver related deaths. Way out of line with my own perception of GI-related &hellip; <a href=\"https:\/\/phcprimarycare.org\/?p=267\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6,13,1],"tags":[],"class_list":["post-267","post","type-post","status-publish","format-standard","hentry","category-formulary-pharmacy-issues","category-prevention","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u201cI don\u2019t want to hold your hand.\u201d \u2013 C.S.Lewis. \u201cI want to hold your hand.\u201d \u2013 The Beatles - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=267\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cI don\u2019t want to hold your hand.\u201d \u2013 C.S.Lewis. \u201cI want to hold your hand.\u201d \u2013 The Beatles - PHC Primary Care Blog\" \/>\n<meta property=\"og:description\" content=\"A recent survey of multiple large, national databases in the US has reported that Clostridium difficile (C.diff) colitis is now the 9th leading cause of gastrointestinal and liver related deaths. 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