CHARACTERISTICS
Clostridium Difficile, family Clostridiaceae, is an anaerobic motile spore-forming bacterium (subterminal spores) appearing in its vegetative form as a pleomorphic bacillus in pairs or short chains. The microorganism is catalase-negative and superoxide dismutase-negative, and produces two types of toxins, enterotoxin A and cytotoxin B, which interfere with the host’s signal transduction mechanisms involving the cytoskeleton.
PATHOGENICITY AND TOXICITY
C. Difficile is the leading cause of antibiotic-associated nosocomial diarrhoea. The administration of antibiotics, or any treatment, that may alter the normal gut microbial flora may lead to excessive multiplication of C. Difficile associated with toxinogenesis, resulting in the clinical manifestations of infection.
The severity of the diarrhoea is variable: some patients may have only intestinal fluid loss for a few days, while others may develop life-threatening pseudomembranous enterocolitis. In the absence of pseudomembranous enterocolitis, diarrhoeal stools that are foul smelling and not bloody may be associated with abdominal pain with or without pyrexia.
Patients with pseudomembranous enterocolitis will have intense colonic inflammation associated with the formation of pseudomembranes on the intestinal mucosal surface, and their general condition will more often be impaired. Rare extra-colonic manifestations of C.
Difficile infection include bacteremia, intra-abdominal abscesses, osteomyelitis, visceral abscesses, empyema, toxic megacolon, colonic perforation and reactive arthritis. The production of exotoxins A and B promotes tissue damage, leading to cellular necrosis and ulceration, diarrhoea and fluid secretion, and colitis.
Ribotype 027, also known as North American Pulsotype 1 (NAP1), represents one of the most pathogenic forms of C. difficile due to its abnormally high production of toxins A and B, its production of a third toxin called binary toxin and its resistance to fluoroquinolones. Another new hypervirulent strain of C. *
Difficile, strain 078 (NAP7/8), causes severe diarrhoea which has been associated with high mortality in the Netherlands and other countries, including Canada.
EPIDEMIOLOGY
C. Difficile is found worldwide and is part of the normal gut microbial flora of 2-5% of healthy adults, with older individuals usually colonised at a higher rate (10-20%). The frail elderly, peripartum women and children are at greater risk of acquiring C. Difficile infection, as are those on medication. Difficile infection, as well as people on antibiotic therapy.
The number of severe outbreaks of C. Difficile infections associated with high mortality has increased in North America and Europe since the early 2000s. These outbreaks are associated with the 027 strain, while the incidence of infection with the 078 strain has increased from 3% to 13% between February 2005 and February 2008.
MODE OF TRANSMISSION
Transmission occurs mainly by the faecal-oral route following contact with contaminated food, vehicles or hands. Overgrowth of C. Difficile from the normal intestinal flora associated with toxinogenesis may also be observed in immunocompromised patients. Cases of nosocomial transmission involving medical personnel and contaminated medical equipment have also been described.
INCUBATION PERIOD
Usually 5 to 10 days; however, the onset of illness may be from one day to several weeks after antibiotic treatment for antibiotic-associated diarrhea (AAD).
SENSITIVITY TO DISINFECTANTS
In general, spores are resistant to disinfection. In particular, Clostridium spp. spores are resistant to ethyl and propyl alcohols; however, they are sensitive to 20 minutes contact with high-level disinfectants such as 2% glutaraldehyde. Formaldehyde at 8% and sodium hypochlorite at 20 ppm are also effective against bacterial spores.
PHYSICAL INACTIVATION: Spores of Clostridium spp. are generally heat resistant and can survive for 3 hours at a temperature of 116°C, while the vegetative form can be quickly inactivated by temperatures of only 55 to 65°C. Most spores can be inactivated by exposure to moist heat of 121°C for 15 to 30 minutes.
Based on this scientific data, it is therefore impossible to disinfect a bedpan containing Clostridium spp. contaminated material. The risk of infection, following the placement of a Clostridium spp. contaminated bedpan in a bedpan washer, is even very high.
The only response that can be given is chemical action, combined with mechanical action and thermal disinfection of the bedpan washer.
THE ARCANIA RESPONSE
After 2 years of research and development, in collaboration with ANIOS laboratories, ARCANIA is pleased to provide a solution to the disinfection of utensils contaminated with Clostridium spp. thanks to its CLINOX 3A TOTAL bedpan washer.
This bedpan washer provides, in addition to bactericidal and fungicidal activities, a sporicidal activity.
A collaborative development by ARCANIA/ANIOS to provide the only sporicidal bedpan washer guaranteed to have no manual contact, without disinfectant.