Clostridium Difficile and Fecal Incontinence: Examining the Source of Infection and Preventing the Spread

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by Cathy Milne APRN, MSN, BC-ANP/CS, CWOCN

I'm probably going to sound like Andy Rooney, the recently deceased colorful commentator from 60 Minutes. With all due respect, I will borrow from his opening lines, "Did you ever wonder why..."

Did you ever wonder why we, as a society, never talk about fecal incontinence? Yes, that's right – poop. I had planned to discuss fiber supplements. My plans went awry when USA Today (August 18th, 2012) had a front page spread that spilled onto the Page 3 about Clostridium difficile (C-diff) infection causing more than 30,000 deaths annually in the United States. I have to talk poop.

Note the terms "spread" and "spilled" in the previous paragraph. Well, obviously, the author of the USA Today piece did not--or would not--grasp the concept of the spread of this deadly disease. The word diarrhea was mentioned ONCE in the article relating to C-diff. Fecal incontinence was not. In a genteel fashion, spore contamination on bathroom fixtures, light switches and bed tables were described. How did it get there? People have fecal incontinence and caregivers remove stool from the patient's skin and immediate environment. As a result, nearly 60% of the healthcare providers may have C-diff spores on their hands after coming into contact with a known C-diff patient.1 Some of this is a result of haphazard management of feces. Some of it is unintentional as when one touches a patient in trying to convey a caring demeanor, and not yet knowing that the patient is a reservoir for the next outbreak. Dementia patients "play" in stool and smear their hands on all sorts of equipment. Lateral wicking of stool on incontinence pads can contaminate the patient's skin other than the perineal area.3 Don't get me wrong, I applaud USA Today for alerting the country to a terrible threat. No one else has been the canary in the coal mine.

Can the layperson imagine that up to 40% of hospitalized patients are unable to control their bowels?2 We are not honest with ourselves or the general public that uses our health services in this country. People poop. Sometimes not where we want them to. I completely understand that controlling this disease, like many others, is a multi-faceted approach. Fecal containment and interventions to promote continence is a start. One other is to start talking about fecal incontinence to our patients and their loved ones. Perhaps this can help stem the flow of infectious disease. I frequently joke that we need a celebrity to talk about their fecal incontinence. Does anyone know of anyone willing to speak up?

Sources

1. Rutala W. Clostridium difficile: what antiseptics and disinfectants should we use? Available at: http://www.unc.edu/depts/spice/dis/CdifficileIDSA09no.pdf. Accessed: August 19, 2012.
2. Junkin J, Selekof JS. Prevalence of incontinence and associated skin injury in the acute care inpatient. WOCN. 2007;34(3):260–269.
3. Jones S, Towers V, Welsby S,Wishin J, Bowler P. Clostridium difficile Containment properties of a fecal management system: an in vitro investigation. Ostomy Wound Management. 2011;57(10):38–49.

About the Author

Catherine T. Milne is the Clinical Editor of IncontinenceSource, and is the co-owner of Connecticut Clinical Nursing Associates, a practice focusing on direct patient care, consultation, education and research in the fields of wound, ostomy and continence care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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