Big diff – poop wages war on diarrhea

Oh crap!

As one of the foremost “poop correspondents” on the internet it falls on me (no pun intended) to bring you this explosive story. Here’s my report filed from the trenches…

Recently, Brea thoughtfully tipped me off regarding some interesting news in the medical world. News that was right up my alley (so to speak).

To put this succinctly, poop transplants are now being performed as “last-ditch treatments” in the fight against an illness known as clostridium difficile or more commonly as “CDF/cdf” or “c. diff.”

According to Wikipedia, c. diff “is a species of Gram-positive bacteria of the genus Clostridium that causes diarrhea and other intestinal disease when competing bacteria are wiped out by antibiotics.”

The disease can be remarkably hard to treat and can be fatal. According to a story in the Associated Press, C. diff is “a germ that so ravages some people’s intestines that repeated tries of the strongest, most expensive antibiotic can’t conquer their disabling diarrhea.”

In dire cases, a new treatment consisting of a “transplant” of fecal matter from a healthy person is performed. A doctor in the story claims, “[fecal matter] is the ultimate probiotic.” (Probiotics are live microorganisms thought to be healthy for the host organism.)

I can only imagine how that doctor/patient consultation goes down. “Your problem, as you well know, is diarrhea. Our plan is to take poop from someone healthy and put it inside you. Poop will be the solution to your diarrhea.”

Sounds ass backwards to me.

It’s a little more complicated than that. The transplant procedure involves relocation of an “entire bacterial neighborhood” from the healthy donor.

Here’s the fun part. C. diff is thought to commonly be a “nosocomial infection.” That’s just a fancy way of saying the C. diff infection is often the “result of treatment in a hospital or a healthcare service unit.”

You go in for health care and come away with a little unplanned bonus. Interesting how that works, eh?

According to Wikipedia, a stay in the hospital up to two weeks represents a 13% chance to pick up the C. diff infection. A stay of four-weeks or more and that rate jumps to a whopping 50 percent!

I wish I was making this stuff up. All I can say is, “I’m not shitting you!”

As a poop correspondent, I’ve often sat around spending my free time daydreaming about things like hand washing rates. (Hand washing represents a substantial chunk of my “Poop Manifesto” I’m hoping to release someday.) We’ve all heard the stories about public handrails with more than 500 different sources of fecal matter on them. Or how people in public restrooms tend to wash their hands more often when they are being watched.

As a civilization we are apparently not big on the whole concept of hand washing and cleanliness. Even though science has told us about the dangers for a long time now.

Imagine a place where you think hand washing would reign supreme. Imagine people who you think would be best at it. It isn’t too hard to surmise that a place like an Intensive Care Unit (ICU) within a hospital might be such a place, right? And that people like doctors might be experts at washing hands, right? We’ve all seen the surgeons at Mash 4077 like Hawkeye, Trapper John and B.J. Hunnicutt “scrub” before working on patients. For them it was a big deal.

As it often turns out, it’s no big surprise (at least to me) when reality turns out to be just a wee bit different.

When doing my research, one thing I noticed was that the ICU industry (for lack of a better term) seemed to be bragging about hand washing rates of 97%. My reaction: How the hell is that something to brag about in a frickin’ hospital???

But it’s worse than that. Much worse. Studies have found that hand washing rates in ICUs are appalling low. Even after “awaresness campaigns,” specialized training, and even when employees are told that their hand washing will be monitored. And these are the people that take care of the sick?

One study found that within an ICU setting, there was a hand washing rate of 72.8%. Nurses were best with a rate of 97.5%. Technicians came in second with a rate of 47.7%. Are you ready to guess who came in last place? Yep, doctors, with a rate of 37.6%.

37.6%? Holy shit!

The study also found that an “educational program” about hand washing improved the hand washing rate among nurses and technicians, but not doctors. Said the study, “No statistically significant changes in the handwashing behaviour among doctors was observed during the study period.” Is this the “God complex” at work? Apparently doctors don’t like to be told what to do, about anything, from anyone. Oh, put your hands on me, doctor! And some people actually want to date doctors?

Side story: My wife worked in a doctor’s office. It was a small office where people sat a few feet away from the restroom. When someone did their business you could hear every “plop,” if you know what I mean. More importantly, however, you could hear if running water was turned on. Running water that would imply that hand washing was taking place. And guess who used the restroom and didn’t turn on the water before coming back out? Yep! The doctor! One of my favorite expressions used to be, “The doctor will fee you now.” But I think that’s old and busted. From now on, I’m updating my phrase to “The doctor will pee you now.” It think that’s a lot more apropos.

So, it seems to me, we just might have identified at least one culprit when it comes to nosocomial infections, eh? Do a serious internet search regarding the problem of simply getting health care workers to wash their hands and you begin to get an idea about the magnitude of the problem we’re facing.

The good news is that, since getting it’s humble start in hospitals and such, C. diff now seems to be making headway in the “outpatient setting,” also known as the general community outside of hospitals. You know, where people like you and me live our daily lives.

Humans! Is there anything they can’t do?

Thanks, Brea, for getting me started! 🙂