[HN Gopher] C diff spores resist bleach and remain viable on sur...
___________________________________________________________________
C diff spores resist bleach and remain viable on surgical scrubs,
fabrics
Author : bookofjoe
Score : 228 points
Date : 2023-11-23 15:20 UTC (7 hours ago)
(HTM) web link (www.microbiologyresearch.org)
(TXT) w3m dump (www.microbiologyresearch.org)
| londons_explore wrote:
| I want to see studies to measure the impact of disease
| transmission in a hospital.
|
| Pick a random (perhaps new) hospital, and make every patient live
| in their own sealed plastic bubble. No air goes in or out -
| instead it is recirculated per-patient like a space station. Make
| staff wear hazmat suits.
|
| Then, after a few weeks, compare patient outcomes.
| userinanother wrote:
| Hospitals in the USA are not super concerned about patient
| outcomes at the administrative level. Everyone just wants to be
| middle of the road "good enough" to not get sued for
| negligence. There isn't really any incentive for doing better
| than that and it costs a lot to be better
| londons_explore wrote:
| The goal wouldn't even be to be better - it would be to
| measure how much benefit could be had with perfect biological
| isolation, so that we could decide where on the
| cost/effort/benefit scale to put our hospitals.
| snitty wrote:
| Hospitals in the US are actually pretty concerned with
| hospital acquired infections. For the sole reason that
| medicare/medicaid and insurance typically don't cover costs
| associated with them. So the hospital itself is on the hook
| for diagnosis, treatment, and any associated costs.
| rubyfan wrote:
| Does this create a moral hazard to not diagnose?
| JoshTko wrote:
| Yes
| haldujai wrote:
| Not really because moral hazard occurs when you're
| protected from consequences. Missing an early nosocomial
| infection means you're now on the hook for very long
| admissions with expensive treatments and interventions.
|
| Personal experience in US academia also suggests not, far
| more concern for early diagnosis of infection and IPAC
| than I saw practicing in Canada.
| giantg2 wrote:
| "Hospitals in the US are actually pretty concerned with
| hospital acquired infections."
|
| Some more than others.
| Scoundreller wrote:
| USA might be best in the world for this, as they look at 30
| day readmission and 30 day post-discharge mortality for
| various conditions.
|
| Of course these stats have their own gameability, but good
| luck getting this level of data elsewhere.
| Teever wrote:
| I worked at a hospital years ago and during the orientation
| session we had a speaker tell the audience that 1/8 pepe who go
| into the hospital will acquire an infection from the hospital.
| londons_explore wrote:
| My n=1 experience is that every time I walk into a hospital
| (even just to visit nana for an hour), a few days later I
| find myself sick...
|
| I suspect that the true figure for hospital acquired
| infections is far higher than 1 in 8, but that they are only
| recorded if the infection is serious enough to cause
| immediate medical treatment to be necessary.
| tobiasSoftware wrote:
| Perhaps you should consider wearing an N95 while visiting
| the hospital. You can a pack on Amazon for $15 (even in
| stylish black), and they really aren't that bad wearing. In
| my opinion, the practice of wearing N95s in medical
| settings is the one response to Covid that should be
| permanent. Unfortunately even in peak Covid medical
| advisors were too scared to advise proper masking and
| settled for cloth and surgical masks, while KN95/N95 offers
| far more protection for yourself. Looking back, we could
| have done away with social distancing, quarantining,
| shutdowns, and all the other extreme procedures if we had
| just ramped up N95 production and told everyone to wear
| them in public while we were waiting on the vaccines.
| cjrp wrote:
| MRSA was a big worry in UK hospitals for a while. Maybe still
| is, but just doesn't get the press coverage.
| adhesive_wombat wrote:
| From the official stats, it's about 0-5 cases of MRSA
| bacteraemia per NHS trust per month.
|
| When I was in hospital a few years ago, they swabbed on
| every admission to test for it so it's definitely a
| concern.
|
| https://www.gov.uk/government/statistics/mrsa-bacteraemia-
| mo...
| b800h wrote:
| There are lots of ongoing experiments like this. Certain
| agencies maintain experimental wards for this purpose.
| corndoge wrote:
| Can you share any more information?
| krisoft wrote:
| I wouldn't be surprised if your proposal, naively implemented
| would lead to worse patient outcomes.
|
| Just simply the staff having to change hazmat suits between
| patients, porting in and out between plastic bubbles, would add
| a lot of overhead and less time to offer actual care.
|
| Not talking about all the risks involved with that "space
| station" like air recirculation. "Sorry about your grandma. She
| did not pick up an infection, but she died when the overworked
| technician forgot to replace her bubble's CO2 scrubber."
|
| Not saying that the current situation is peak optimum and the
| best possible. Just that infection control is not the only goal
| to optimise for in a hospital.
| KaiserPro wrote:
| It doesn't have to be that extreme.
|
| For example, you can't run a food preparation place like a
| hospital.
|
| However the NHS have done studies for side rooms vs group
| wards. there is a lot of prior research out there.
| toomuchtodo wrote:
| Oof, this is terrible news, might have to treat all of these
| materials as hazardous and incinerate it all instead of reusing.
| patmorgan23 wrote:
| Or they might need to be irradiated before reused.
| toomuchtodo wrote:
| I had not thought of that! Good call out, definitely an
| opportunity for gamma radiation treatment as part of the
| cleaning cycle after mechanical washing.
| TeMPOraL wrote:
| I'd maybe start with UV-C, but then again, doesn't it break
| down/embrittle some plastics?
| toomuchtodo wrote:
| Wouldn't get inside the clothing (gowns, scrubs, etc).
| The benefit of gamma is you can throw it all in the
| target area and ensure somewhat uniform exposure (similar
| to food/ag irradiation).
|
| Regardless, the outcome is going to be shorter lifetime
| of these medical resources due to decay rate from the
| more aggressive treatment cycle.
| dbsmith83 wrote:
| I wonder if a pressure chamber would be feasible. Might be
| cheaper to incinerate, honestly. Or irradiate
| orra wrote:
| This is bad news. But it doesn't tell us that washing with
| detergent is unable to remove the pathogen from scrubs. Nor
| does it tell us that that washing at high temperatures no
| longer kills it.
| SoftTalker wrote:
| Hot wash (boiling water) with detergent, followed by hot air
| tumble drying also, will pretty much sterilize clothing. Of
| course that doesn't prevent contamination at some point
| later.
| SiempreViernes wrote:
| This is talking about "Clostridioides difficile" bacteria, so
| despite the title it is not about how difficult it is to get rid
| of those bits of legacy C code nobody understand any more.
| wellthisisgreat wrote:
| Yeah it's the the cryptic variable names that make running diff
| on C code particularly difficult
| h2odragon wrote:
| Suggests a nice addition to the "Evil C Standard": All
| variable names shall be in latin
| escapecharacter wrote:
| I, too, enjoyed the domain whiplash I experienced as I went
| from word 1 to 2 in the article title.
| cratermoon wrote:
| I'm in that overlapping part of the Venn diagram where I read
| "C diff" and both programming and infectious bacteria come to
| mind. But I see it written that way in the context of medicine
| far more than some incidental reference to diff in the C
| programming world.
| anthk wrote:
| Well, Unix it's the ultimate virus, so...
| davikr wrote:
| Yeah, we've known C. difficile spores are also resistant to
| alcoholic solutions. Pseudomonas can contaminate hand soap too.
|
| It is recommended to wash your hands with water and soap, but if
| there is no visible dirtiness, hand sanitizer will do.
| s_dev wrote:
| I'm not a biologist but how can certain bacteria and viruses be
| resistant to alcohol?
|
| I barely recall an internet discussion where people were
| concerned about "super bugs" coming about from using alcohol to
| disinfect -- "will this not create a resistance in them by
| using the one tool we know works to kill bacteria" they
| inquired.
|
| I recall a researcher saying it would be like humans becoming
| resistant to nuclear explosions. It just simply won't happen
| and yet here we are.
| margalabargala wrote:
| Nothing will ever _grow_ in pure alcohol, but there exist
| some spores which can last varying lengths of time in alcohol
| before being destroyed.
|
| To continue the same analogy, humans will never become
| resistant to nuclear explosions, but we can build bunkers
| that allow us to last for varying lengths of time after one
| happens. The better the bunker, the longer we last.
|
| If the alcohol isn't applied long enough then the longest
| lasting spores can make it through.
| robocat wrote:
| The Evolution of Bacteria on a "Mega-Plate" Petri Dish:
| https://youtu.be/plVk4NVIUh8
| quaddo wrote:
| I used to think that isopropyl alcohol was the last word in
| cheap-and-convenient surface sterilization, such as hands.
|
| For better or for worse, watching a handful of YT videos from
| doctors saying "just wash the wound with soap and water" or
| even "all you need is to wash your hands with soap and water"
| has made me dial back the "douse it with alcohol" thinking.
|
| I still use alcohol from time to time. Or hydrogen peroxide,
| depending. But at least now I'll get a fresh wound (cat bite
| or whatever) under a thorough rubbing with soap + water as
| the immediate first step. A thorough wash, at that.
| Pxtl wrote:
| I mean hospitals already have a tremendous amount of radioactive
| equipment so the ship has already sailed about having the
| skillset to safely manage ionizing radiation and hyper-hazardous
| materials, so why not set up an industrial food irradiator in the
| laundry system to sterilize things?
| unsupp0rted wrote:
| My family members are doctors and I'm always cognizant of where I
| am in a room relative to my male family member's neck tie.
|
| If there's anything "difficile" they brought home from the
| hospital any day in the last few weeks, that's where it lives.
| jdietrich wrote:
| Here in the UK, nearly all hospitals prohibit clinical staff
| from wearing ties or long sleeves.
|
| https://www.england.nhs.uk/wp-content/uploads/2020/04/Unifor...
| haldujai wrote:
| It's become a lot more accepted to wear scrubs in the US
| post-pandemic as well.
|
| Some places are still old fashioned though, I believe Mayo is
| still suit and tie.
| demondemidi wrote:
| I got lost in the article: is surface prep just longer exposure
| time or is there no way to kill it on a surface now?
| elzbardico wrote:
| Gamma Rays, shoot the bastards with Gamma Rays in an irradiation
| chamber.
| Pxtl wrote:
| Exactly what I was thinking. Hospitals already use a lot of
| hyper-hazardous materials and ionizing radiation, this is
| within their skill and logistical abilities. A hospital could
| leverage something similar to a big industrial food irradiator
| within its laundry system to sterilize everything.
| LargoLasskhyfv wrote:
| Maybe industrial application of so called 'cold-plasma' would
| be a more sensible thing to do? Or in addition, just to 'be
| sure'.
| jayknight wrote:
| I work at a children's cancer hospital and they have UV
| robots that go into rooms to disinfect them between patients.
| genewitch wrote:
| at the main hospital here they have a large UV/ozone
| machine that makes a popping sound like a large flashbulb
| twice a second or so. I don't think it's a robot.
|
| As an aside, where can i reliably get _any_ real UV-C +
| Ozone bulb these days? I had 3, i gave one away and two
| broke during the pandemic, and all i have been able to find
| in the past year and a half is UV-C that doesn 't produce
| ozone, but instead that weird "too much sunlight" smell -
| anti-septic smelling but it doesn't murder pathogens like
| ozone does.
| ajb wrote:
| I dunno about that. I remember reading about an incident
| where a radiation source was transported in a lorry for miles
| without the cap on. Would have been a quite damaging if it
| hadn't happened to be pointed downwards
|
| Edited to add: found it: https://archive.is/mtvCY
| cratermoon wrote:
| See also
| https://en.wikipedia.org/wiki/Goi%C3%A2nia_accident "an
| unsecured radiotherapy source was stolen from an abandoned
| hospital site in the city."
| ycombinete wrote:
| That's how you get gamma ray resistant bacteria.
| giantg2 wrote:
| Are there any resistant to gamma irradiation procedures
| today?
| hoseja wrote:
| Hydrothermal vent extremophiles are also very resistant to
| radiation.
| giantg2 wrote:
| Thanks! I was able to find a very interesting article on
| that subject with those search terms.
|
| https://news.ycombinator.com/item?id=38394859
| LargoLasskhyfv wrote:
| While not directly on-topic, this article has many
| interesting links
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137497/
|
| Also we don't really know that much of funghi, mosses,
| lichen & algae, and their symbiotic relations utilizing
| bacteria.
|
| All in all a rather undiscovered territory.
| the8472 wrote:
| https://en.wikipedia.org/wiki/Radioresistance#Radioresistan
| c...
|
| But hopefully the intersection between radio-resistant,
| antibiotic-resistant and dangerous-to-humans is empty.
| ajnin wrote:
| Wait until they evolve to use them as energy like the mushrooms
| of Chernobyl.
| reedf1 wrote:
| My worst nightmare is a catastrophic infection after minor
| surgery.
| Pxtl wrote:
| Even a minor infection is scary. I just had my wisdom teeth out
| and I'm being hyper cautious about masking and sticking to WFH
| while my mouth is full of swollen wounds, because I know
| catching a cold would be absolute _agony_. My co-worker went
| through catching a bug recovering from same and was out for a
| few weeks.
| lagniappe wrote:
| Good luck with your healing! I broke my sternum recently,
| caught a sneezing cold right after. Sometimes luck has a
| plan.
| eurekin wrote:
| I don't know if it will help, but I had a routine check not
| that long ago. Turned out I was in the early sick stage.
|
| I'll spare you exact details, but each sample put under
| microscope had clearly visible bacteria.
|
| It looks like any infection could spread around the body and it
| handles it well. By well I mean three days of fever got rid of
| it
| giarc wrote:
| Other than urine, blood and CSF fluid, a sample from pretty
| much any part of the body will have visible bacteria. A Gram
| stain is performed on many cultures to start to eliminate
| groups of bacteria.
| eurekin wrote:
| It was blood and urine
| superkuh wrote:
| Yep. It can go very bad. My father just had a simple (mostly
| non-invasive) biopsy done and ended up nearly dying and with
| brain damage due to antibacterial resistant bacterial infection
| from the minor surgery.
| AbraKdabra wrote:
| My time to shine.
|
| I had a surgery last January, broken labrum on both hips, left
| was "ok" and the right was really damaged, still it was an
| arthroscopic surgery and I could go on with my life 2 weeks
| after, but... 3 weeks after the surgery my right hip was
| getting worse, way worse, the pain was like nothing I have ever
| felt, I couldn't sleep, I couldn't walk, I couldn't even touch
| my fucking leg that I felt a nuclear bomb going off inside of
| it. No fever, puncture was ok, nothing that could deemed it as
| an infection. I was in literal agony, not even the strongest
| analgesics worked. I did a blood test and the PCR was off the
| charts, "yup, that's an infection, it's 10 AM, don't eat
| anything, today at 17hs you go in surgery".
|
| I had a toilette done, infection was cleaned off but still I
| couldn't even move my leg, I lost all the muscle. Fast forward
| today, I had the worst 7 months of my life, antibiotics for 6
| months but wait, there's more... Both infection and the initial
| cartilage problem evolved into a septic arthritis, last week I
| went into surgery again to have my hip replaced by a temporary
| spacer while the biopsy is performed and I will go in again in
| a month or so to get my definitive prosthesis.
|
| For those who want to know, the bacteria was a Pseudomona.
|
| So yeah, don't fuck with infections.
| JR1427 wrote:
| I'm really sorry to hear that. That doesn't sound fun at all
| :(
| nonrepeating wrote:
| Good Lord, all of that sounds horrible. More power to you for
| whatever else you face ahead on this.
| fnordpiglet wrote:
| I am so sorry you are experiencing all this. I sincerely hope
| things turn a corner and things improve for you. I've had my
| share of horrific trauma related to my health, and it often
| felt this would never end. Luckily my issues did end, but it
| does really change your perspective on how fragile and
| valuable life is, but in some ways it also made me more
| accepting of death having fully accepted a number a times
| death was preferable to my situation. I had people that
| depended on me though so it was more a recognition of the
| fact.
|
| I did find places like HN and other outlets really helpful,
| little bit sized opportunities to nerd out and connect, that
| were just small enough that I could keep focus during the
| worst of things.
|
| Good luck.
| reactordev wrote:
| So what you're trying to say is the fear is justified. That
| going in for surgery or a stay at the hospital is as much (or
| more) risky due to after procedure infections.
|
| I've broken my olecranon (the pointy bit of your elbow) and
| declined surgery. I set it myself. Glad I did. It hurt. It
| wasn't pleasant. But to me the risk of infection from being
| opened up for something so minor was too much of a risk. If I
| had internal bleeding or something I would have gone for it
| but a simple broken bone (even a joint) isn't enough for me.
| SoftTalker wrote:
| It's like any medical procedure or drug. There are always
| risks and possible side-effects. The idea is that the risks
| of not treating the problem are worse than the risks of the
| cure.
|
| Yes some people get infections after surgery. Most do not.
|
| The COVID vaccine killed some people. Most were fine.
|
| Don't make your medical decisions based on anecdotes.
| hombre_fatal wrote:
| I broke my elbow tip as well on a skateboard but figured it
| would sort itself out like i do with all injuries.
|
| A decade later I can't do an elbow plank without some pain
| usually and I can't put a lot of weight on that part of my
| elbow. My favorite laptop position is on my belly on the
| floor so it sometimes hurts too much to do that.
|
| I don't know if surgery would have helped but it's annoying
| sometimes.
| haldujai wrote:
| I wouldn't jump to the conclusion that the fear is
| justified, not every broken bone is "simple" and while most
| fractures are nonoperative some do require surgical
| fixation.
|
| Pain reduction isn't the main reason to operate or the
| metric of interest, there are many ways to alleviate acute
| pain including casting.
|
| Functional impairment (immediate and delayed) and reducing
| the risks of posttraumatic arthritis are far more
| important.
|
| Joint infections (and pseudomonas in general) are an
| absolute nightmare as the joint space is not vascular.
|
| Bone infections/osteomyelitis are much rarer and for the
| most part less catastrophic (although they certainly still
| can be).
|
| As always patient autonomy is paramount and we all value
| risks differently. For myself as a young healthy adult (not
| an orthopaedic surgeon) I would rather accept the minimal
| risks of surgical reduction and fixation for a fracture
| needing one than risk needing complex reconstruction or
| joint replacement in 10-20 years which has much higher
| complication rates and longer recovery.
| KaiserPro wrote:
| Statistics is your friend here. You will be able to get
| stats for morbidity (fancy word for oopsey rate) for the
| procedure and the hospital.
|
| there will be a point where the risk of infection is far
| outweighed by the reward of surgery.
| AbraKdabra wrote:
| > So what you're trying to say is the fear is justified.
| That going in for surgery or a stay at the hospital is as
| much (or more) risky due to after procedure infections.
|
| Short answer: What? No, no way.
|
| Long answer: It depends, If you can avoid being opened
| sure, avoid it like the plague, I've learned that the hard
| way that no matter how much sterilization is done, bacteria
| is there, and if your body is cut there's a chance bacteria
| could get in, but there are cases when you have no other
| road, like my case. Last December I couldn't walk a single
| complete street, the labrum was damaged to the point that
| the only solution was an arthroscopy, there was no option
| for me to say no. My surgeon told me "patients get
| infected, shit happens", but on top of that I got extremely
| unlucky, I got the worst fucking bacteria in the universe,
| I had no fever and the needle that was inserted in my hip
| to test for bacterial growth yielded negative results.
| augustulus wrote:
| my question with this kind of thing is how does it not almost
| immediately infect the rest of your body? is it just WBCs or?
| AbraKdabra wrote:
| The hip joint is pretty isolated from the rest of the body
| I assume, I had the same question for my surgeon and he
| told me there was no way for that to happen.
| codersfocus wrote:
| Aren't there any antibacterial sprays or devices they can
| leave behind? What if antibodies were extracted from the
| patient's blood before surgery then sprayed on at the end
| of the operation?
| haldujai wrote:
| You wash, irrigate, and provide prophylactic antibiotics
| but shit happens, this was a very unfortunate case
| especially as there was no implant.
|
| Pseudomonas infections are rare in healthy patients and
| few antibiotics work.
| teruakohatu wrote:
| This is the thing of nightmares. I hope things improve and
| you get a working hip back.
| KaiserPro wrote:
| > Pseudomona
|
| Fucking Pseudomonas.
|
| Wife had appendicitis, or what looks like it. She had given
| birth a few months before and it didn't really go well. She
| had to have emergency surgery, and was pretty close to
| snuffing it.
|
| Anyway, that healed, but she had some persistent pain, but
| that could just be scar tissue being a dick.
|
| fast forward a few months, she has text book appendicitis
| symptoms. Now, as she's a doctor, she knows what it is, I
| know what it is, but she refuses to actually go into
| hospital. I drag her arse to the GP, who looks at me and
| says: "why haven't you taken her to A&E" I told the GP, that
| the patient knows too fucking much and won't listen to a
| muggle.
|
| The GP turns to my wife and says: "you and I both know you
| need to go to hospital"
|
| She goes in for assessment. Cant see much on the ultrasound.
| Go for a slice and dice to section the appendix.
|
| Puss drained, appendix Yeeted, lots of IV antibiotics. Looks
| like a rampant infection rather than a swollen appendix.
|
| Important note: men, topology wise, you are a doughnut. There
| is a tube from face to arse, and everything is mostly
| sealed(lungs are excluded for simplicity).
|
| Women, are not doughnuts, There is a gap between the ovaries
| and the fallopian tubes, which from what I recall is only
| really sealed with "mucus".
|
| This means that bacteria can get in from the outside. The
| hypothesis is that either when my wife was being
| professionally fisted by the midwives, or when she was being
| crash sewn up to stop her bleeding to death after the baby
| was born, is when Pseudomonas got in.
|
| Thus, in conclusion, Pseudomonas can get to fuck.
| djmips wrote:
| It sounds like things didn't end well. I am sad for you.
| wycy wrote:
| Is she better now?
| DoreenMichele wrote:
| Thank you for your testimony.
|
| I'm wondering if this was pseudomonas aeruginosa.
|
| https://en.m.wikipedia.org/wiki/Pseudomonas_aeruginosa
| AbraKdabra wrote:
| Yup.
| buggythebug wrote:
| best morningstallion
| davidw wrote:
| My grandmother died from a hospital acquired infection after
| very minor surgery.
| bell-cot wrote:
| Oh Lordy, yes. I've not yet lost a friend or family in that
| specific way...but there have been a number of too-close calls.
| Seemingly thanks to "top-rated" hospitals - where doctors' fat
| egos and shiny stuff are far more important than the dreary
| dull old routines of preventing post-surgical infections.
| mytailorisrich wrote:
| In Western countries the place where you are the most likely to
| catch a disease or infection are hospitals.
|
| Especially I think most 'nasty' infections are actually caught
| in hospitals.
| moffkalast wrote:
| Getting MRSA seems to be as likely as a coin flip for any
| bone related operation these days. Being stuck for weeks in
| an unsanitary recovery ward while there's a metal rod screwed
| through your skin is a really hilariously bad recipe for
| disaster with superbugs around.
| 303uru wrote:
| The worst thing I saw in residency was a case of a 32 year old
| father of three who came presented with spontaneous
| pneumothorax. Chest tube was placed and he was admitted,
| usually no big deal. Next morning the incision was slightly
| inflamed and he had some pain and mild fever. Later in the day
| he had follow up with pulmonary and he had black spots on the
| skin, pus, tachycardia, confusion. He was immediately taken to
| surgery and necrotizing fasciitis had already spread to his
| upper arm and a large portion of his chest. Arm and pectoral
| gone and he was placed into a hyperbaric chamber. 8 hours later
| no improvement, wheeled back to surgery, chest wall resection,
| lat removed, infection nearing hip. Back into hyperbaric. 8
| hours later no improvement, hip and both legs gone, lobectomy
| and large section of neck had to be resected. 8 hours later and
| he was dead. Guy went from healthy, athletic actually, to a
| head connected to half a torso then dead in a day.
| fatbird wrote:
| JFC.
|
| At no time did the doctors say "we can keeping cutting it
| away, but who wants to wake up like that?" After the second
| surgery, was there even a remote chance he'd survive?
| 303uru wrote:
| In hindsight the decision is easy, at the time less so. The
| patient was making informed decisions alongside family but
| the speed and nature of necrotizing fasciitis make it very
| difficult. The skin can look largely fine until you begin
| surgery and find that the infection has spread 12 full
| inches along the fascia. So you cut that all out, plus some
| margin and hope for the best. There certainly was a chance
| he could have lived after the second surgery with a very
| altered life. And I get that, now that I have children I'd
| probably chose to live a very rough life just for a chance
| to watch them grow up.
|
| I truly can't imagine what that man and his family went
| through in that short period of time. Decision making I
| slow decline with weeks or months is hard enough.
| haldujai wrote:
| It is not up to physicians to decide whether the resulting
| quality of life reduction and morbidity from heroic
| interventions is worth it for a patient.
|
| If the intervention is unequivocally futile for preserving
| life it is permitted to not offer care, there are processes
| in place.
|
| While unlikely, it is possible to survive necrotizing
| fasciitis and multiple debridements. Although it will come
| with many months of reconstructions, rehabilitation and
| pain.
|
| We are legally and ethically obligated to offer heroic life
| saving measures if there is a chance of surviving. Quality
| of life is not a factor in our decision making process.
|
| I do not know the exact discussion was had with this
| patient and their decision maker when incapacitated but it
| would be extremely unusual for a previously healthy 32 year
| old to decline heroic interventions, this is also a very
| rapidly evolving infection where you don't have much time
| to think.
|
| With that said I've also met 80+ year olds who want major
| surgeries that will leave them significantly impaired and
| almost certainly fail despite having time to think. At the
| end of the day patient autonomy supersedes our thoughts and
| opinions.
| itsabadone wrote:
| Posting from a throw away. C-Diff is huge problem now and has
| been for a while. If the immune system is weakened and the system
| develops this specific infection that person will experience a
| life changing event. Medical professionals can tell that
| infection by the smell of the room. I don't know what to do about
| it - C-Diff is a bad one
| h2odragon wrote:
| That smell is not as widespread as it was, but I still catch a
| whiff passing by people sometimes.
|
| https://en.wikipedia.org/wiki/Trehalose
|
| > Outbreaks of Clostridium difficile were initially associated
| with trehalose. This finding was disputed in 2019.
|
| I don't find "was disputed" conclusive there. The trehalose
| stuff got into ice cream, then C. Diff. became a widespread
| problem. They took it out of most of them, and C. Diff died
| back down.
| nevernude wrote:
| I got infected in a hospital while already suffering from an
| autoimmune flare. I was isolated for a week, hazmat suits, the
| works. Lost 15lbs in the hospital and had to take antibiotics for
| 3 months to make sure any resistant spores were killed. I've
| heard that fecal transplants have a very high success rate in
| curing Cdiff but didn't have that option at the time.
| giarc wrote:
| Transplants are typically reserved for those with recurrent CDI
| (although that is likely different in the US where I think you
| can pay for one privately). In Canada it is a covered
| procedure.
| haldujai wrote:
| Not sure about Canada anymore, Queens was doing this in
| select cases when I was there, but FMT is also increasingly
| used for initial episode fulminant CDI in the US as well
| (varies by institution).
|
| I was unlucky enough to get CDI in medical school when flagyl
| was first line and had to pay OOP for PO vanco, I assume
| that's changed now.
|
| What's first line in Canada these days, is fidaxomycin
| covered?
| Scoundreller wrote:
| > fidaxomicin
|
| Couldn't tell you about inpatient hospital use. Outside of
| hospital, it's covered by the public drug plan in Ontario
| if you've failed (or have allergies to) vancomycin
| treatment.
|
| Metronidazole is still first line under that program for
| "mild" cases, otherwise it's vanco. But nobody is really
| checking, so it comes down to how your doctor wants to
| document it.
|
| Private drug coverage will vary in their rules.
| haldujai wrote:
| Glad to hear approval for vanco is relaxed, this was 2015
| when I think vanco first line was still new. I was also
| on the university drug plan which required documented
| treatment failure at that time.
|
| I remember we used to give patients vanco IV bags to
| drink on discharge for outpatient therapy because the PO
| formulation was too expensive for some (iirc I paid $300
| for a 10 day course).
|
| Thanks for the info!
| verisimilitude wrote:
| These infections are a huge problem. My neighbor missed 2
| _years_ of college recovering from a C. diff infection. And you
| are correct: fecal transplant is the way, for now.
|
| Per the article, these bleach (sodium hypochlorite) resistant
| spores are a HUGE problem. At my office, we clean surfaces with
| quaternary ammonium compounds, and those are supposed to be
| superior against spores. But still, if the required contact
| times to disinfect surfaces keep increasing in healthcare
| settings, we are going to have a major issue where only the
| most resistant spore-forming bacterial strains survive
| (basically, we'll be selecting for the strongest... you know,
| evolution).
| TeMPOraL wrote:
| > _basically, we 'll be selecting for the strongest... you
| know, evolution_
|
| Fortunately TANSTAAFL[0] applies to evolution as well, right?
| Specific adaptations come with increased metabolic cost, so
| e.g. strongly bleach-resistant bacteria should eventually
| start losing resistance to other antimicrobials/antiseptics.
| _Right?_
|
| --
|
| [0] -
| https://en.wikipedia.org/wiki/No_such_thing_as_a_free_lunch
| quaddo wrote:
| >TANSTAAFL
|
| Man. Way to rustle the ol' memory tree.
|
| I think the first time I saw this in print was in
| Programming Perl back in the mid-1990's.
| hinkley wrote:
| The standup set that put Tig Notaro on the cultural radar
| centered around getting pneumonia, catching c diff, and then
| her mother dies from a freak head injury and she gets diagnosed
| with breast cancer. She was never what anyone would call
| 'sturdy' to begin with. I can only imagine she looked like
| Skeletor by the end.
| zug_zug wrote:
| Maybe they need well ventilated hospital rooms and disposable
| (e.g. paper towel) scrubs that are burnt after each use.
|
| Probably time to start questioning some of the fundamentals of
| our modern healthcare setup.
| cf100clunk wrote:
| After use, throw all the gear into an autoclave and not into a
| fire. That's been fundamental sanitation technology for about
| 120 years.
|
| BTW, a non-electronic pressure cooker does exactly that in
| almost any situation, off-grid and even in the bush.
| keep_reading wrote:
| from wikipedia:
|
| > However, prions, such as those associated with Creutzfeldt-
| Jakob disease, and some toxins released by certain bacteria,
| such as Cereulide, may not be destroyed by autoclaving at the
| typical 134 degC for three minutes or 121 degC for 15 minutes
| and instead should be immersed in sodium hydroxide (1M NaOH)
| and heated in a gravity displacement autoclave at 121 degC
| for 30 min, cleaned, rinsed in water and subjected to routine
| sterilization.
|
| Seems like we should just burn them like the parent
| suggested. Prions are no joke.
| cf100clunk wrote:
| Point taken, so I'll need to fit my bugout kit with some
| lye (sodium hydroxide) too so I don't have to burn anything
| unless absolutely necessary.
| genewitch wrote:
| I thought prions were immune to fire as well, as in
| Creutzfeldt-Jakob infected cows _must not_ be burned, as
| the particulates can infect the feed on adjacent and nearby
| farms.
| foolfoolz wrote:
| when my dad had cancer he took chemo that needed him to in the
| hospital for a week at a time. one of those stays he got a c diff
| infection. the c diff almost killed him. it was really bad, he
| didn't leave the hospital for a month. and from what we heard,
| this wasn't that rare. especially for chemo patients with low
| immunity
| genewitch wrote:
| When my wife was on chemo my hands suffered so much, due to all
| of the washing i did between interacting with her; to prevent
| this sort of thing. As another anecdote about how little of a
| joke chemo is, half of _my_ hair fell out, just from being near
| her.
|
| c. Diff is awful.
| kijin wrote:
| Surgical scrubs are disposable. Patient gowns are usually made of
| tough materials like cotton and polyester that can tolerate a
| fair amount of heat. If bleach in lukewarm water doesn't work,
| how about a boil wash?
|
| Boil washing is usually done at 90-95C, but I suppose you could
| achieve higher temperatures with a bit of extra pressure in a
| purpose-built machine. No living pathogen is known to survive an
| autoclave at 120C.
|
| Steam might be similarly effective on fixed hard surfaces like
| stainless steel and linoleum. Any non-disposable material that
| cannot withstand bleach, alcohol, or 120C for a few seconds a day
| probably doesn't belong in a hospital anyway.
| jjeaff wrote:
| unfortunately, some deadly pathogens are not alive and can
| survive a standard 120c autoclave treatment. Prions being one
| of them.
| kpozin wrote:
| Note:
|
| > biocide-exposed spores were spiked onto surgical scrubs and
| patient gowns and recovery was determined by a plate transfer
| assay
|
| The article says nothing about washing scrubs and gowns. They put
| bleach-treated spores onto fabric, did _not_ treat the fabric,
| and then collected samples from the fabric.
| TeMPOraL wrote:
| I.e. this is less of a "spores on gowns surviving disinfection"
| case, and more of a "you bleached this surface, you thought
| it's enough, but your gown touched it too early and the fabric
| 'rescued' the spores" one, am I right?
| haldujai wrote:
| Yes, the relevance is providers don't change scrubs between
| patients (although do wear typically disposable gowns and
| gloves when entering a patient room with c. diff).
|
| Also relevant for things that travel between rooms and are
| disinfected in between, like ultrasound machines.
|
| Other studies have reported that spores can survive washing
| processes in use.
|
| https://pubmed.ncbi.nlm.nih.gov/30322417
| vaidhy wrote:
| The fact the spores were treated with bleach and were still
| active means that you treating the fabric with the same biocide
| will not kill the spores.
|
| Spores alone survive the bleach. Spores + fabric will survive
| the bleach. Hence treated fabric cannot be considered safe.
| refulgentis wrote:
| That doesn't necessarily follow --
|
| it's tempting because it seems obvious.
|
| If X + Y = Z, X on surface + Y = Z _must_ follow, because "on
| surface" was just a hidden term in X + Y = Z anyway...right?
|
| But, both biology and fabrics have a lot of hidden surface
| (pun intended :P)
| derefr wrote:
| You don't just sterilize fabric with bleach. (How would that
| even work? Hang the gown, spray the bleach on it, and let it
| drip off?) You sterilize fabrics with bleach + water +
| detergent + heat + agitation -- with the goal not being to
| lyse the spores/other germs, but rather to _detach_ all the
| contaminants from the fabric and suspend them in the water --
| which then gets flushed away.
|
| In theory, bleach _could_ help decrease the _adhesion_ of the
| spore to a surface. A possible mechanism would be if it
| oxidized -- and so weakened /destroyed -- some spiky organic
| hooks that the spores were using to adhere to the fabric.
|
| Of course, agents other than bleach -- things not normally
| considered biocides, in fact -- would likely be a lot _more_
| effective at removing spores during fabric washing, since the
| goal is detachment, not lysing the spore.
|
| The obvious things (detergents themselves, and other soaps)
| would work, of course, to varying degrees.
|
| But also, less-obvious things could provide benefits here.
| For example, if spores tended to stay adhered to fabrics
| because they possessed a rough proteinous exosporium that
| acted sort of like nano-scale velcro, then _conditioners_
| (yes, like the kind you use in hair) might get that protein
| coat to relax and lay flatter, in a way that disrupts the
| velcro-like effect.
|
| _Lubricants_ might also work, by "filling up" the rough
| valleys of the spore's surface. (Of course, you'd then need
| an extra wash cycle to remove the lubricants.)
| exmadscientist wrote:
| There are some really amazing detergents out there. My go-
| to for cleaning anything I don't have specific information
| about is Tergajet. It's gentle, extremely powerful, low-
| foaming (so machine compatible), oxidizing, bleach
| compatible, and contains a protein degradation enzyme
| potent enough to disrupt prions:
| https://technotes.alconox.com/detergents/tergazyme/do-
| enzyme...
|
| The downside to this magic stuff is that it's fairly
| expensive ($45 for 4 pounds). So, not for wanton use. But
| well worth it to solve tough problems or when time is more
| important than money.
| hinkley wrote:
| oxidizing and bleach compatible is an unusual pairing is
| it not? There are a bunch of chemicals you can't mix with
| bleach because you create chemical weapon precursors if
| you do. Even the precursors can send you to the ER.
| askvictor wrote:
| Indeed; this is why washing hands with soap is effective
| even though the soap doesn't kill the pathogens.
| haldujai wrote:
| The drying is probably the more effective part for
| mechanical disruption.
|
| Similarly why bleach wipes > soaking in bleach for
| disinfecting surfaces, as alluded to in this paper.
| jojobas wrote:
| Additionally, if the spore didn't get detached in the
| washing process, it's veeeery unlikely to get detached when
| you're just walking around being a nurse.
|
| It might activate within the fabric if the conditions are
| right, but that's not very fast and you shouldn't be
| wearing scrubs contaminated by a nutritional substance for
| too long anyway.
| chiefalchemist wrote:
| Perhaps. But why not test that then? Why the special non-real
| life case? Because it got a result worth sensationalizing?
| For me, it makes me wonder what other study "gymnastics" they
| used.
|
| I hear ya. But to mitigate any doubt they should have covered
| all their bases, or at least the base most inline witb real
| life.
| haldujai wrote:
| This is a real life case.
|
| This article explores surface disinfection (commonly bleach
| in the hospital). Although provider gowns are removed after
| entering contaminated rooms, disinfected surfaces commonly
| come into contact with provider scrubs which are not
| laundered in between same day patient encounters as well as
| other patients (such as the table of a CT or MRI).
|
| I don't see the gymnastics you're referring to, other
| studies have looked at laundering processes which is not
| the focus of this study.
|
| https://pubmed.ncbi.nlm.nih.gov/30322417/
|
| https://academic.oup.com/lambio/article/75/6/1449/6989408
| pvaldes wrote:
| Clostridioides difficile spores
|
| Seeing C and diff here normally would mean the language and the
| program
| gumby wrote:
| Sporination is a really great strategy (except when you're a
| human and don't want _C Diff_ ). A highly resistant way to
| disseminate DNA, even, if necessary, over extremely long
| timescales (hundreds of ky at least, probably my).
|
| I worked on a drug program against a pathogen that was
| transmitted as spores. Basically the treatment was given when
| there was a flare up, because the organism was only vulnerable in
| that mode. We tried killing the spores themselves but evan at
| toxic-to-human doses the spores didn't give a shit. So people
| would get better, then have further outbreaks.
|
| Note that from a drug company's perspective, this is actually
| pretty great. You don't treat them for long enough that it's
| considered a "chronic condition" from a regulatory perspective
| (which would mean much more complex trial protocols) yet you know
| if you treat anyone you'll have a repeat customer, probably for
| the rest of their lives. But despite public opinion of pharma
| companies, I never heard anyone say "thank you spores!" In fact
| we did continue to try to attack the spores.
| imdsm wrote:
| Could you share the name of the illness/pathogen? Very curious.
| whatshisface wrote:
| As long as there is more than one pharma company, there's an
| incentive to cure chronic conditions because you'll take all of
| your competitor's business away and can charge a price equal to
| the lifetime costs of the chronic treatment.
| zer00eyz wrote:
| An efficient market is characterized by a perfect, complete,
| costless, and instant transmission of information...
|
| You have conflated your incentive (a cure) with people who
| make and sell treatments (maximize profits).
|
| As long as there are Pharma companies, there is incentive to
| make slightly better treatments. That is same effect lower
| production cost, or same cost and better effect.
|
| It kind of sad that treatements have gone from prescription
| to subscription.
| Grimblewald wrote:
| Everything is going the way of subscriptions. Ill probably
| be in subscription housing the rest of my life unless there
| is a crash in the property market.
| shoubidouwah wrote:
| Just wanted to add as an additional wrinkle in the simple
| ecomnomic explanations : a lot of the "discovering drugs"
| part -still necessary before you can actually sell drugs,
| afaik-, hinges very much on having really good researchers
| work for you. And these researchers do care about curing
| diseases: I do not have one colleague that does not dream
| of being a new Salk. The market needs thus to correct for
| it: it tends to be more efficient / worth it to be ethical,
| because it is a prerequisite for top talent hiring in this
| space.
|
| This is of course complicated further by the sheer
| pigheadedness of CEOs with a career half life of 3 years
| who come in, _revolutionize_ something by destroying it and
| antagonizing the workers, bloat HR a bit more and drive
| sales through something illegal; and finally move on,
| tallying that one a success.
| mx20 wrote:
| But only as long as the patent lasts. You usually can't sell
| a better cure if the original already cures. A treatment on
| the other hand leaves room for "improvement".
| hinkley wrote:
| I am getting into canning, and half the people have absolutely
| no fear of _Clostridium botulinum_ and half of them are
| terrified. It has a similar sporulation strategy and even
| boiling doesn 't necessarily kill it. Most recipes that have
| been scientifically proven to be safe with possible botulism
| vector foods use pH and sugar content to ensure that the little
| fuckers can't divide. Some pressure cook to raise the max
| temperature, and pH still matters in many of those.
|
| It's the same strategy bees use (modulo the heat). Honey can
| contain botulinum spores, but the pH is so low and the sugar
| crushingly high so it can't divide - until you try to make mead
| and fuck up the recipe. Or feed it to an infant.
| hinkley wrote:
| > Basically the treatment was given when there was a flare up,
| because the organism was only vulnerable in that mode
|
| Committing the sin of a double reply, different subject.
|
| There are treatments for HSV, some experimental but I thought I
| heard one had just about cleared the FDA, that are a cocktail
| of drugs that kill serum herpes simplex but as a chaser to a
| drug that tricks HSV into coming out of dormancy. So while it
| would always be good for big pharma to spend more research on
| prevention and less on treatment, it's not like no progress is
| being made.
|
| Whether they're sandbagging I really couldn't say.
| polalavik wrote:
| weird coincidence - I just had C diff. I was healthy before it,
| had not taken antibiotics in years, so I suspect what caused my c
| diff was years and years of taking pepcid. Long term antacid use
| are one suspected cause of c diff. Doctors like to act like
| antacids are pretty safe and you can just use (abuse?) them for
| years without consequence.
|
| I went on a bender reading about c diff when I had it. The
| antibiotics for it have like 70% or less success rate [1]. The
| gold standard is a drug called dificid. With insurance my dificid
| was $1300, $4000 without insurance. There is a manufacturer
| coupon that makes the drug $50 with insurance - just a heads up
| if you ever find yourself in the same situation. The other
| antibiotics are not that great (vancomycin and metronidazole) and
| have more side effects, from my reading.
|
| Fecal matter transplant (FMT) [2] seems to have the highest
| success rate [3]. There was recently a FDA approved drug for FMT
| called vowst, but its expensive as well. The whole science and
| process of FMT and FMT donors is super interesting and it will be
| exciting to see the developments in this field in the coming
| years to see what other things FMT can help out with (IBS,
| etc...). Its frustrating that FMT, with its high success rate, is
| considered a last resort method to cure c diff recurrence - it
| seems much safer than the general population using novel
| antiobitics with not-great success rates in preventing
| recurrence.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867563/
|
| [2] https://www.youtube.com/watch?v=i6RBfoITbls
|
| [3] https://www.mayoclinic.org/medical-
| professionals/digestive-d....
| pstuart wrote:
| Perhaps banking FMT might be considered pursuing? If one is
| hale and hearty, save that for later. It should alleviate
| _some_ of the squeamishness for "dealing with other people's
| shit".
| djmips wrote:
| I always suspected that taking antacids might negatively affect
| bacterial infections. It was just a conjecture, and I hadn't
| researched it, so thank you for the information.
| TillE wrote:
| If you have GERD or similar you should be on a PPI, not over-
| the-counter antacids. I can't imagine a doctor recommending
| that except for mild, occasional complaints.
|
| PPIs have their downsides, but they're the best available
| treatment to avoid acid damage.
| polalavik wrote:
| PPIs do the same thing - suppress acid. That suppression of
| acid makes you vulnerable to bacteria like c diff. Long term
| use of PPIs is also linked to dementia.
| InSteady wrote:
| Studies into the risks of using PPIs long term show all
| kinds of potential problems. Higher incidence of all kinds
| of mineral deficiencies, sometimes even life threatening.
| Increased risk of cancers. Increased risk of developing
| SIBO. Increased risk of respiratory and urinary tract
| infections. The list goes on.
| eth0up wrote:
| https://www.newscientist.com/article/2245361-crops-sprayed-w...
| "Crops sprayed with 'barcoded' spores could help trace food
| poisoning...."
|
| Spores are tough.
| DoreenMichele wrote:
| Two thoughts:
|
| 1. We really should try harder to use the internet to reduce
| hospital visits. This was a missed opportunity during the
| pandemic when hospitals were a source of spread and hospitals are
| also an ongoing source of antibiotic resistant infections.
|
| 2. I wonder what copper would do in this case. Copper is
| sometimes used in hospitals for railings, etc. because microbes
| typically die within an hour, thereby reducing transmission of
| disease.
| Qem wrote:
| I wonder if this changes the prospects for finding life in Mars
| somehow. IIRC, one thing making life in Mars difficult is the
| presence of oxidizing chlorates or peroxides in the surface. If
| we have a example of microorganisms developing extreme resistance
| to oxidation here on Earth, I think it improves the odds of some
| microorganisms still being able to thrive in Mars today.
| twic wrote:
| Spores are highly resistant to oxidisation, but for a spore to
| produce more spores, it has to develop into a bacterium, and
| bacteria are not resistant to oxidation. This is not
| happenstance - spores can be resistant because they don't do
| anything, they are just simple storage containers for DNA and
| the minimal machinery to use it, whereas a complete bacterium
| has to do much, much more. So, this is not a model for life
| which can exist in a permanently oxidising environment.
| hinkley wrote:
| Rarely have I encountered a latin name as accurate as
| _Clostridioides difficile_. For those without a Romance Language
| background, 'difficile/difficilis' is Latin for 'difficult' and
| difficile is preserved verbatim in French, <looks it up> and
| Italian, and is phonetically the same word in Portuguese and
| Spanish (minus the e and add some accents).
| amluto wrote:
| I'm surprised there's so little discussion of the _form_ of
| chlorine. Chlorine dissolved in water can be dissolved Cl2, HOCl,
| OCl-, and chlorinated cyanurates. These are all in a pH-dependent
| equilibrium, and the latter is most of what you get when you mix
| "NaDCC" with water.
|
| HOCl is generally considered the best disinfectant, and OCl- is
| weaker. Chlorinated cyanurates are very weak (and fairly UV-
| stable and non-irritating) and can replenish HOCl and OCl- as
| they are consumed.
|
| Yet somehow the food-and-beverage-service standard for
| disinfection seems to be "100 ppm as Cl2" without regard to the
| balance of chlorine species.
|
| On the other hand, this paper tested concentrations up to
| 10000ppm, which is really quite high.
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