Shana Roberson 1 Rationel:

My purpose of this speech is to inform my listeners how the lack of proper hand hygiene and the overuse of antibiotics in today's populations is creating a problem in healthcare settings such as infections, increasing mortality rates, longer hospital stays and increasing cost of healthcare. The audience that I would like to focus on for my speech would be healthcare workers in general that have direct contact with patients, due to the fact that they would be responsible for proper hand hygiene to prevent spread of infections and monitor the safety of their patients at all times. The goal of this speech is to bring awareness to the spread of clostridium difficile infections in healthcare settings, its effects on the patient's, and ways to prevent the spread of c­difficile among the healthcare workers with direct patient care that could prevent harm to patients. Shana Roberson 2

What would you think if I told you that according to the CDC, one gram of poop contained one million germs? The first reports of Clostridium difficile, also known as C­Diff was originally founded in 1978 as the cause of antibiotic induced pseudomembranous colitis, and according to the CDC, is now the leading cause of antibiotic­associated diarrhea in healthcare settings. Research shows that C­Diff infections are a problem in healthcare settings due to poor hand hygiene from all healthcare workers that have direct patient care and the overuse of antibiotics. In the next few minutes I'm going to discuss with you the importance of hand hygiene, to stop the spread of C­Diff and how overuse of antibiotics are responsible for the leading cause of C­Diff infections. We will also discuss how we as health care workers can make a difference in stopping the unnecessary spread to protect our patients. To start lets take a look at how hand hygiene has an impact on the spread of C­Diff. The two major reservoirs to C­Diff in healthcare settings are infected humans and inanimate objects.
When a person gets diarrhea from C­Diff infections they can spread the bacteria in the environment, when that infected person touches an object with unwashed hands, C­Diff can be spread to that object, so when others touch these objects they also contaminate their hands. This is how the illness is spread from one person to another. According to the American Journal of
Infection Controls hand hygiene guidelines, healthcare workers hands are frequently contaminated with C­Diff following patient contact. C­Difficile is unable to be killed by alcohol rubs or sprays and therefore traditional hand washing with antibacterial soap and warm water is

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recommended for removal of the actual spores that carries the disease. Proper hand hygiene and the use of the proper PPE, such as gloves and gowns when having direct care to not only patients with C­Diff but their environment is important to stop the spread. According to the CDC and
WHO, improper hygiene is said to be one of the most important contributors to the spread of infections. When washing your hands consider asking yourself a few questions, how and where should I dispose of gloves, When and what type of hand hygiene is required after each task that is performed, how long should hands be washed for, the proper way to dry hands and how long to dry them. Opportunities for hand hygiene to stop the spread of infections occur 24 hours a day, 7 days a week, 365 days a year that involve both clinical and nonclinical personnel. Hand hygiene should be performed before and after each contact with infection patients or their environment. If hand hygiene is completed properly, C­Diff spread can be reduced by 70% in healthcare settings. (CDC, 2013.) Now that we have talked about how hand hygiene can help prevent spread of C­Diff, let's talk about how our patients are getting it. Several risk factors for getting C­Diff is being a child, elderly adult, have low immune systems, being hospitalized or living in a crowded environment, such as nursing homes. But the number one cause of C­Difficile is the overuse of antibiotics.(APIC 2015) Studies show that 71% of patients with C­Diff had been previously on an antibiotic for respiratory, ear, nose or throat illnesses, that were most likely viral, not needing antibiotics. It is estimated by APIC that nearly half of all antibiotic uses are unnecessary.
Antibiotics kill bacteria that are essential to a balanced immune and digestive system. If a patient is over exposed to antibiotics, the naturally occurring bacteria called C­Difficile can over

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produce and cause the patient to become infected with Pseudomembranous colitis. Nearly all antimicrobials have been indication in C­Diff infections but certain classes such as cephalosporins, clindamycin, and fluoroquinolones, seem to cause higher risk for disease.
Fluoroquinolones have been proven to be the major class of antimicrobials indicated. Although we know that long term therapy and broad spectrum antibiotic use is one of the leading causes of
C­Diff infections, a single dose of antibiotics, such as preoperatively, can also cause C­Diff.
Therefore promoting the use of narrow­spectrum antimicrobials or questioning if the illness your patient has needs an antibiotic at all, could reduce the incidence of C­Diff and control frequent outbreaks. As you can see from our discussion about the spread of C­Diff from improper hand hygiene, and the overuse of antimicrobials being the leading cause of C­Diff, in just a few short steps C­Diff could be dramatically reduced. By knowing the proper hand hygiene and teaching this to not only to our healthcare workers, but also to our patients families as well. Also questioning if the illness our patients are showing signs and symptoms of is a virus that needs the symptoms treated or if it is a bacterial infection that needs antibiotics, and then questioning if the illness can be treated with narrow spectrum antibiotics versus wide spectrum antibiotics. Just these simple steps can reduce the onset and spread of C­Diff. C­Diff is the most common bacteria responisable for healthcare­associated infections in the United States hospitals and may account for 14,000 deaths per year, simply reducing the use of high risk broad spectrum antibiotics by 30% could lower C­Diff infections by 26% according to the CDC estimates of
2014.

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REFERENCES Khanna S. (2012) Clostridium Difficile Infection: New insight into treatment. Mayo
Clinic. Page 87.
Rebmann T. (2015) Preventing Clostridium Difficile Infections: elimination guide.
American Journal of Infection Control, APIC. Page 39­139
Centers for disease control and prevention (2013) National center for emerging infectious diseases: Measuring hand hygiene. Page 14­173
Headley CM. (2012) Deadly diarrhea : Clostridium Difficile for healthcare providers.
Centers for Disease Control and Prevention. Page 30­159
The Center for Disease Dynamics, Economics and Policies. (2015) bimonthly
The
Global Antibiotic:
Garpnet Volume:3 Issue: 1

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C­DIFFICILE DEATHS PER YEAR
Centers for disease control and prevention (2013)