Public awareness of C. difficile must rise

Most bacteria never have a breakout year. But when the nerve center for the nation’s fight against deadly diseases last fall ranked C. diff. first among the three most “urgent” threats to public health, an overdue spotlight shone on an epidemic that much of the press overlooked for decades.

Scientists at the Centers for Disease Control and Prevention (CDC) weren’t the only ones calling attention to the threat from C. diff last year. Comedian Tig Notaro made headlines for her darkly sarcastic stand-up performance highlighting her own bout with the superbug.

Then in December, HBO began airing the somber workplace comedy “Getting On,” set in the long-term care ward of a Southern California hospital. The show is the first major television program to mention C. diff. routinely in its scripts.

What accounts for this breakthrough? First, the show originated in Britain in 2009, to rave reviews. Public debate about C. diff., and the system of mandatory disclosure of statistics regarding its prevalence at caregiving facilities, is much stronger in the U.K. Second, it’s not coincidental that the original show had three women at its helm as writers and performers. Not only do women make up the lion’s share of the long-term care workforce in both the U.K. and U.S., who do battle daily with the disease while adhering to commonsense precautionary measures. But also, women–in part because of longer lifespan and the heightened risk of C. diff. exposure in geriatric care environments where they predominate — are the majority of reported C. diff. cases and fatalities.

More than 28,000 Americans will die of C. diff. this year. The disease involves a common bacteria transmitted through bodily fluids. Most people’s digestive tracts contain bacteria that counteract C. diff. and keep it in check. But some antibiotics kill the counteracting bacteria, which can allow C. diff. to flourish, gradually taking over the intestines. C. diff. infections, or CDIs, manifest with flu-like symptoms that include fever, abdominal cramps, and diarrhea. Unrecognized and without proper treatment, a CDI can prove deadly within just a few days. Regular hand-washing with soap, thorough cleaning using chlorine (since alcohol-based rinses do not kill C. diff.), and limiting antibiotic use help prevent C. diff.

Like “The Office,” the long-running NBC series that also originated with the BBC, “Getting On” draws humor from awkward dynamics among co-workers. In the first two episodes of the program in the U.S., C. diff. was mentioned nearly often enough to be considered a cast member. Indeed, the disease figures prominently in the profile of the foremost character. For the growing coalition of public-health advocates, the show is a welcome addition to the cable lineup. We need network programming and producers in other media to follow suit.

The fight against deadly superbugs is in part a fight for the media spotlight. In order for America to mount the full-scale effort to recognize and prevent C. diff., public awareness about the disease must rise. Silence about the disease, because its symptoms involve defecation, is no laughing matter. Prominent and recurring media attention to C. diff. is absolutely indispensable to stopping it.

Christian John Lillis is co-founder and director, The Peggy Lillis Memorial Foundationthe first national organization dedicated to reducing and eradicating Clostridium difficile infections, or CDIs, through education and advocacy.

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  • Pat Mastors

    Christian, thank you for this important, insightful and articulate post. (Not sure how you could write it without mentioning your own beloved mother, a healthy 50-something kindergarten teacher, died of C. Diff within days of taking antibiotics for routine dental work.) At any rate, you are spot-on re: popular culture/the arts’ capacity to elevate awareness about the dangers of C.diff, as the movie “Philadelphia” did with AIDS awareness. Thank you for all you do to spread awareness and save lives.

  • Christian John Lillis

    The example I would give is MRSA which was long only really understood by healthcare personnel rather than the general public. In the late 1990s, MRSA because a household word, primarily due to its migrating out of the hospital and into the community. Once the public was a aware of the threat, a range of activism by both patients and physicians, led to much better disease awareness, tracking and reporting, and, ultimately, to a decrease in the burden. As C. diff increasingly becomes a community-acquired disease, and death rates continue to climb, public awarness can aid in prevention and spur institutional chance.

  • Christian John Lillis

    MRSA infections declined significanlty from 2005-2011 as the public became aware of the threat and demanded change. http://www.cdc.gov/mrsa/tracking/index.html

  • Christian John Lillis

    Public awareness of MRSA led to insistence on transparent reporting of said infections by hospitals and citizens demanding that hospitals take action to tackle the epidemic. That, in turn, has led to better infection control techniques which has led to decreased rates in healthcare settings. In fact, the only way that we know that rates are declining is because the public demanded that hospitals report their rates. You’re seeing the same thing now with C. diff. Given that the C. diff is largely driven by antibiotic overuse, particularly in the community, having a educated public that doesn’t demand unnecessary antibiotics and can spot risk factors and symtpoms will decrease infections and save lives.

    • PoliticallyIncorrectMD

      Are you implying that thousands of healthcare professional who were aware of MRSA epidemic conspired to ignore it and only because of public pressure it was addressed?

      • Christian John Lillis

        No. I’m saying that those professionals didn’t have the tools, funding or bandwidth necessary to truly tackle the MRSA epidemic until public pressure was applied. This isn’t a patient vs. healthcare worker debate. But it’s incredibly hard for people operating in a system to change that system without outside pressure, particularly when there’s no financial incentive for the system to change.

  • Christian John Lillis

    Now you’re just being rude. It’s unclear to me if you’re actually a doctor but if you are then you would no that handwashing compliance among all healthcare workers is abysmally low with doctors being among the worst offenders. Yes, ADI helped but you keep focusing on infection control techniques without ever addressing the incentives or disincentives to actually employing those techniques.

  • Christian John Lillis

    The effectiveness of public health and disease awareness campaigns – from smoking to seat belts to HIV/AIDS – is indisputable and has saved millions of lives. http://www.thecommunityguide.org/news/2012/HealthCommunicationCampaigns.html

    Far from “breeding paranoia and distrust”, raising awareness of the risks of engaging in any behavior arms the public with the information they need to effectively partner with healthcare providers in disease prevention and management. In fact, an engaged public that understands C. diff and modifies behaviors, in particular ceasing its demand for unnecessary antibiotics, and is capable of participating in early detection of C. diff via assessment of risk factors and symptoms, will be a huge advantage in ensuring that people with CDIs, both hospital and community-acquired, get treatment swiftly and avoid dangerous complications like pseudomembraneous colitis and toxic megacolon.

    Further, we work closely with members of the medical community – as advisers and partners in developing our strategies – who are committed to ending this very preventable epidemic. And, personally, my father-in-law and brother-in-law are physicians, so there’s no animus toward the medical community on our part.

    Morally and ethically, patients have the right to understand the risks and benefits of any treatment, particularly well-established and potentially life-threatening side effects. To deny them that is to remove their ability to make an informed decision. It seems to me that you’re using the specter of “hurting the public” (for which there’s no evidence) as a smokescreen to prevent citizens from seeking life-saving reforms.