Quarantined for clostridium difficile

December 24, 2012 10:47 PM

I live with someone who was just put on a six-month home quarantine for clostridium difficile. I have advanced heart disease including multiple heart attacks, stents, open-heart operations and a couple mini-strokes. The infected person is also on lactulose due to a severe intestinal problem and must wear diapers at all times. Further, she is an alcoholic who has started drinking heavily in the last two weeks, and she is tracking feces all over the house.

I am moving ASAP, and I am calling my doctor on Wednesday. I cannot afford a hotel or I would leave immediately. I am thoroughly washing my hands often, and confining both myself and my cat to my room through Christmas.

Are there any other precautions I should take?

posted by Ardiril to Health & Fitness (25 answers total)

Response by poster: By "live with someone", I mean we share a house. We are not in any way intimate.
posted by Ardiril at 10:48 PM on December 24, 2012 [2 favorites]

Wash with soap and water. Don't wash with alcohol-based hand sanitizers, because they don't kill the C. difficile spores.

Maybe call your doctor and see if you can get a prescription for Cavi-Wipes to wipe down any of your common surfaces. Or see if they will just give you a canister of them.

Are you sure there are no friends you can stay with?
posted by honeybee413 at 10:58 PM on December 24, 2012 [1 favorite]

I don't suppose you have any friends or family nearby who you could stay with for a few days until you can move out? Because that sounds like a seriously untenable situation that you have there. Your housemate sounds like she is going through a really terrible time as well, but that doesn't mean that you shouldn't do everything in your power to get out immediately.

Have you done much research on the disease? This CDC page might be a good place to start.

Fortunately it looks like C. difficile is mostly a risk for people who are on long-term antibiotics and whose gut flora are therefore reduced. Unfortunately it also looks like it is spread through feces and like spores can persist for a long time.

I would consider abandoning the bathroom if your housemate is getting feces everywhere. Find somewhere else that you can use for a few days. In fact, you might do best just from a sanity standpoint to set yourself up in like a coffeeshop or a library or something, or really anywhere that's open. If nowhere is open then go for long walks. Get out of the house, is what I'm saying.

You are probably going to be fine from a health standpoint but your housemate situation seems pretty hellish. I'm sorry you are having to deal with this.
posted by Scientist at 11:01 PM on December 24, 2012 [1 favorite]

I would use bleach in cleaning everything. Everything. It's safe to wash glasses, plates, and silverware with a weak bleach solution. I would wash every bit of tableware and every pan and utensil with a weak bleach solution before using, even if you've just taken them from the cupboard and they're theoretically clean.

If you can find Clorox Germicidal Wipes with Bleach or similar, those are recommended by the CDC for use in cleaning up after C. Diff.

Keep your toothbrush and your towels in your room, not in any bathroom she might use. Clean the bathroom surfaces with bleach before brushing your teeth (including the faucet spigot and handles).

I wouldn't eat food that she might have touched, or from a container she might have touched, including pouring myself milk or soda or juice from a communal bottle.

Would taking your shoes off at the door of your room be possible? Just so you wouldn't be tracking contaminated feces traces in from the rest of the house?

So sorry you're having to deal with this. Honestly, it's kind of outrageous that her health care providers were so cavalier about the risks to others living in the same house.
posted by Sidhedevil at 11:08 PM on December 24, 2012 [4 favorites]

Response by poster: I have done as much research as I could, but very little that I found addresses those who must share a home. Also, I read hints that a super-strain exists, and I found no information on why she may have been so strictly confined to the house for six months. That is a form of quarantine, right?

Because of my heart disease, my immune system has been heavily compromised, otherwise I would not be fretting so. Plus, I take omeprazole to control acid reflux. I can skip a day of that without problems. Nothing around here will be open on Christmas, so I am stuck here.

"Would taking your shoes off at the door of your room be possible?" Ah, good one. I will wear slippers outside my bedroom when I absolutely must go out, and leave them at the door.

I wouldn't fully blame her healthcare providers. They may have given her strict warnings that she was too drunk to relate to me.
posted by Ardiril at 11:16 PM on December 24, 2012 [1 favorite]

Seconding Clorox wipes with bleach though much the same effect can be had with regular face cloths soaked in a bucket of water with bleach. A typical mix is one table spoon per gallon changed every two hours.

A box of nitrile gloves is only $10 or so and you could wear gloves any time you are out of your room.

Sidhedevil writes "I wouldn't eat food that she might have touched, or from a container she might have touched, including pouring myself milk or soda or juice from a communal bottle."

Along with staying out of the house as much as possible I would just eat out for the next week even if that means a jar of peanut butter and a bag of bread supplying most of my meals. Substitute what ever no-cook meals works for you.


Ardiril writes "Nothing around here will be open on Christmas, so I am stuck here."

Not to second guess your local knowledge or situation Ardiril but when I have had a loud room mate have a "friend" over I've used my office and a Truck stop coffee shop (order something every hour or so and tip well) to get away from them. Also I'd bet on Christmas all sorts of churches will be open even though it's mid week though you'd have to listen to sermons but they do tend to be low key at this time of the year. Finally some hotels, even if their restaurants aren't open 24 hours will have either lobby or restaurant seating available for guests to work quietly in and they never check to see if you are actually staying there. Just a few out side the box thoughts.
posted by Mitheral at 11:45 PM on December 24, 2012 [1 favorite]

Response by poster: I am on Social Security Disability and I am down to couch change now. Also, the local transit system is shut down for Christmas, and I cannot afford to take a cab. Please, this is not a plea for a loan.

After Christmas is over, I have a few resources I can tap, but primarily I am hoping for a medical profressional to weigh in on what I should do until I can call my doctors Wednesday morning. What puzzles me is this strict six-month quarantine. Nothing I can find on the web even approaches such precautions of that magnitude.
posted by Ardiril at 11:55 PM on December 24, 2012

Best answer: I'm with the young rope-rider. I'm a physician and I've never heard of a 6 month quarantine for C diff. That's not to say that it is impossible but it is not the standard of care. The precautions you are taking should be adequate and I'm not sure how her physicians could have addressed it differently, other than possibly more social services (although whether she'd be eligible or would have been compliant with this idea in her current state would be questions).
posted by treehorn+bunny at 5:10 AM on December 25, 2012 [4 favorites]

Question: who exactly ordered this quarantine? Is this something only she told you about or do you have good knowledge this comes from whoever is taking care of her medically?

The more I look into this, I too think this it sounds like the young rope-rider has it nailed. Drunks often create medical reasons that cannot be refuted to allow them to continue their addictive habits. Also, I have dealt with quarantines before (I am not a doctor though like treehorn+bunny) but in those cases, it was due to the possibility of airborne transmission. Sounds to me like this person is more interested in emptying bottles as opposed to simply wiping their butt.

To answer the question - as far as precautions go, the first will be to lay down the law about personal hygiene. Making it personal and rude also may be a good precaution as well – drive the point home in no uncertain terms that this is not acceptable. Having an illness (that can be managed) is not an excuse for unsafe and unsightly behavior. It also may be some of the best medicine this person could use for her issues other than clostridium difficile. It is BS that you have to move because another person will not take responsibility for themselves. Particularly for something that can be at least somewhat dealt with by donning a diaper.
posted by lampshade at 5:44 AM on December 25, 2012

lay down the law about personal hygeine

If the roommate is drunk, you can "lay down the law" all you want; it probably won't do anything and might result in retaliation (of the smearing-feces-on-your-door variety, not of the silent treatment variety). I don't advise it. Just stay the hell away from her until you can get out of there. If you have no money, don't be too proud to go to a soup kitchen or drop-in centre, that's what they are for, and you can get coffee with that couch change.
posted by windykites at 5:53 AM on December 25, 2012 [3 favorites]

I am so sorry you are having to put up with this, Ardiril. Best of luck for a safer situation soon. My spouse had c.diff. but a quarantine was never mentioned. I suspect it's a fiction.
posted by emjaybee at 6:16 AM on December 25, 2012

Could the Salvation Army give you some hospitality right now? If you can't get to them, maybe you could call them up and they could help figure out a means of transportation?
posted by tel3path at 6:24 AM on December 25, 2012

I would phone a nursing help line to see if they can give advice. It looks like there are a few in Seattle, and one of them might be open today.
posted by jeather at 6:50 AM on December 25, 2012 [1 favorite]

Response by poster: Thanks to everyone for your responses. I had my suspicions, but I wanted to see whether and how you all would address the lying issue.

From what I gathered, the primary cause of C Diff is taking antibiotics that kill the good bacteria that would keep C Diff under control. Antacids are also indicated, but weakly. I am not currently taking antibiotics, although because of my heart condition, I must take them prior to any dental procedure. Avoiding them for the few more weeks I must live here will not be difficult.
posted by Ardiril at 8:35 AM on December 25, 2012

She might be lying or confused.

You mention lactulose and heavy drinking. Is it possible your roommate has hepatic encephalopathy due to end stage liver disease? In my limited experience lactulose is more commonly used for that rather than constipation.
posted by TedW at 9:16 AM on December 25, 2012 [3 favorites]

Response by poster: Possibly, TedW, but such speculation is kind of outside the topic at hand. I had already decided to move soon anyway for unrelated reasons. Thanks for the link, however, it does explain a lot of things.
posted by Ardiril at 9:28 AM on December 25, 2012

Response by poster: I see now that C Diff is not a major factor here. This is full blown end stage liver disease. I was totally duped by my lack of knowledge in this area.
posted by Ardiril at 10:41 AM on December 25, 2012 [1 favorite]

You may also want to start taking a pro-biotic. It may help minimize the chance of an infection if you do get exposed (as the friendly and unfriendly bacteria compete for turf in your gut...)

That's probably enough, but you can also supplement with Saccharomyces boulardii which can also help with c Diff...
posted by NoDef at 10:43 AM on December 25, 2012

How awful for you. Do you have anything like a crisis line that sends social workers/other officials that can make a determination if someone needs to be hospitalised due to an inability to care for themselves? She does not sound like she is able to look after herself and it would give you a bit of breathing room while you move out if she is in care. I hope the new year is a better start for you in a better situation.
posted by saucysault at 11:36 AM on December 25, 2012 [1 favorite]

It sounds like you're starting to figure it out: your housemate is likely suffering diarrhea because of the lactulose, which is probably intended to treat high ammonia levels secondary to advanced liver disease. Your housemate may or may not have C diff: lying is one possibility, but it's just as easy for your housemate to be in denial about her true diagnosis, or to be confused about her true diagnosis. It is unfortunately common for people with hepatic encephalopathy to leave the hospital without understanding what's going on. It's not impossible that she has both liver disease and C diff infection, but what you're describing is pretty common for people with just liver disease.

Sometimes people with advanced liver disease seem drunk even when they're not. So if you're not seeing empty bottles, just speculating based on her history and behavior, maybe it's a little easier to deal with, a little less infuriating, to blame her behavior on her liver disease rather than her alcoholism.

If your housemate is taking lactulose just for constipation, she should probably speak to a doctor, because she doesn't sound very constipated.

If your housemate actually does have C diff, you're doing exactly as you ought. In the hospital, if I was dealing with somebody on isolation for C Diff, I would wear a gown that was washed (or disposed of) after every contact, I would wear gloves, and I would wash my hands with soap and water. If you've completely described your health problems, you are not at any special risk for contracting C diff. I've never heard of healthcare workers contracting C diff themselves, and we deal with a lot of poop. There's a bit of a special route from your teeth to your heart, which is why you get the antibiotics for dental work, but you're not particularly immunocompromised as it would apply to C diff. From what you've said, at least.
posted by nathan v at 1:04 PM on December 25, 2012 [2 favorites]

Response by poster: Ascites with an umbilical hernia, the hepatic encephalopathy, empty bottles -- all the major symptoms identifiable by a layman are quite evident, as well as a household full of circumstantial evidence and a calendar of related events.

My prior experience with alchoholism of any degree was a virtual blank slate, so her cover story was totally plausible. However, I know now exactly what is happening, and I agree that the presence of an actual C Diff infection is unlikely and may only be a continuation of the ruse.

As for a confrontation concerning her hygiene and her soiling both the floors and lower walls (my latest discovery), I believe she would deny all of it, and I prefer to devote my energy to finding a new place ASAP. Hopefully that occurs before the next time the power company cuts off the electric or the cable company cuts off the internet.
posted by Ardiril at 1:45 PM on December 25, 2012

Glad to see you've found the answers here helpful. You may also be interested to look into the term 'confabulation' - it's used to describe a common, specific feature of alcoholic dementia in which the person suffering from the confusion forgets what really happened and makes up a story to explain what they think may have happened. It's different from outright lying because the patient is not aware that they are doing it.
posted by treehorn+bunny at 8:11 PM on December 25, 2012

Hey, so while it’s great that you’ve gotten all of this information on how to deal with the health factors at hand, nobody has mentioned yet that you should also be focusing on how to not be held liable for your roommate’s fecal fireworks. You don’t want to take any sort of fall for this after you move out. I don’t have much advice as far as specifics are concerned, but this is another very important element that perhaps someone else here will jump onto.

I’m sorry this is your situation. I can’t even imagine. :(
posted by oceanjesse at 4:48 AM on December 26, 2012

Response by poster: I rent a room here. She is the homeowner. Also, I am on disability and basically unsueable.
posted by Ardiril at 11:38 AM on December 26, 2012

Did you pay a security deposit?

If so, I'd take pics of the condition of your room (presumably without feces in it), and the rest of the place. In case she decides to keep the security deposit because of this (and somehow blaming you and/or holding you partially responsible), you'll have proof that you didn't cause this in case you need to try to get it back.
posted by spinifex23 at 5:47 PM on December 26, 2012