How much and what kind of effort should I put into avoiding C. Diff.?
September 15, 2018 8:51 PM   Subscribe

My partner is a nurse on a psychiatric unit at a hospital (ie. without the types of isolation precautions or materials you might find on a medical/surgical unit). Last night she was exposed to two patients with possible C. Diff. I really don't want to get C. Diff. What precautions are reasonable?

I am looking for both researched data about the relative contagiousness of C. Diff, and practical strategies. If my partner has been exposed, is it safe to kiss? Eat off her plate? Should I avoid her for a couple of days? We don't live together.

I would also like to not treat my partner like a potential vector for disease. I'm a germaphobe and she is not. We are planning to move in together in the next few months and I would like to know more about how others deal with intimate relationships with healthcare providers and the potential associated risk of infection.

So, I'm seeking information in relation to either the social or epidemiological aspects of this problem.
posted by unstrungharp to Health & Fitness (17 answers total) 2 users marked this as a favorite
I don't have any research data for you but ... I am an ER RN, I frequently (probably even more frequently than I realize, which is very frequently) come into contact with patients with C. Diff before anyone realizes they have C. Diff (and therefore am not wearing any PPE), and neither I nor anyone I have ever met has contracted C. Diff or for that matter any other disease I have been exposed to in the hospital (well, I may have gotten gastritis a couple years ago, who can say where it came from). And I am exposed to a lot of things, every day.

C. Diff is opportunistic, unless you have a weakened immune system, are on IV antibiotics, etc, I would not worry about it. It's also transmitted via fecal matter so I would think you should be fine to kiss her. I would not spend one second of my time worrying about this.
posted by queens86 at 9:03 PM on September 15, 2018 [28 favorites]

C Diff is spread by fecal spores and you’re unlikely to become infected if you aren’t elderly, immunocompromised, or on antibiotics. If she showered after her shift, you’re probably fine.

My husband is a surgery resident and comes into contact with all kinds of grossness in the course of his job. I work in a hospital as well, in a field where I learn a lot about hospital associated infections, and honestly that knowledge is helpful. I’m not much of a germaphobe, but reminding myself that I’m healthy and probably already colonized with bacteria that could harm me in the right circumstances (a large portion of the population has staph on their skin, for instance) helps me feel better. Also, knowing that he follows appropriate precautions as much as possible.
posted by MadamM at 9:11 PM on September 15, 2018 [1 favorite]

Don't move in with this poor woman until you've seen a doctor and started working on this anxiety. My parents were health care professionals, I know many working in this field, and you are the first person I've ever heard (outside the lab where they worked with prions) worrying about "deal[ing] with intimate relationships with healthcare providers and the potential associated risk of infection." I mean, obviously there is a nonzero risk of a health-care provider being exposed to something dangerous and therefore a nonzero risk of transmission to a family member, but that this is a looming problem in your mind indicates to me that you need help. People can reassure you about C.diff. now, but there will always be another thing, and then another.
posted by praemunire at 9:12 PM on September 15, 2018 [33 favorites]

My spouse is an ER doc and sees all kinds of things at work. He changes out of his scrubs when he is done with work and washes his hands before/between/after patients as per usual protocols. I have lived with him for 10 years and neither I nor him nor anyone we know who works in the ER with him has picked up anything directly attributable to their work there. Your girlfriend’s risk is not zero but it’s pretty close if she is washing her hands like she should and has a normal immune system. Yours is even closer to zero and there is no reason you should be worried about interacting with her as you would normally do.

If it makes you feel better when you’re living together it wouldn’t be unreasonable for her to be extra careful to change out of her clothes and shower after work, but in general I’m going to second, very seriously, seeking help for your anxiety.
posted by charmedimsure at 9:26 PM on September 15, 2018 [7 favorites]

I'm a germaphobe and she is not.

A huge part of your partner's job is to be aware of and responsible with germs. If she isn't concerned, you shouldn't be either. You are letting your anxiety spill over into your relationship in an extremely unhealthy way.
posted by schroedingersgirl at 9:35 PM on September 15, 2018 [4 favorites]

I'm not necessarily sure that it's fair to say I'm being extremely unhealthy. Everything I know about C. Diff came from that Tig Notaro documentary. I'm also content to do nothing and continue being intimate and affectionate and sharing space in the usual ways, I just want to feel out what is appropriate and then do the appropriate thing.

For context: I haven't, to date, let my anxiety or any concern about germs affect our relationship, and it's been about a year. I just want to know if I'm being safe currently, and what other people do, since it's not my field.
posted by unstrungharp at 9:39 PM on September 15, 2018 [4 favorites]

I'm a healthcare provider who has been in relationships with non-healthcare folks, and I have been exposed to lots of gross things, contracted a few, and managed to never share them with my partners by following universal precautions. Residential care or longer term care, like psych inpatient, will have some different risks than working in an outpatient situation like a doctor's office, and this is definitely something I'd suggest you discuss with your partner before you move in together if you really are a "germophobe"--you can talk about what precautions she takes at work, what your expectations are for her when she comes into the home, and what is reasonable. When I was working in residential care, I always changed out of my work clothes right away and washed my hands before engaging in anything around the house. If there was something going around, I would take it a step further and put my clothes straight in the washer (for example, if there was a stomach flu or a rash happening, even if I didn't have symptoms).

C. Diff is no fun, and I don't think you being worried about it is a sign that you need therapy so much as a sign that you've heard enough about a contagion to worry you, and not enough to assuage your worries. It is spread through contact with feces or fecal matter--like, if someone has a bowel movement, doesn't wash their hands well, and then touches a table, that table can be contaminated with C.Diff. Bleach kills it. If partner is wearing gloves at work, practices good hand-washing, and she changes clothes before coming to see you, you're going to be fine, especially if she's not interacting with the bathroom habits of patients frequently, and if patients are also practicing hand-washing. Here is a little more information on the disease and its contagion---basically, it's everywhere in our environment and only becomes a problem for people whose native gut bacteria can't keep it in check.
posted by assenav at 11:39 PM on September 15, 2018 [2 favorites]

I want to add--even if it's not a med/surg unit, as a nurse she should have access to basic universal precautions training and PPE, especially gloves. That's normal in all settings where health and personal care happen, even if there isn't active doctoring going on.
posted by assenav at 11:40 PM on September 15, 2018

Are you aware that the reason that the psychiatric floor doesn't have isolation or PPE like a med/surg floor is that all psychiatric patients must be medically cleared to be transferred to that floor?
If it is determined that they need isolation after the transfer,
they will be transferred off the unit back to a medical floor.

I'm a social worker who works in a large ER. Have her wash her hands and change clothes when she comes home, but don't worry about it.

Sounds like two patients had diarrhea at the same time which could be C diff, but could also be a thousand other things. They did some testing and will take appropriate steps including transfer of patients if needed.
posted by AlexiaSky at 3:38 AM on September 16, 2018 [2 favorites]

C. diff, the bacteria, is a lot like staph in that it’s already basically everywhere, but if you have a healthy immune system and decent hygiene, you’re unlikely to get an infection. In other words, you are already really good at avoiding C. diff just by doing what you’re already doing.

I have some medical anxiety and the only time I think about C. diff is when I’m already on hardcore antibiotics for something else, and even then I’m not concerned as long as I’m pooping okay. It helps my anxiety to remember that there’s no use worrying about something unless/until there’s evidence that it’s there, and most things are easy to catch and treat.
posted by Metroid Baby at 5:05 AM on September 16, 2018 [1 favorite]

Tig got C Dif because she was on extreme antibiotics which kill off good gut bacteria AND she had undiagnosed breast cancer at the same time. (I also think she got it while staying IN the hospital?) Unless you are dealing with chronic illness or a weakened immune or digestive system then your risks are low. As stated it is spread by feces.

And I do think it’s beneficial for everyone to seek therapy but especially if this is your situation related to your own worries and your partner’s profession. As an Anxious Sick Girl I definitely have more fear of illness than most but I would also hope that your partner is following their training which is better than what the average person does.
posted by Crystalinne at 10:26 AM on September 16, 2018 [4 favorites]

In grad school I had a job at the state department of health where I called up everyone in 5 counties diagnosed with a “community acquired” case of C diff (as opposed to those infected during an hospital or nursing home stay). The vast, vast, vast majority of the people I talked to had been on antibiotics, often multiple rounds of them, and a lot of those people had been on antibiotics prescribed quite indiscriminately by dentists due to dental work. Things I learned from my year cold-calling people and asking about their diarrhea: use antibiotics judiciously, avoid dentists who hand them out like crazy, and wash your hands with real soap when you come home from everywhere (especially if you have been visiting a nursing home). Maybe take probiotics.
posted by Maarika at 11:15 AM on September 16, 2018 [1 favorite]

I would like to know more about how others deal with intimate relationships with healthcare providers and the potential associated risk of infection.

I'm a healthcare provider and of the small handful of times I've been sick since I started working in the hospital, I can attribute almost all directly to something I caught from my partner. Casual contact with friends and relatives is much more concerning to me, with regard to getting sick, than time in the hospital or contact with patients.

I basically always assume that my patients could get me sick, so I take what I consider to be extremely reasonable and standard precautions: washing my hands before and after patient contact, washing my hands before eating, refraining from absentmindedly touching my face or putting things in my mouth (e.g. pen caps), and changing into "house clothes" either before leaving the hospital or upon arriving home (these are all in addition to any patient/infection-specific protocols like wearing a face mask for patients with TB). Needless to say I don't engage in any of the "high risk" activities for infection transmission with my patients that I make a habit of with my partner and loved ones (sharing drinks, hugging and kissing, etc).

My institution also requires that I remain up to date on my vaccinations, including influenza, and get screened for TB every year. For all of these reasons, I think I am probably less likely to transmit an infection to my partner than if I didn't work in a hospital. If my partner were in healthcare and didn't do these things, I would suggest they start.
posted by telegraph at 11:38 AM on September 16, 2018 [3 favorites]

I'm also a germaphobe and I really relate to your question--before my spouse started working in post-acute care, I had a roommate who worked in the ER, and I still have waves of panic whenever I hear about something gross happening at my spouse's workplace. But I've never gotten sick because of anything he or my former roommate was exposed to at work.

And, as a data point, we adopted a puppy a few months ago who had a rambunctious case of C. diff (uncontrollable diarrhea all over the place, in our house), and nobody else in the family, including our other dog, contracted it from the puppy. We cleaned up the C. diff poop with normal Clorox and that was enough. Also, a vet visit and some good meds that got her well and healthy.
posted by witchen at 11:47 AM on September 16, 2018

C. diff is endemic. It's in soil, food, probably in your gut. If you become ill, or takea long course of antibiotics, have a compromised immune system, it can get out of balance and out of control. If you'reap a germaphobe, I assume you wash your hands often, cover your mouth when you cough or sneeze, and bathe or shower regularly. That's the best you can do. Eat vegetables, a little garden dirt helps keep your gut bacteria diverse and healthy, Fermented foods lije sauerkraut or kimchi, too. Antibacterial products are bad for the environment and don't promote health. Kiss your sweetie and worry more about climate change. And get your flu shot.
posted by theora55 at 4:50 PM on September 16, 2018 [1 favorite]

As others have noted, Tig Notaro was on heavy duty antibiotics that left her vulnerable to opportunistic C. diff infection. It is also worth noting that no one else in her life became ill as a result of being in contact with her.
posted by goggie at 12:51 PM on September 17, 2018 [1 favorite]

"It's also transmitted via fecal matter so I would think you should be fine to kiss her."

I don't know what the appropriate way to ask this is, but what about eating ass? Typically the act is done in such a way as to ensure it's clean as possible anyway, but does that act have an increased risk compared to making out?
posted by GoblinHoney at 3:13 PM on September 17, 2018 [1 favorite]

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