World Water Day and C-diff

As this is a blog for water and environmental issues, I will refrain from comment on the biggest news of the day, health care. But I would like to discuss public health on this, World Water Day (see www.worldwaterday.org).
Yesterday, the Associated Press reported that a new “superbug,” Clostridium difficile, has appeared in the nation’s hospitals (see http://hosted.ap.org/dynamic/stories/U/US_MED_HOSPITAL_SUPERBUGS?SITE=ILMOL&SECTION=HOME&TEMPLATE=DEFAULT).
How is this a water issue? Well, directly, it’s not. But the article notes how difficult it has been to exterminate the little beast known as “C-diff.” Like its hospital superbug forerunner, MRSA, C-diff is extremely resistant to the normal means of dealing with bacteria: antibiotics. In fact, MRSA stands for “methicillin-resistant Staphylococcus aureus,” and methicillin is a common antibiotic.
If Plan A doesn’t work, what is Plan B? Chemical disinfection, just as we see in water treatment. However, according to the AP, C-diff is “difficult to kill with most conventional household cleaners or alcohol-based hand sanitizers.” Why is this? Because C-diff forms “spores.”
In water treatment, we have similar concerns for pathogenic microorganisms that are resistant to our chemical disinfectants. These microorganisms include Giardia and Cryptosporidium. What makes these organisms so resistant? They form “cysts” or “oocysts” – not unlike the “spores” of C-diff. These are all dormant forms of microorganisms, and the microorganisms transform into these dormant forms when life gets too hard for them. If they encounter low food or water supplies, or if their environment turns too harsh, they form what is similar to a caterpillar’s cocoon or a plant’s seed. And then they wait.
Once “the coast is clear,” the cocoon opens or the seed sprouts, or the spore or cyst or oocyst returns to the “normal” form of the microorganism – and then people get sick. C-diff, like the pathogens we battle in water treatment, really likes living in the intestines. Our bodies desperately try to get these guys out, using diarrhea.
In water treatment, we take two approaches to dealing with pathogens: chemical disinfection – which is not highly effective against these types of microorganisms – and particle removal. Yes, our old, tried-and-true conventional treatment is still the best way to deal with spore- or cyst- or oocyst-formers.
Unfortunately for our hospitals, they don’t have this tool to deal with C-diff.

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