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Nutritional Management of Clostridium difficile …

Spring 2007 Volume 31 Number 4 EpidemiologyClostridium difficilewas first recognized as the causative agent ofpseudomembranous colitis almost 30 years ago1and is now recognizedas the major cause of nosocomial infectious number , known disease (CDAD),doubled between 1993 and 2003, with most of the increase occurringfrom 2000 to from the US Centers for Disease Controland Prevention reveal that the diagnosis of CDAD upon hospital dis-charge has increased significantly from 31 per 100,000 (82,000) popula-tion in 1996 to 61 per 100,000 (178,000) in overall rate inpersons 65 years or older in 2003 was 228 per 100,0005, five times therate for other age difficileis a gram-positive, spore-forming anaerobic bacteri-um, which is found everywhere in the environment, including the soil, air,water, human and animal feces and on almost all two toxins (A and B), which are responsible for many of thesigns and symptoms of most individuals develop CDAD during or shortly following a course of antibiotics, signs and symptomsmay not appear for weeks or even months after treatment has ended,resulting in misdiagnosis

THE CONSULTANT DIETITIAN - PAGE 2 Public Policy and YOU by Priscilla Carleton, MHA, LDN/RD, CD-HCF Legislative Network Coordinator We just returned from ADA’s 2007 Public Policy

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Transcription of Nutritional Management of Clostridium difficile …

1 Spring 2007 Volume 31 Number 4 EpidemiologyClostridium difficilewas first recognized as the causative agent ofpseudomembranous colitis almost 30 years ago1and is now recognizedas the major cause of nosocomial infectious number , known disease (CDAD),doubled between 1993 and 2003, with most of the increase occurringfrom 2000 to from the US Centers for Disease Controland Prevention reveal that the diagnosis of CDAD upon hospital dis-charge has increased significantly from 31 per 100,000 (82,000) popula-tion in 1996 to 61 per 100,000 (178,000) in overall rate inpersons 65 years or older in 2003 was 228 per 100,0005, five times therate for other age difficileis a gram-positive, spore-forming anaerobic bacteri-um, which is found everywhere in the environment, including the soil, air,water, human and animal feces and on almost all two toxins (A and B), which are responsible for many of thesigns and symptoms of most individuals develop CDAD during or shortly following a course of antibiotics, signs and symptomsmay not appear for weeks or even months after treatment has ended,resulting in misdiagnosis in some RResponse tto major risk factor for the acquisition of the develop-ment of CDAD is the use of antibiotics.

2 Antibiotics disrupt the normalflora of the colon, which allows the rapid growth of the C- difficile bacteriaonce it is ingested. However, use of antibiotics alone is not sufficient tocause CDAD. A three-hit model has been first hit isexposure to antimicrobials and the second hit is exposure to after the occurrence of the first two hits, mostpatients will be colonized with the bacteria, becoming asymptomatic car-riers without diarrhea. This has led to the belief that the presence of atleast one other factor leading to clinical illness is also is required. Otherfactors that have been suggested include the susceptibility or immunityof the patient, the virulence of the or the type and timingof the antimicrobial page 3 See page 3 for The Chair s Pinnacles.

3 Public Policy & YOU ..2 The Chair s Pinnacles ..3 Dietitians at Risk of Being Sued? ..4 UPCOMING SEMINARS - NationalInstitute for News ..12 Medicare s Competitive BiddingProgram ..13 Food Safety Update ..14 Continuing Ed Certificate ..15 Medical Challenges in Corrections ..16 Ann Gallagher Award Scholarships and Leaders for from the Areas ..19 ADA Tools ..21 Spring 2007 CD-HCF ConsultantDietitian Continuing Management of Clostridiumdifficile-associated Disease in Long-term Careby Janet McKee, MS, RD, LD/N & Susan Tassinari, MS, RD, CSG, LD/NContinued on page 5 THE CONSULTANT DIETITIAN - PAGE 2 Public Policy and YOUby Priscilla Carleton, MHA, LDN/RD,CD-HCF Legislative Network CoordinatorWe just returned from ADA s 2007 Public PolicyWorkshop (PPW) in Washington, As always,the Washington and Chicago staff did a terrific jobwith this conference- including providing us with thebest weather we have ever had for this meeting!

4 Attending as CD-HCF representatives were JoJoDantone-DeBarbieris, MS, LDN, RD, CDE; SuzanneCryst, RD, LD; Carolyn Yanosko, MS, RD, LD (2007 PPW scholarship winner), and me. The meeting Champion Nutrition - Making Your (RDs) Mark inWashington started with another dynamic presenta-tion from Mike Dunn on the importance and effec-tiveness of our participation in the political of his presentation are available from theWashington office to be used at local and stateevents. Many RDs gave background information onMNT and the farm bill legislation for us to take our2007 messages to our own state representatives onWednesday, April is always exciting to hear the current and formermembers of Congress who take time out from theirbusy schedules to share with us their recognition ofthe importance of nutrition issues, and who continueto support nutrition legislation.

5 This year we heardfrom Rep. Fred Upton (R-MI), Rep. Jo Bonner (R-AL), former Rep. Nancy Johnson (R-CT), and Wasserman (D-FL). Rep. Wassermanclosed our conference at breakfast by telling us that good nutrition is not just good public policy, it isgood politics. 2007 MMessages tto CCapital HHill -- MMedical NNutritionTherapy ((MNT)This year there are three MNT issues we are askingCongress to support:1. Sen. Jeff Bingaman s bill ( ) and Rep. Xavier Becerra s bill (no number at time this wentto press) to give CMS (Center for Medicare & Medicaid Services) the authority to expand MNT benefits to other disease states if CMS determines it to be reasonable and cost effective. 2. Sen. Charles Schumer s bill (S. 755) to require state Medicaid programs to cover screening andtreatment (including MNT) for diabetes and renal Rep.)

6 Diana DeGette s bill (no number at time thiswent to press) to add pre-diabetes to the Medicare coverage under Medicare. Farm bill issues we are askingCongress to support include:1. Establishment of the National Institute for Food and Agriculture (S. 971), Reps. Peterson, Boustany, Graves bill in the Preserve and adequately fund USDA s Human Nutrition Research Centers,3. Issue the Dietary Guidelines for Americans every10 years. Build public education and acceptanceand research for future guidelines into the cycle. 4. Support improvements to USDA s food assistance programs to serve those in need. Help beneficiaries use food stamps for diets consistent with the Dietary Guidelines through incentives and nutrition will continue to monitor these legislative initiativesand pass them on to CD-HCF members throughemails, and forwarding issues of On the Pulse, andpostings to the Web DDPG SScholarshipNext year the meeting again returns to the wintermonths, February 4-6, 2008.

7 ADA provides eachDPG with a scholarship for registration costs, andCD-HCF provides a $ stipend for our scholar-ship winner. This can be awarded to someone whohas not attended PPW in the last five years. Pleasecontact me for more information if YOUare interest-ed in applying for next year s scholarship. F. AAnn GGallagher AAwardCongratulations to Tammy Heyman, RD, LD, CDE,this year s F. Ann Gallagher Award recipient. Tammywas recognized at the Awards luncheon at PPW,April 24 with a $ award from the AmericanDietetic Association Foundation. She will also berecognized at the Foundation Dinner at FNCE inPhiladelphia this fall. This award was created for CD-HCF members whohave demonstrated interest in state or federal leg-islative issues, and who are not currently on the CD-HCF executive committee.

8 If YOUor anyone youknow meets the criteria, please contact me as next year s PPW isonly nine months away!BOB,TThhee BBeesstt ooff tthhee BBeesstt ooff CCDD--HHCCFF, is includedin this issue of the Consultant hope that you will enjoy this gift from your 2006-2007 CD-HCF Executive Committee (EC). Themembers of the EC are listed on the back page ofthis newsletter. The EC members who contributedmaterials toBOBare listed on the CD. As this is my farewell article, I would like to take theopportunity to say thank you for allowing me to rep-resent you. You have been so very supportive duringmy term as Chair. This year has flown by with FNCEin Hawaii being the highlight. Hawaii was only sec-onded by our April mid-year EC meeting in NewOrleans.

9 I know these cities are exciting places tobe, but the work we have done while at those meet-ing is awesome. I would like to list just a few of theaccomplishments of your EC during this past yearwith the lead person(s) on each of these being stat-ed in parentheses. Keep in mind that most thingsaccomplished on the EC is a compilation of effortsfrom several people or a of course has to be listed first - given as a FREE mmember bbenefitto all members (Jo Jo Dantone-DeBarbieris and Linda Roberts)2. Taping of the Pre-FNCE Workshop to make it available for purchase along with continuing professional education (CPE) being made available. (Suzanne Cryst, Jo Jo Dantone-DeBarbieris, Brenda Richardson, Linda Roberts,and Marla Carlson)3. A competitive ballot to ensure that two candidates are put on the ballot for CD-HCF elections so as to give members a choice of candidates.

10 (Nominating Committee Chaired by Becky Dorner)4. Change to online voting and change in the timingof CD-HCF elections to coincide with ADA elections. (Suzanne Cryst)5. Moving forward on the formation of geographical sub-units within CD-HCF. (Mary Vester-Toews)6. Project to redesign and update of the CD-HCF Web site which will be continuing into the comingyear. (Georgianna Walker)7. Approval of a policy regarding the restrictions and CD-HCF s responsibility of postings of information on the CD-HCF Web site. (Georgianna Walker)8. New products released:a. Survival Skills for Nutrition Services (Carolyn Breeding)b. MNT Inservice (Cynthia Piland)9. Continuation of the CD-HCF sponsorship program, without which many of our projects would not exist THANK YOU SPONSORS!


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