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Bacterial diarrhoea develops when harmful organisms enter the gut through contaminated food, water, hands, or surfaces. These bacteria live in raw poultry, undercooked meat, unwashed produce, and unclean water. Shared rooms, communal dining, and close contact increase spread in nursing homes. Older adults become dehydrated fast and face higher risk of complications.
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Common bacteria that cause diarrhoea
These organisms often contaminate food and the environment when hygiene breaks down. Salmonella, Shigella, Campylobacter, toxin producing E. coli, and C. difficile are the main causes. Each of these bacteria produces toxins or inflammation that trigger loose stools and abdominal discomfort.
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Where the bacteria come from?
Bacteria come from a variety of sources, including soil, water, air, and living organisms, as they are found in nearly every habitat on Earth. For example:
- Raw or undercooked meat, poultry, and eggs
- Unwashed fruits and vegetables
- Contaminated water sources
- Unclean hands during toileting or food handling
- Toilets, commodes, bed rails, and high touch surfaces
- Shared equipment used across multiple residents
- Staff or residents who carry the bacteria without symptoms
Challenges in managing bacterial diarrhoea
Managing bacterial diarrhoea is difficult because of multiple factors in a nursing home. Many residents have dementia, so they struggle with toilet hygiene and hand washing. High dependence on staff for daily care increases contact points. Antibiotic use is common, which increases C. difficile risk. Limited isolation rooms slow containment. Outbreaks demand increased cleaning and staff fatigue builds fast. Identifying the first case is also hard because early symptoms look mild. These issues create gaps that allow the infection to spread.
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How serious bacterial diarrhoea can be?
Bacterial diarrhoea leads to dehydration, low blood pressure, weakness, and confusion. Kidney injury develops fast when fluid loss continues. Toxin producing strains of E. coli cause bloody diarrhoea. C. difficile results in severe abdominal pain, fever, and life threatening colitis. Older adults decline quickly because their reserves are low and their immune response is weaker.
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Investigations to identify infection
Investigations help pinpoint the cause and guide urgent treatment. The different investigations may include:
- Stool culture to identify bacteria species
- Stool toxin to test confirm C. difficile
- Blood tests to check inflammation and hydration status
- Kidney and electrolyte to test and guide fluid replacement
- Environmental and food sampling to trace outbreaks
How to prevent bacterial diarrhoea?
In a nursing home setting where elderly are vulnerable, a strong prevention strategy protects residents and reduces outbreaks.
- Wash hands before meals and after toileting
- Train kitchen staff to handle food safely and maintain temperature control
- Keep raw and cooked food separate
- Wash produce thoroughly
- Maintain clean toilets and high touch surfaces
- Use dedicated equipment for residents with diarrhoea
- Ensure safe water and maintain filters
- Review antibiotic use to lower C. difficile risk
- Isolate symptomatic residents when needed
- Increase cleaning in dining areas, pantries, and shared spaces
- Educate staff to act early when symptoms appear
Conclusion
Bacterial diarrhoea in nursing homes is serious and needs fast action. Early recognition, strong hygiene, and proper food safety protect older adults from avoidable harm. Prompt investigation and targeted treatment prevent complications and reduce spread. Every episode deserves urgent attention to keep residents safe and well.
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