Doc: Preventing C. diff spread requires routine hygiene

Dear Dr. Roach: We have a close family friend who was hospitalized with C. diff several months ago after working at an assisted-living facility.

How do we minimize the risk to our family when this person visits our home? If he has another episode, will he know if he is contagious?

Anon.

Dear Anon.: If your friend has been out of the hospital for several months, it is likely that he is no longer contagious if he is not having symptoms. It is possible to still have the bacteria without having diarrhea, the major symptom.

A person who has Clostridium difficile (“C. diff”) and no symptoms is called a “carrier.” Both carriers and those who are symptomatic are potentially contagious (the route of infection is fecal-oral).

However, C. diff can cause serious illness, and is worth being concerned about.

Fortunately, no more than routine hygiene is necessary to protect your family. The spores of Clostridium are difficult to eradicate, so washing them away is the best option.

Your friend should wash his hands with soap and hot water, as should your family, especially before eating and after using the bathroom.

Person-to-person spread between family, work or social contacts is rare.

Dear Dr. Roach: I am a 93-year-old man who has a hernia on his belly button. I have had it for a long time, and I was always told to leave it alone. Sometimes, it gets large and uncomfortable.

L.R.

Dear L.R.: This is called an umbilical hernia. A hernia is a defect in the abdominal wall, through which abdominal contents — especially the intestine — can protrude. Most hernias can be safely watched if they are small and have no symptoms.

However, yours is starting to bother you. Although I think a surgeon would be reluctant to operate on a 93-year-old, sometimes these hernias can become incarcerated, meaning that the abdominal contents go through the defect and get stuck there, unable to come back into the abdomen, where they belong. This requires emergency surgery, which is dangerous for a 93-year-old.

Only a surgeon can evaluate whether it is worthwhile to repair the hernia and prevent that possibility.

Email questions to ToYourGoodHealth@med.cornell.edu.