Escherichia coli (E. coli)

Thousands of different Escherichia coli types exists as part of the natural intestine workings, and of those some can cause infections, severe infections and death. This section of Curas Infection Prevention resource pages will only discuss the E. coli types that are in the intestine system causing problems, however, highlighting the severity of infections caused outside the intestine e.g. ExPEC (Extra intestinal pathogen E. coli).

Of those E. coli types causing outbreaks, serious illness and death across high-density modern healthcare facilities are pathogenic E. coli strains which are categorized into patho-types. Six patho-types are associated with diarrhea and collectively are referred to as diarrheagenic E. coli:

  • Shiga toxin-producing E. coli (STEC) (Note: STEC may also be referred to as Verocytotoxin-producing E. coli (VTEC) or enterohemorrhagic E. coli (EHEC).
  • Enterotoxigenic E. coli (ETEC)
  • Enteropathogenic E. coli (EPEC)
  • Enteroaggregative E. coli (EAEC)
  • Enteroinvasive E. coli (EIEC)
  • Diffusely adherent E. coli (DAEC)

As patients in hospitals are all using the toiletries / human waste facilities during the time care is being provided; Curas advocates for a default selection of disposable products (e.g. Bed Pans and Urinals) as a first logical step to physically end the spread-risk/-path via the reusable utensils.

STEC (Shiga):
As E. coli is a generically used label for a wide range of topics, Curas wish to highlight specifically the Shiga toxin-producing E. coli: The bacteria that make these toxins are called “Shiga toxin-producing” E. coli, or STEC for short, and the bacteria called verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC) all refer generally to the same group of bacteria.

The strain of Shiga O104:H4 that caused a large outbreak in Europe in 2011 was frequently referred to as EHEC. Mainly STEC in North America is E. coli O157:H7 (often just “O157”). Compared with STEC O157 infections, identification of non-O157 STEC infections is more complex. First, clinical laboratories must test stool samples for the presence of Shiga toxins. Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. Clinical laboratories typically cannot identify non-O157 STEC. Some types of STEC cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS), which is a type of kidney failure.

“Although food-borne transmission is a primary cause of outbreaks of VTEC in nursing homes, in institutions for people with intellectual disabilities, in acute hospital facilities; person-to-person spread by the faecal-oral route also occurs and is a particular risk factor in these settings. Transmission to staff from residents in a nursing home and from a patient to a nurse have been reported and the converse can also happen.”

“Spread of infection is more likely during the diarrhoea phase when faeces contain higher numbers of bacteria. Staff can become contaminated as a result of contact with a patient/resident or following contact with the contaminated environment. Staff assisting or reassuring patients/residents who are vomiting or have diarrhoea are at increased risk of becoming infected”

“Alternatively, disposable bedpans may be used and disposed of in a bedpan macerator. Supports for disposable bedpans are reusable and should be washed with general purpose detergent and water, then wiped with a chlorine based disinfectant (e.g. 0.1% hypochlorite solution (1,000ppm available chlorine), and dried after each use. An individual support is recommended for each patient.” Source:

Note: Curas offers a complete Infection Prevention product solution for E. coli outbreaks, major elements are: Examination Gloves, Aprons, Shoe Cover, Disposable Bed Pans and Urine Bottles, SAP by Curas™ fluid absorber, disposable Wash Gloves & Wipes, Dissolvable Laundry Bags and further.

Around 5–10% CDC of those who are diagnosed with STEC infection develop a potentially life-threatening complication known as hemolytic uremic syndrome (HUS). Persons with HUS risk their kidneys stop working and they may develop other serious problems. Most persons with HUS recover within a few weeks, but some suffer permanent damage or die.

It is worth reminding our readers of these pages that most infections are not route-caused (initiated) by hospitalization itself, in the case of E. coli most often food or dirty water are causing the initial illness leading to hospitalization; but once the infectious person is hospitalized the risk of nosocomial cross contamination increases and potentially expose the wider population of the hospital or nursing home, mainly due to the patients’ human waste handling and associate nursing processes.