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What is Clostridium difficile? Clostridium difficile (C.

difficile) is a bacterium which is found in the gut of up to 3% of healthy people, but may be present in the faecal flora of between 13 - 40% of hospitalised patients. Up to two thirds of infants may have C. difficile in the gut, where it rarely causes problems. Although generally C. difficile is a hospital infection, it can occur in the community setting. How do you catch it? C. difficile is normally kept in check by the good bacteria in the intestine. Certain antibiotics kill the good bacteria, disturbing the normal balance in the gut, making you more susceptible to infection with C. difficile. What kind of illness does it cause? C. difficile can cause diarrhoea, ranging from a mild disturbance to a very severe illness with ulceration and bleeding from the colon (colitis). Severe inflammation of the bowel, although unusual can be life threatening. Other symptoms can include fever, loss of appetite, nausea and abdominal pain or tenderness. How is it diagnosed? It is difficult to diagnose C. difficile infection on the basis of symptoms alone, therefore the infection is normally diagnosed by carrying out laboratory testing which shows the presence of the C. difficile toxins in the patients faecal sample.

Patients who are most at risk are those who have recently been treated with broad spectrum antibiotics e.g. those antibiotics that affect a wide range of bacteria, including the good intestinal bacteria. In addition the elderly, particularly those over the age of 65 years, patients debilitated with an underlying illness e.g. immuno-compromised, or patients in long length stay healthcare settings are especially vulnerable to infection. Repeated enemas or gut surgery also increase the risk of a person developing the disease. How is it spread? It is possible for the infection to spread from person to person because those suffering from C. difficile associated disease shed spores in their liquid faeces (stools). These spores can survive for a long time in the environment, and can then be transported on the hands of healthcare personnel, via direct contact from infected patients to uninfected patients or indirect contact from contaminated environmental surfaces. Spread is most likely to occur while the patient has symptoms of diarrhoea, because this is when they are most likely to heavily contaminate the environment. What are the key measures to prevent spread? Broad spectrum antibiotics should be avoided where possible, so that the patients natural protection is not weakened. Always wash your hands with soap and water after you have had physical contact with an infected patient, after using the restroom and before eating. Do not rely solely on the alcohol gel as this does not kill

C. difficile spores. The use of gloves and plastic aprons for direct contact with faeces or soiled items, especially when dealing with bedpans etc. is important for all carers. To reduce environmental contamination with spores, since these can survive for months, ensure thorough cleaning, followed by the use of a disinfectant containing chlorine or other sporicidal agent. In hospital, symptomatic patients with suspected or confirmed C. difficile diarrhoea are usually nursed in isolation rooms with their own toilet/commode, until they have formed stools. How is it treated? C. difficile symptoms can vary. Symptoms may subside on their own with no actual treatment other than stopping the patients antibiotics. If diarrhoea persists, the patient can be treated with a course of specific antibiotics. There is a risk of relapse in 20 30% of patients therefore other treatments may be required. Most cases of C. difficile diarrhoea make a full recovery. Does somebody who has had C. difficile infection pose a risk to others after they have been discharged? Both staff and members of the public who are healthy are unlikely to become infected with C. difficile, provided all basic hygiene measures are observed. There should be no restriction on the discharge or transfer of patients who have had C. difficile infection if they are clinically asymptomatic, i.e. they no longer have diarrhoea. Once someone has recovered clinically from C. difficile infection, provided they observe the normal hygiene precautions of hand washing after using the toilet, they are not a risk to others,

Which patients are at risk of infection?

although they may continue to carry C. difficile toxin in their stools for a period of time. A patient with a formed stool, who is continent, is not considered to present a risk for environmental contamination or cross infection. Thus, a history of C. difficile infection is not a contra-indication to a patient returning to a care home / nursing home / community hospital.

UNIVERSITY HOSPITALS
Contacts:
Linda Doddrell Infection Control Nurse Adviser Royal Lancaster Infirmary Ashton Road LANCASTER LA1 4RP Tel: 01524 583796 / 583770 Sheila Pratt Infection Control Nurse Adviser Westmorland General Hospital Burton Road KENDAL LA9 7RG Tel: 01539 735281 Sue Askew / Lorna Preston Infection Control Nurse Advisers Furness General Hospital Dalton Lane BARROW-IN-FURNESS LA14 1LF Tel: 01229 491121

Morecambe Bay NHS Trust

Clostridium difficile

For any other queries, please discuss with the nurse /carer responsible for your care or contact the Infection Control Nurse Adviser.

Please Note: IT IS NOT NECESSARY TO SEND FURTHER STOOL SAMPLES FOR CLOSTRIDIUM DIFFICILE INFECTION CLEARANCE. For more information: www.clean-safe-care.nhs.uk www.hpa.org.uk

Key facts and frequently asked questions.

Review May 2009