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Clostridium Difficile

What is Clostridium Difficile?

­Clostridium difficile (C. difficile) is the major cause of antibiotic-associated diarrhoea and colitis. It is more commonly seen in patients being cared for in healthcare facilities, and mostly affects elderly patients with other underlying diseases who are already vulnerable to infection.

Background

C. difficile is a bacterium of the family Clostridium (the family also includes the bacteria that cause tetanus, botulism, and gas gangrene). It is an anaerobic bacterium (i.e. it does not grow in the presence of oxygen) and produces spores that can survive for a long time in the environment.

Its usual habitat is the large intestine, where there is very little oxygen. It can be found in low numbers in a small proportion (less than 5%) of the healthy adult population. It is kept in check by the normal, 'good' bacterial population of the intestine. It is common in the intestine of babies and infants, but does not cause disease because its toxins (poisons) do not damage their immature intestinal cells.

Although C. difficile was first described in the 1930s, it was not identified as the cause of diarrhoea and colitis following antibiotic therapy until the late 1970s.

What 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) and, at worst, perforation of the intestine leading to peritonitis. It can be fatal.

Generally, it is only able to do this when the normal, healthy intestinal bacteria have been reduced in number by antibiotics. When not held back by the normal bacteria, it multiplies in the intestine and produces two toxins (A and B) that damage the cells lining the intestine. The result is diarrhoea and colitis (inflammation of the intestine).

Who gets C. Difficile infection?

Those at greatest risk of C. difficile infection are patients who have been treated with broad spectrum antibiotics (these antibiotics destroy a wide range of bacteria, including intestinal bacteria). Most of those affected are elderly patients with serious underlying illnesses. Most infections occur in hospitals (including community hospitals), nursing homes etc, but it can also occur in primary care settings.

How does it spread?

Although some people can be healthy carriers of C. difficile, in most cases the disease develops after cross infection from another patient, either through direct patient to patient contact, via healthcare staff, or via a contaminated environment. A patient who has C. difficile diarrhoea excretes large numbers of the spores in their liquid faeces. These can contaminate the general environment around the patient's bed (including surfaces, keypads, equipment), the toilet areas, sluices, commodes, bed pan washers, etc. They can survive in the environment for a long time and be a source of hand-to-mouth infection. Those at most risk of developing symptoms are those who have been on antibiotics.

How is it diagnosed?

A sample of diarrhoeal faeces is tested for the presence of the C. difficile toxins. This is the main diagnostic test and gives a result within a few hours. In outbreaks, or for surveillance of the different strains circulating in the population, C. difficile can be cultured from faeces and the isolates sent to the Anaerobe Reference Laboratory (National Public Health Service, Wales; Microbiology, Cardiff) for typing and testing for susceptibility to antibiotics.

Infection control measures

If a person with C. difficile has diarrhoea then the following infection control measures must be taken to prevent ‘cross-infection’ to others. These include:

  1. Nurses/Doctors/Care staff wearing plastic gloves and aprons.
  2. Thorough daily cleaning of your room paying particular attention to all horizontal surfaces (door handles, bathroom/toilet facilities, windowsills etc.)
  3. Thorough cleaning of any shared equipment/facilities between patient/client use with warm water and detergent and then disinfected with a chlorine-based solution i.e. Milton
  4. Separate laundering of any clothes, linen or laundry. Laundry should be washed on the hottest wash the material will allow and as soon as possible.
  5. Hand Hygiene using soap and water not alcohol gel as it is ineffective against C. difficile. 

If you are in a hospital or care home you may be cared for in a separate room or with other patients experiencing the same symptoms. You will have your own toilet or commode.

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