What is Clostridium difficile?
Clostridium difficile is a spore forming bacterium that is commonly found in the human gut, particularly in babies and young children. These bacteria can live harmlessly in the human body without causing any problems.
When the balance of gut bacteria, which protects against more harmful infection, is disturbed, C. difficile can grow in the gut and cause diarrhoea. This can occur when an individual receives antibiotic treatment for an infection, e.g. chest infection.
If a patient has diarrhoea or is incontinent, C. difficile spores can enter the environment and survive in most surroundings such as toilets, commodes, bedclothes, skin and clothing for long periods. It can then spread to vulnerable patients.
Good hand hygiene and cleaning are the most important ways of controlling the spread of the bacteria. All patients over 65 years and most hospital inpatients with diarrhoea are tested for C. difficile.
What are the signs and symptoms?
- Watery or bloody diarrhoea lasting from a few days to several weeks.
- Abdominal pain.
- Raised temperature.
- More unusually, severe inflammation of the bowel can also occur, leading to more severe symptoms.
Who is at risk?
- Patients who are already ill and vulnerable to infection.
- Patients who are on repeated or certain types of antibiotics, especially broad spectrum antibiotics which kill a wide range of bacteria.
- People over the age of 65 years, who make up over 80% of cases.
Healthy people such as family members or staff are not at risk.
How do we treat C. difficile?
Treatment is required for patients with diarrhoea. If possible, the antibiotic that has caused the problem will be stopped. This will allow the normal bowel bacteria that have been killed off to grow back, and the natural balance of bacteria in the bowel will be re-established.
Stopping the antibiotic may be the only treatment necessary if the diarrhoea is mild or moderate. People with more severe diarrhoea will normally be given an antibiotic (such as vancomycin or metronidazole) that is known to kill C. difficile.
Symptoms will then usually ease within 2-3 days. Patients who are known or suspected to have C. difficile may be nursed in a single room (whenever possible), to prevent spread of the infection to other vulnerable patients on the ward. Sometimes if there are several patients affected in the hospital they may be nursed together in one room or ward (cohort nursing). Patients will need to remain in isolation whilst they have diarrhoea and for at least 48-72 hours afterwards.
Staff will wash their hands with soap and water rather than using the alcohol rub, and use gloves and disposable aprons when attending directly to the needs of the patient.