Clostridium difficile Infection

Information for patients

Clostridium difficile

What is it?
Clostridium difficile (C.difficile) is a bacterium (germ) that can be found in the bowel (gut)
of up to 3% of healthy adults and 66% of infants. It rarely causes illness in children or
healthy adults because it is kept in check by the normal bacterial (good bacteria) in the
gut.

How does C.difficile infection (CDI) occur?

Infection with C.difficile is often associated with the use of broad spectrum antibiotics
which are used to treat a wide range of infections. Antibiotics can change the natural
balance of bacteria in the gut sometimes destroying good bacteria and allowing
C.difficile to multiply in large numbers and produce toxins. These toxins affect the lining
of the gut, causing the symptoms of the infection, known as Clostridium difficile infection
(CDI). There is also of a risk acquiring CDI by the contamination of the environment.
This could be communal settings such as public transport, Clinics etc.

What are the symptoms of C.difficile infection?

The main symptoms include: diarrhoea which can be mild or severe, abdominal cramps/
pain, nausea (feeling sick), loss of appetite and fever. In very serious cases, C.difficile
can cause inflammation and bleeding in the sufferer’s large bowel which can lead to
bowel perforation and even death. Therefore monitoring of symptoms is extremely
important.

Who is most at risk?

Those most at risk include people who:
 have been recently treated with broad spectrum antibiotics
 are over 65 years old
 have other underlying illnesses/ conditions
 have a weakened immune system
 have had a prolonged stay in a healthcare setting or care home

How is it spread?
C.difficile bacteria produce spores (bacteria with a protective coating) which are present in faeces,
particularly diarrhoea. Spores are able to survive for long periods outside of the body and in the
environment unless they are killed by specific cleaning measures. A person who has C.difficile

Issued: October 2018 Written by: HRCH Infection Prevention and Control team Review date: October 2020 Version: 4.0
diarrhoea excretes very large numbers of the spores which may contaminate the environment and
is a potential source of infection for other patients. Spread is usually via the hands following contact
with the infected person or contaminated environmental objects e.g. toilets or surfaces.

How is C.difficile infection diagnosed?

C.difficile infection may be suspected if a person develops diarrhoea and/ or other likely symptoms
especially during or soon after antibiotic treatment. However, clinical staff will immediately enhance
the level of infection prevention and control precautions for any patient with unexplained diarrhoea;
this will include moving the patient into a single room if the patient is in hospital to prevent the
spread of infection. Diagnosis is made by the clinical staff completing a risk assessment and based
on this assessment; sending a stool sample to the laboratory to confirm whether it contains
C.difficile toxins.

How is it treated?
Treatment will be based on symptoms. In some cases, stopping the antibiotics and any other drugs
that can cause diarrhoea may be sufficient. This decision will usually be taken by your doctor in
conjunction with advice from the microbiologist and pharmacist. If treatment is necessary, a
specific course of antibiotics therapy which is active against C.difficile may be prescribed.

It is possible for people who have come into contact with C.difficile to become carriers of the
bacteria. If the person has no diarrhoea, then they are not an infection risk to others and therefore
do not need to be treated. Affected patients are no longer considered infection risks once diarrhoea
has stopped and stools become formed.

What precautions are taken on the Inpatient Unit at Teddington Memorial

Hospital?

Isolation
If a patient develops diarrhoea and non-infectious cause cannot be ruled out i.e. caused by
laxatives or other non-infectious causes, the affected patient will be moved into a single room with
their own toilet facilities. This is to prevent spread of infection and to protect other patients within
the ward who may be particularly vulnerable to this type of infection.

Hand hygiene
Good hand washing with liquid soap and water is one of the key elements in preventing the
transmission of C.difficile. Hygienic hand rub must not be used when caring for anyone with
C.difficile infection as it cannot kill C.difficile spores.
It is very important that visitors wash their hands when they enter an isolation room and again
when they leave. Hands should be washed whenever they feel ‘grubby’ or are visibly dirty, and
particularly before eating food and after visiting the toilet.

Issued: October 2018 Written by: HRCH Infection Prevention and Control team Review date: October 2020 Version: 4.0
Gloves and aprons
Staff will wear gloves and an apron when caring for a patient with C.difficile. It is usually not
necessary for your visitors to wear gloves and an apron unless they are helping to provide hands
on care, such as washing and dressing. The care staff will advise if this is necessary.

Cleaning
Cleaning is very important in order to reduce the number of spores in the environment. In hospital,
rooms will be cleaned at least daily using a chlorine-containing cleaning solution; these solutions
contain bleach and are effective in killing C.difficile spores.

Antibiotic management
It is important that patients do not receive unnecessary antibiotics, or have antibiotics for an
unnecessary period of time. The trust has antibiotic guidelines which provide staff with guidance to
doctors and nurses on appropriate antibiotic prescribing.

Can I have visitors in hospital and at home?

C.difficile is unlikely to affect your healthy relatives and friends therefore visitors can visit you whilst
in hospital and at home. If any of your visitors are unwell or particularly vulnerable please ask a
nurse if it is appropriate for them to visit you. Visitors must wash their hands with soap and water
when they visit you and again when they leave.

How should soiled clothes and linen be washed?

Soiled clothes and linen must be washed separately, on the hottest wash that the fabric can
tolerate using washing powder/ liquid, followed by ironing when dry which will eradicate any
remaining germs.

Can I go home with C.difficile?

It is possible to go home whilst you have Clostridium difficile infection. However, there are many
other factors to consider, such as whether you are physically well enough, your diarrhoea has
settled and whether you are a risk to anyone at home. Your doctor or nurse will discuss this with
you if it is appropriate.

Any Concerns
If you have any concerns, please speak to the nursing staff or the Inpatient Matron.

It's OK to ask
If you are not sure if a member of staff has cleaned their hands before they commence an
examination/ treatment or any type of personal care, please ask them!

Issued: October 2018 Written by: HRCH Infection Prevention and Control team Review date: October 2020 Version: 4.0
Making a comment, suggestion or complaint
The Patient Advice and Liaison Service (PALS) provide free, informal, confidential help and advice
for service users, carers and their families. You can contact the PALS officer on 0800 953 0363 or
pals.hrch@nhs.net

If you wish to make a comment, suggestion or complaint, please contact the PALS Officer at
Thames House,180 High Street, Teddington TW11 8HU, Telephone: 0800 953 0363.

Translation services
Hounslow and Richmond Community Healthcare NHS Trust has access to interpreters who can
speak other languages. This leaflet can be made available in large print, Braille or on audiotape
and a translation service is available. Please contact the PALS team for further information.

Issued: October 2018 Written by: HRCH Infection Prevention and Control team Review date: October 2020 Version: 4.0