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Clostridium Difficile

(from the Canadian Institute of Public Health Inspectors)

What is Clostridium difficile?

Clostridium difficle is a bacterium that has been associated with outbreaks of diarrhea and colitis in hospital patients and nursing home residents. The bacteria usually cause problems in people who have had antibiotic treatment. Most of the positive cultures for C difficile come from children under 2 years of age, but there are not usually any symptoms in this age group. The bacteria produce a spore that can survive in the environment for long periods of time. The spores prefer to live in dry dusty areas, but have been found on handrails, toilet seats and bedpan washers in hospitals. Approximately 30% of hospitalized patients have these bacteria in their intestine at any given time, but do not have symptoms. This is called "colonization."

How do C. difficile Infections Happen?

C.difficile infections usually occur in a person who has been on antibiotic therapy. It is believed that many people carry these bacteria in their intestines without any symptoms. Antibiotic use can activate the bacteria into producing symptoms. The bacteria can also be passed from person to person through direct contact, environmental contamination (bedding, commodes, bedpans, sinks, floors, thermometers and stethoscopes) and can be carried on the hands of health care workers as they move from patient to patient.

Symptoms and Treatment

Diarrhea is the most common symptom seen in patients infected with C. difficile. The severity of the diarrhea ranges from no symptoms, to mild diarrhea to very severe diarrhea with a frequency of up to 20-30 stools a day and lasting 2 to 3 months. Discontinuation of the antibiotic may be all that is necessary to treat the illness. Treatment of asymptomatic patients is not recommended. About 10-20% of patients will experience a recurrence of symptoms after they complete their first course of treatment.

How is C. difficile Prevented?

  • Hand washing is the single most effective method of preventing this and many other infections. Hand washing is especially important after handling feces and prior to eating, feeding or providing mouth care to patients.
  • Isolation of any known cases of C difficile in health care facilities is important to limit the spread to others. The isolation procedures should include dedicated stethoscopes, thermometers and commode chairs that will be used for that person only.
  • Proper cleaning and disinfection of surfaces in a C. difficile positive person's room is imperative.

For more information, contact your public health department.