FAQ: Clostridium difficile

• What is Clostridium difficile?
• Can C. difficile be harmful?
• How is C. difficile transmitted?
• Who is at risk?
• What precautions can be taken to prevent the spread of C. difficile?
• Are family and visitors allowed to visit a patient with C. difficile?
• How is C. difficile associated disease (CDAD) treated?
• Is Clostridium difficile an increasing problem?
• Where can I find more information about C. difficile?

» What is Clostridium difficile?

Clostridium bacteria are rod-shaped spore-forming bacteria that live under anaerobic conditions. Clostridium difficile was first discovered in 1935 and first associated with disease in 1978. C. difficile is an opportunistic pathogen which causes Clostridium difficile-associated diarrhea (CDAD). Common environmental reservoirs include soil, water, hay, and sand.

From a healthcare standpoint, the most common reservoir is within the intestines of infected individuals or carriers. According to Health Canada, approximately 2-3% of adults are asymptomatic carriers and approximately 50% of healthy newborns become carriers in less than a year.

» Can C. difficile be harmful?

• About 1-3% of all people carry C. difficile in their stool without having any symptoms.
• Sometimes after a person has been given an antibiotic for another infection, the C. difficile will over grow and produce enough toxin to cause illness.
• Symptoms of C. difficile associated disease (CDAD) can include: diarrhea or loose stools, fever, abdominal pain and abdominal cramps.
• In some cases diarrhea may be mild, and the patient will improve without the need for treatment. However, it can sometimes be a more serious illness.
• In serious cases of CDAD, stool may contain blood and mucus.

» How is C. difficile transmitted?

• C. difficile is spread by contact with the hands. Caregivers can unknowingly spread the germ during routine procedures between patients.
• C. difficile can also be spread through contaminated surfaces, objects, or equipment such as: bedrails, thermometers, toilet seats, wheelchairs, and commodes.
• C.difficile is shed in feces. Any surfaces, patient equipment, and personal items that become contaminated can become sources of infection.

» Who is at risk?

• People who have multiple hospital stays or are from nursing homes
• People who are taking antibiotics
• People who have had gastrointestinal tract surgery

» What precautions can be taken to prevent the spread of C. difficile?

• Patients with C. difficile should be isolated in their rooms.
• It is very important for all staff and visitors to wash their hands when they enter and leave the patient room.
• Visitors and hospital staff coming into the patient room will need to wear gloves and yellow gowns to prevent them from picking up C. difficile and spreading it to other patients or the environment.
• Patients must wash their hands before they go to another part of the hospital for tests or treatments. Staff transferring the patient and helping with the tests also need to wear gowns and gloves, and wash their hands carefully.
• Because C. difficile lives on objects in the room, patients with C.difficle should have their rooms cleaned twice daily.

» Are family and visitors allowed to visit a patient with C. difficile?

• Yes. Visitors mush wash their hands when they enter and leave the patient room. They must also put on yellow gowns and gloves when they enter the room.
• If any visitors are experiencing diarrhea, they should not visit the patient until they are better. Infection Control should also be notified of this immediately.

» How is C. difficile associated disease (CDAD) treated?

• C. difficile can be treated with special antibiotics. Patients will get better. Occasionally, the diarrhea can come back. If this happens, patients will need to be treated again.
• Once it is certain that the diarrhea will not reoccur, the C. difficile precautions will be stopped.

» Is Clostridium difficile an increasing problem?

• The increase in incidence and severity of Clostridium difficile associated disease has been documented in US and UK surveillance systems.
• In Canada, the number of cases and deaths associated with C.difficile has also been increasing.
• Nosocomial transmission in Canada has increased from 2.1 cases per 1000 admissions in 2002 to 10 per 1000 in 2003. It is estimated that nosocomial transmission can increase to 18 cases per 1000 in 2004.

» Where can I find more information about C. difficile?

• Websites
  • C. difficile Q&A: Public Health Agency of Canada
  • C. difficile in Ontario Hospitals: OHA
  • Clostridium difficile information for healthcare providers: CDC
  • Clostridium difficile FAQ: CBC
  • C. difficile genome sequence: The Sanger Institute
  • Infection Control of C. difficile: University of Pittsburgh Medical Center
• Presentations
  • Audio presentation by Dr. Cliff MacDonald of the CDC