Clostridium difficile

What is Clostridium difficile (C. diff)?

Clostridium difficile (C. diff) is a bug that can be found in the intestine of both healthy and ill people. C. diff can be harmful when found in significant numbers.

When a person is healthy and not taking antibiotics, the millions of good bacteria in the intestine keep the C. diff under control.

What happens when I take antibiotics?

When antibiotics are taken, the levels of good bacteria are reduced. If the antibiotic, along with the good bacteria does not kill C. diff then it is possible that the C. diff will grow in greater numbers inside the intestine.

Often, inflammation of the bowel (colitis) develops, causing diarrhoea, which can be severe in some cases.

What is C. diff colitis?

When there is an imbalance of bacteria in the intestine, C. diff may produce toxins that affect the lining of the bowel and give the symptoms of C. diff colitis. The symptoms usually include diarrhoea and cramping pain. Sometimes you may experience nausea and vomiting and see blood in the stool/faeces.

How is C. diff colitis diagnosed?

If a person has been taking, or is currently taking, antibiotics and has diarrhoea, then C. diff colitis may be suspected. Diagnosis is made by sending a sample of faeces to the laboratory to confirm whether a toxin is present. Results may be available within 48 hours.

Is C. diff colitis 'catching'?

A person is at greatest risk of getting C. diff colitis infection if they are taking antibiotics.

C. diff produces spores that can survive in the environment for a long period of time. It can be spread from one person to another via the faecal-oral route, especially when a person has diarrhoea.

To avoid spread, strict hygiene by the patient, visitors and staff is essential, and attention to hand washing with soap and water is of the utmost importance. In this instance, alcohol rub alone does not work.

What happens in hospital once C. diff is detected?

Within hospital, if C. diff colitis is detected (i.e. you have diarrhoea and are toxin positive), you will be moved to a single room to be isolated if one is available. This is to ensure that potential spread of the infection is limited.

The nurses will wear aprons and gloves while attending to you and will be required to wash their hands before and after contact with you, your bed linen and soiled items.

A commode or toilet will be allocated for your individual use in certain situations. Where there are several people with the same infection it may be necessary to nurse patients of the same sex in the same bay. If no single room is available, the same principle will be applied around your bed area on the ward.

How long will I stay in isolation and need these precautions?

Once the diarrhoea has settled for a minimum period of 48 hours, you will no longer be considered infectious. Isolation will then cease, enabling you to go back onto the open ward.

How is C. diff colitis treated while in hospital?

C. diff colitis is treated with oral antibiotics which must be taken as prescribed. It is important that the whole course of antibiotic treatment is completed even if the symptoms (diarrhoea and abdominal cramps) resolve. The symptoms may re-occur. If this happens a further course of oral antibiotics may be prescribed. It is important to drink plenty while you still have diarrhoea.

When the diarrhoea settles this indicates that the infection has passed. No further stool testing is required once C. diff has been diagnosed. Whilst symptomatic you may be cared for in a single room if one is available, or designated a particular commode or toilet.

Will this prevent me from going home?

Having C. diff colitis will not necessarily prevent you from going home. If you are being discharged to a nursing/residential home the hospital will inform the home of your condition prior to discharge.

What about my laundry?

Laundry should be bagged and left in the patient's room for relatives or friends to collect as soon as possible. It can be washed in the usual way with normal detergents, on the hottest setting possible and separate from other items.

Alternatively, hospital clothing can be provided. Remember to wash your hands after handling soiled linen.

Can I have visitors?

You can have visitors but please seek advice from the nursing staff on the ward. All visitors will be asked to wash their hands with soap and water before entering and leaving your room/bed space. For further advice ask any member of the nursing or medical staff.