You may have heard stories in the media about a germ called
Clostridium difficile that has caused outbreaks of severe diarrhoea
resulting in death in some cases. Click on the link below to read
more about Clostridium Difficile.
Question 1: What is Clostridium difficile?
C. difficile is a spore forming bacterium
which is present as one of the 'normal' bacteria in the gut of up
to 3% of healthy adults. It is much more common in babies - up to
two thirds of infants may have C. difficile in the gut, where it
rarely causes problems. People over the age of 65 years are more
susceptible to contracting infection
Question 2: How do you catch it?
C. difficile can cause illness when certain
antibiotics disturb the balance of 'normal' bacteria in the gut
making you susceptible to infection with C. difficile. Its effects
can range from nothing in some cases to diarrhoea of varying
severity, which may resolve once antibiotic treatment is stopped,
through to severe inflammation of the bowel which can sometimes be
It is possible for the infection to spread from
person to person because those suffering from C. difficile
-associated disease shed spores in their faeces. Spores can survive
for a very long time in the environment and can be transported on
the hands of health care personnel who have direct contact with
infected patients or with environmental surfaces (floors, bedpans,
toilets etc.) contaminated with C. difficile.
Question 3: What are the symptoms of C. difficile infection?
The effects of C. difficile can vary from
nothing to diarrhoea of varying severity and much more unusually to
severe inflammation of the bowel.
Other symptoms can include fever, loss of
appetite, nausea and abdominal pain or tenderness.
Question 4: How do doctors diagnose C. difficile infection?
It is difficult to diagnose C. difficile infection on the basis
of its symptoms alone, therefore the infection is normally
diagnosed by carrying out laboratory testing which shows the
presence of the C. difficile toxins in the patient's faecal
Question 5: Who does it affect? Are some people more at risk?
The elderly are most at risk, over 80% of cases are reported in
the over 65 year -age group. Immuno-compromised patients are also
at risk. Children under the age of 2 years are not usually
affected. Repeated enemas and/or gut surgery increase a person's
risk of developing the disease. C. difficile infection occurs when
the normal gut flora is altered, most frequently by antibiotics,
allowing C. difficile to infect an and produce a toxin that causes
a watery diarrhoea. Antibiotics may also alter the normal gut flora
and increase the risk of developing C. difficile diarrhoea.
Question 6: How can it be treated?
C. difficile can be treated with specific antibiotics. There is
a risk of relapse in 20-30% of patients and other treatments may be
tried, including pro-biotic (good bacteria) treatments, with the
aim of re-establishing the balance of flora in the gut. Most cases
of C.difficile diarrhoea make a full recovery. However, elderly
patients with other underlying conditions may have a more severe
course. Occasionally, infection in these circumstances may be life
Question 7: What should I do to prevent the spread of C. difficile to others?
If you are infected you can spread the disease to others.
However, only people that are hospitalized, particularly those on
antibiotics are likely to become ill. In order to reduce the chance
of spreading the infection to others: it is advisable to wash hands
with soap and water, especially after using the restroom and before
eating; keeping surfaces in bathrooms, kitchens and other areas
clean and cleaning these on a regular basis with household
Question 8: How can hospitals prevent the spread of C. difficile?
Unfortunately patients with diarrhoea, especially if severe or
accompanied by incontinence, may unintentionally spread the
infection to other patients, which may lead to outbreaks of C.
difficile in hospitals. In addition, the ability of this bacterium
to form spores enables it to survive for long periods in the
environment (e.g. on floors and around toilets) and disseminate in
the air e.g. during bed making. Staff should wear disposable gloves
and aprons when caring for infected patients and affected patients
may be segregated from others. Rigorous cleaning with warm water
and detergent is probably the most effective means of removing
spores from the contaminated environment, whilst staff should
observe good hand washing practice. Alcohol gels should be used
routinely by healthcare staff between treating patients, but only
if their hands are not visibly soiled. When hands are visibly
soiled, they must always be washed with soap and water first. In an
outbreak situation, the Infection Control Team may introduce
special measures for staff, patients and visitors to follow.
Question 9: I have heard that some patients are at increased risk for C. difficile - associated disease. Is that true?
That is true - the risk for disease increases
in patients with the following:
- Antibiotic exposure
- Gastrointestinal surgery/manipulation
- Long length of stay in healthcare settings
- A serious underlying illness
- Immunocompromising conditions
- Advanced age
Question 10: Does somebody who has had a C. difficile infection pose a risk to others after they have been discharged?
There should be no restriction on the discharge or transfer of
patients who have had C. difficile associated diarrhoea and are now
clinically asymptomatic, ie, they no longer have diarrhoea. Once
someone has recovered clinically they are not a risk to others even
if they continue to carry C. difficile in their stool for a period
provided that they observe the normal personal hygiene precautions
of handwashing after using the toilet. A patient with a formed
stool and who is continent is not considered to present a risk for
environmental contamination or cross infection. Thus a history of
C. difficile infection is not a contra-indication to a patient
returning to a care home/nursing home/community hospital.
Question 11: Has a new type of C. difficile infection been detected recently?
The HPA initiated a sampling scheme on 1 January 2005 to detect
new types of C.difficile. One strain that has been identified
through this sampling scheme is C.difficile 027 which is closely
related to a strain previously found in North America. The HPA
first detected 027 in Preston in 1999 as a single isolate but it
was not related to any notable outbreak or disease severity. It
wasn't until the outbreak at Stoke Mandeville hospital that this
strain was identified as the cause of an outbreak.
Question 12: How common is the 027 strain in the UK?
The HPA surveillance programme showed that type 027 is the
second most common strain of 881 samples received. Three strains
(106, 027, and 001) were in roughly equal proportions across
England accounting for approximately 75% of the cases detected
during the sampling period.
Question 13: Is this strain more difficult to treat?
C.difficile 027 can be treated with antibiotics, in the same way
as other types. Research has not yet shown any solid links between
type 027 and and the severity of the symptoms it causes, although
studies are ongoing to identify more conclusive trends.
Question 14: Are hospital infections caused by C. difficile any more difficult to remove from the environment than other hospital infections?
C.difficile is a type of bacterium that produce resistant spores
that are able to persist in the environment longer than other
bacteria. Although they will not be killed by alcohol hand gels,
they can be removed with soap and water. Staff, patients and
visitors need to wash hands with soap and water in addition to
using alcohol hand gels. Disinfectants containing bleach need to be
used on surfaces and floors to ensure that the spread of infection