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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.

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

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 life threatening.

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.

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.

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 sample.

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.

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 threatening.

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 detergent/disinfectants.

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.

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

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.

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.

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.

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.

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 is controlled.