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Control and Management of Clostridium difficile

Page updated 5th March 2007

Control and Management of Clostridium difficile

Key Points

C. difficile is common in the hospital environment

Patients are likely to acquire the organism during their hospital stay

Some strains are more likely to be associated with disease than others and these may become endemic in a ward

Disease associated with this organism in the large bowel is generally precipitated by antibiotic use

Whereas all antibiotics can cause diarrhoea, some are more likely than others to precipitate pseudomembranous colitis, which is a rare but serious infection with a high mortality

All patients with diarrhoea should be nursed in Source Isolation

1.0. Summary

This policy aims to provide operational guidance for the control and management of Clostridium difficile . It is based on DH operational management policies.

The main and most important aspects of this policy are:

2.0. Introduction

2.1. Background

Clostridium difficile (C. difficile ) is a spore-forming anaerobic bacterium acquired by the ingestion of spores after contact with the contaminated environment, other patients or the hands of staff. C. difficile is common in the hospital environment and rarely acquired outside hospital. Some strains produce toxins. C. difficile disease is associated with the use of antibiotics which may result in disruption of the "normal bowel flora".

C. difficile acquisition may result in asymptomatic carriage, loose stools or profuse diarrhoea which can result in life-threatening pseudo-membranous colitis. C. difficile infections are most common in people over the age of 65 years but any age group may be susceptible.

Large outbreaks of C. difficile with significant mortality have been documented in healthcare facilities. Robust management to prevent secondary spread is essential.

Confirmation of infection occurs following identification of C. difficile toxin in stool samples. It is necessary to grow the organism to do epidemiological typing.

Control of C. difficile infection focuses on:

2.2. Ribotype 027

In 2006, a single hypervirulent clone of C. difficile PCR ribotype 027 emerged first in Canada then in the USA and Europe . This strain is more virulent than sporadic strains. It produces higher levels of toxins and the course of infection is more severe and carries more complications, a higher risk of relapse and a higher mortality.

C. difficile 027 causes outbreaks in hospitals. Fluoroquinolones have been implicated as a risk factor for disease and all strains are inherently resistant to quinolones.

This type of infection is likely to be identified because a cluster of patients with severe C. difficile infections occurs in one ward. Additional tests are required to grow and identify the strain. These take a long time and action has to be taken on clinical grounds together with the results of toxin tests.

If an outbreak of 027 occurs, it is likely that control can only be achieved by ward closure, intensive cleaning and activity reduction or cessation.