This guide explains what clostridium difficile is, ways in which it can cause infection and how it is treated.

As a patient or visitor you may be concerned about clostridium difficile or have been told you have it.

What is clostridium difficile?

Clostridium difficile (also known as C. difficile, C. diff or CDI) is a bacterium (germ) found in the human gut. It is the main cause of antibiotic associated diarrhoea and colitis, an infection of the intestines. It is part of the clostridium family of bacteria, which also includes the bacteria that cause tetanus, botulism and gas gangrene. It is an anaerobic bacterium, for example it does not grow in the presence of oxygen and produces spores that can survive for a long time in the environment. It most commonly affects elderly patients with other underlying diseases.

C.difficile produces spores, so alcohol and gel and some disinfectants do not work against it.

Since January 2004, C.difficile has been part of the mandatory surveillance programme for healthcare associated infections.

Where does it come from?

The gut of healthy people contains bacteria that are usually harmless. Amongst these, there may be small numbers of C. difficile. Normally, the harmless bacteria will keep the C.difficile in check, but if something happens to affect the normal bacteria, it may survive and multiply, causing an infection. The usual reason for this is antibiotic treatment.

Once somebody has an infection, the bacterium can then be spread to others.

What does it cause?

An increase in C. difficile will irritate the gut lining. The most common symptom is diarrhoea, however it can also cause abdominal pain, fever, loss of appetite and sometimes sickness.

Sometimes, C. difficile infection can cause a very severe illness including bleeding and ulceration of the large intestine. Occasionally, infection can be fatal.

Who is at risk?

• Anyone taking certain antibiotics.
• People in hospital (including community hospitals), especially if they are over 65.
• People with inflammatory bowel disease.
• People who have had surgery on their stomach or bowel.
• People being treated for cancer or whose immune defences are lower than usual.

How long do symptoms continue?

This varies from person to person. A common time is between seven to 10 days. However, it may be longer or shorter than this.

How is it diagnosed?

A stool sample is sent to a laboratory to confirm what is causing your symptoms.

How is it treated?

If you are taking antibiotics, these may be stopped or changed and this may stop your symptoms. However, you may be given a different antibiotic specifically to treat the C. difficile infection. It is important not to become dehydrated so you may need to drink extra or possibly have fluids administered intravenously.

If you develop a C. difficile infection, you may need to be cared for in a separate room to other patients and may need to use a toilet or commode reserved for you. Staff will have to wear gloves and aprons when caring for you.

Cleaning of the environment is very important to prevent spread, so this may be increased. Different chemicals may be used for cleaning as well.

How does it spread?

It is usually spread by person to person contact although the spores it can form enable it to survive for long periods in the environment.

What can I do to prevent infection?

• Always wash your hands after you have been to the toilet, or before eating.
• Do not be afraid to ask staff to wash their hands before caring for you.

What is Kent Community Health NHS Foundation Trust doing to prevent infection?

Kent Community Health NHS Foundation Trust places patient and staff safety at the heart of its strategic objectives. Infection prevention and control is a vital part of fulfilling that objective.

All staff are expected to comply with all infection prevention and control precautions when undertaking your care, in all settings, whether or not you have an infection.