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

As a patient or visitor in our community hospitals or at home, you may be concerned about clostridium difficile or have been told you have it.

What is clostridium difficile?

Clostridium difficile is often shortened for C. difficile, C. diff.

It is a bacterium (germ) which can be found in the human gut of about five per cent of the population without causing any problems. The good bacteria in your gut will normally protect your body against this kind of infection by keeping it under control.

However, if the number of good bacteria is reduced, for example by taking antibiotics, C. diff can multiply quickly and produce toxins (poisons) which can inflame the gut and cause diarrhoea.

What are the symptoms of C. diff?

C. diff can cause diarrhoea, ranging from a mild infection that lasts a few days to a very severe illness with symptoms that last for several weeks, ulceration and bleeding from the colon.

Diarrhoea can sometimes clear up on its own without any treatment. Most patients will recover fully. However, in most cases, treatment is required for the toxins in your gut that are produced from the infection. Some patients may become seriously ill and develop inflammation of the bowel (colitis). If colitis is severe (pseudomembranous colitis) it can be life-threatening.

Other symptoms may include stomach cramps, fever, nausea (feeling sick), vomiting and loss of appetite. The loss of fluids caused by diarrhoea may lead to dehydration. You should drink every hour during the day to avoid this.

People are more at risk of developing C. diff infection (CDI) if they:

• are over 65 years
• are taking, or have recently taken antibiotics
• have a reduced ability to fight infection (a weakened immune system)
• have had a recent stay in hospital
• have had gut surgery or a procedure involving the gut.

Most infections occur in healthcare settings or following care from a healthcare setting. This includes hospitals (including community hospitals), nursing homes etc. but it can also occur in primary care settings.

How do patients become infected?

Although some people can be healthy carriers of C.diff, in most cases the disease develops after taking broad spectrum antibiotics. Because it develops in this way, the patients who are most at risk of infection with C.diff are those who have been treated with broad spectrum antibiotics (those that affect a wide range of bacteria, including intestinal bacteria).

The C.diff bacteria are passed out in the faeces of an infected person. Once outside the body, they change to the spore form which can survive in the environment (surroundings) for a long time. Spores can be transferred to patients’ hands from contact with a contaminated environment or hands of other patients, visitors or staff who have touched a contaminated surface such as furniture, medical equipment, toilets, handles, sinks or taps.

If the hands are not washed before eating or drinking, these spores can be ingested (swallowed) and can reach the gut and cause diarrhoea.

All staff, visitors, and anyone receiving care can spread the infection to themselves or other people if they don’t wash their hands properly after contact with anyone receiving care, their surroundings or contaminated equipment.

If you are taking antibiotics and develop diarrhoea please make sure you tell your healthcare provider as soon as this happens.

How is C. diff infection (CDI) diagnosed?

If you are having diarrhoea, a sample of your faeces is collected and tested for the C. diff bacteria.

If you have a toxin positive result it means that the C. diff in your bowel is most likely causing the diarrhoea and other symptoms you are experiencing and you may need treatment for it. If the result is C. diff toxin negative it means you may have C. diff in your bowel but you do not need treatment for it and diarrhoea should resolve in a few days. However, you should be aware that you may pass it on to others. If your symptoms become worse instead of resolving you need to contact your healthcare practitioner as this could be an indication that that the C. diff bacteria has started to produce toxins.

How is C. diff infection (CDI) treated?

You may be given an antibiotic that treats the C. diff infection. Any other antibiotics that you are on may be stopped or changed to an antibiotic usually given by mouth which is effective against the bacteria. It should start to work within a few days.

Milder cases of C. diff infection may not need any treatment. Diarrhoea, however, can also cause dehydration. It is very important to try and avoid becoming dehydrated so you need to drink plenty of fluids.

How will C. diff infection affect my stay in hospital?

If you are a community in-patient and have a C. diff infection you may be moved to a single occupancy room to reduce the risk of spread to others while you have diarrhoea.

Staff, carers and visitors will need to follow infection control precautions until your diarrhoea has stopped. Hospital staff will wear disposable aprons and gloves and wash their hands with soap and water every time they attend to you.

It is not necessary for your visitors or carers to wear gloves and aprons unless they are helping you with personal care such as washing and dressing. After use, the gloves and aprons should be put into the orange bin in the room. Visitors must then wash their hands with soap and water.

To help staff you should:

• Let staff know when you have diarrhoea so they can monitor your progress and identify a toilet for you to use.
• Always wash your hands with soap and water after using the toilet and before meals.
• It is important to have good personal hygiene to stop your skin from becoming sore and to prevent the spread of C. diff. Your dignity is also very important and you should not feel embarrassed to ask for help with personal care. If your skin becomes sore around your bottom you will need to use a barrier cream. This will protect your skin from coming into contact with diarrhoea. The staff caring for you will be able to provide this and will also check on your condition regularly.
• Limit the number of personal belongings in your room. Keep your bed and locker clean and free from clutter so it can be cleaned easily.
• Cover food and sweets that you may have at your beside. Do not share them.
• Always ask staff to wash their hands before and after they touch you.
• Ask your visitors to wash their hands with soap and water before and after visiting.

As soon as you are well enough, you will be able to go home. Having C. diff should not stop this.

Please do not hesitate to ask a member of staff if you do not understand what is happening.

The staff are there to help and care for you and answer any questions that you or your relatives may have. If you have any concerns please speak to the nurse in charge.

Alternatively, you can ask the ward staff to contact the Infection Prevention and Control Team who can answer any further questions.

How will C. diff affect me at home?

People who have C. diff symptoms can live at home as usual but need to take extra care to reduce the effects of their illness and ensure they do not pass the bacteria onto anyone else. If you have these symptoms you should:

• Avoid unnecessary close contact with other people until you have been symptom free for 48 hours.
• Clean hard surfaces in kitchens and bathrooms with a bleach-based product (don’t forget door handles and tap tops). If your floors or surfaces become soiled with faeces, clean them first using a disposable cloth and warm soapy water and then a bleach-based solution. Do not use bleach on carpeted or fabric areas.
• Make sure you wash your hands thoroughly with liquid soap (a bar of soap can harbour germs) and water, especially after going to the toilet and before preparing/eating food.
• Ask your guests to wash their hands thoroughly with liquid soap and water before leaving your home but do not share towels with them.
• Wash clothing and bedding from an infected person separately from your normal load. These items should be washed at >60ºC or the highest temperature recommended by the manufacturer. Take care not to overload the machine so that the water can circulate freely, as this will help to rinse away the germs. Wash your hands with soap and water after handling soiled or used clothing. Clean the area around your washing machine, such as the door of the machine and worktops, with a kitchen cleaner that contains bleach. Tumble dry clothes where possible (following manufacturer’s guidance), or iron according to manufacturer’s guidance. A hot iron with steam is best, if possible.
• If you use incontinence pads, contact your local authority waste disposal department for advice. They should not be put out for domestic rubbish collection.
• Having diarrhoea makes some people feel unwell, bloated and sick with little appetite or fear that the diarrhoea might get worse. It is very important to ensure that you still drink and eat whilst you have diarrhoea. Avoid foods that may irritate your stomach. Simple and soft foods, such as bananas and apples, scrambled or boiled eggs, white rice and toast, little and often, are best.

Drinks such as: Water squash, unsweetened fruit juices, herbal tea or decaffeinated coffee are all suitable and will help rehydrate the body.

In some cases, your GP or healthcare professional may prescribe you a rehydration solution which contains all the electrolytes your body needs to function but will have been lost due to your diarrhoea.

• Always carry your C. diff card and show it to any doctors, nurses, carers, pharmacists, dentists and other healthcare professionals involved in your care. Remember: Do not take medicines to stop diarrhoea. These medicines stop the bacteria being cleared from your body.

When you go home

If you have been discharged from hospital but are still taking medication for your C. diff infection, it is important to complete the course of antibiotic treatment even if you are feeling better and your diarrhoea has stopped.

What if I have a healthcare appointment?

If you have symptoms of diarrhoea and you are due to have an outpatient appointment, health test or operation ring the hospital or your GP. They will be able to tell you whether your treatment can go ahead or if your appointment needs to be rearranged.

Can C.diff infection come back?

There is around a 10 per cent chance that your C. diff infection may come back. This can happen up to three months following treatment. A very small number of people may suffer several relapses.

What should you do if the diarrhoea returns?

Contact your GP straight away if you develop diarrhoea after you are discharged from our community hospital. The discharge letter to your GP should state that you had a C.diff infection but make sure that you mention it to your GP as well.

Do not take any medicines to stop the diarrhoea (such as loperamide) without discussing with your GP. This is because it can prevent the infection being cleared from your body.

If you are readmitted or admitted to another hospital please tell a member of staff that you have had a C. diff infection.

Contact information

If you need further advice please speak to the nursing staff looking after you. The Infection Prevention and Control Specialists will visit you while you are in our community hospital.

Further information

NHS UK website: www.nhs.uk/conditions/c-difficile/

With thanks to Leeds Community Healthcare NHS Trust