Clostridium difficile (C.diff)

Information for patients from the Infection Prevention and Control Team

What is Clostridium difficile?

Clostridium difficile, also known as C.diff, is one of a large number of different bacteria that can live in the bowel. It is kept in check by the other normal or “good” bacteria, which prevent it from multiplying or over-growing.

Approximately 2 to 5% of the UK population carry C.diff in their bowel without causing any problems. It is particularly common in elderly patients, babies, and infants.

What causes Clostridium difficile?

If patients carry C.diff in their bowel and are treated with antibiotics for an infection, the antibiotic treatment can upset the balance of bacteria in the bowel. Some of the “good” bacteria are killed off, and if C.diff is present it can begin to multiply and produce toxins which irritate the bowel and cause diarrhoea and abdominal pain. C.diff bacteria can survive in the environment for a long time and patients may acquire C.diff from this source.

What are the signs and symptoms of C.diff infection?

C.diff infection can be mild or severe. Patients with C.diff develop very loose or runny bowel motions (diarrhoea) which may also contain mucus or a “jelly-like” substance and have a “farm-yard” or “manure” type smell. They may have several episodes of diarrhoea a day. Some patients, but not all, may experience abdominal (stomach) pain, a temperature, and feel generally unwell.

How is C.diff discovered?

If a patient develops diarrhoea in hospital and is currently on, or has recently completed, a course of antibiotics, a specimen of diarrhoea (called a stool specimen) will be sent to the Microbiology Laboratory for testing.

How is C.diff treated?

Patients with C.diff only need treatment if they have diarrhoea. If so, other antibiotics will be prescribed to treat the C.diff infection, such as Vancomycin. This treatment can be taken in either tablet form or given through a drip, and the symptoms should begin to settle down within a couple of days. Sometimes more than one course of these antibiotics is needed if the symptoms are severe, particularly if the patient has been on several other antibiotics.

Is C.diff dangerous?

Severe C.diff infection can sometimes cause complications, such as ulceration and bleeding of the bowel wall, or perforation of the bowel. The risk is higher in elderly people and people who have other very serious health conditions. However, most patients respond to treatment very quickly.

What precautions are taken in hospital?

Patients with C.diff infection or patients who we think may have C.diff infection will be moved to a side room to protect other patients from cross infection, and will be given their own toilet facilities. Visitors do not need to take any special precautions but must wash their hands using liquid soap with running water before leaving the room.

What happens on discharge from hospital?

Patients with C.diff can be discharged from hospital as soon as they are well enough. No special precautions need to be taken in the home beyond normal hygiene measures, such as washing your hands after using the bathroom. You are able to resume normal daily routines such as shopping, visiting friends, and family, as long as you feel well. Sometimes symptoms can return, even after a course of treatment and another course of treatment may be needed. If your symptoms return after you have been discharged home, you must tell your GP.

What is the Green NHS “CDI Important Information” card?

The Infection Prevention and Control Team will provide you with a green NHS “CDI Important Information” card. It is important that you keep this card with you and on each visit show this card to any doctor, pharmacist, dentist, or other healthcare provider as it lets them know that you have been identified as having had a C.difficile infection. Therefore, care should be taken if you need antibiotics in the next few months as this may trigger a return of symptoms.

What if I have further questions?

If you have any questions or concerns, please speak to either the nurse in charge of the ward or the matron. If they are unable to help you or you need further information, please contact a member of the Infection Prevention and Control Team on:

References

  1. East Kent Hospitals University NHS Foundation Trust. Infection Control Manual. Policy for the Management of Clostridium difficile.

  2. Public Health England. Updated guidance on the management and treatment of Clostridium difficile infection