C. difficile

The rate is calculated as follows:
Number of new hospital acquired cases of C. difficile in the facility x   1000
Total number of patient days (for one month)

So just what exactly is C. difficile and CDAD? And why are hospitals now required to report these rates?

C. difficile is just one of the many types of bacteria that can be found in the environment and the intestines. For most people, it does not pose a health risk. However, C. difficile associated disease (CDAD) can sometimes occur when antibiotics are prescribed. Antibiotics work by killing off bacteria – the bad bacteria – but also good bacteria. This can allow the C. difficile bacteria to multiply, which may cause diarrhea and can damage the bowel.CDAD is the most common cause of infectious diarrhea in healthcare facilities. The effects of CDAD are usually mild but can sometimes be more severe. In severe cases, surgery may be needed, and in extreme cases CDAD may cause death.  

What are hospital-acquired infections?
Sometimes when patients are admitted to the hospital, they can get infections. These are called hospital-acquired infections. In the case of C. difficile, this may mean that symptoms began 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to that hospital within the last four weeks.

What is C. difficile?
C. difficile (Clostridium difficile) is a bacteria. C. difficile can be part of the normal bacteria in the large intestine and is one of the many bacteria that can be found in stool (a bowel movement).
A C. difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing the C. difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause diarrhea. C. difficile is one example of a hospital-acquired infection and is one of the most common infections found in hospitals and long-term care facilities. C. difficile has been a known cause of health care associated diarrhea for about 30 years.

Who is at risk for C. difficile?
Healthy people are not usually susceptible to C. difficile. Seniors, and people who have other illnesses or conditions being treated with antibiotics and certain other stomach medications, are at greater risk of an infection from C. difficile.

What are the symptoms of C. difficile?
The usual symptoms are mild but can be severe. Main symptoms are watery diarrhea, fever, abdominal pain /tenderness. In some cases there may not be diarrhea. Blood may or may not be present in the stools.

How do you get C. difficile?
C. difficile is the most common cause of hospital associated infectious diarrhea. Since it can be part of the normal bacteria that live in the large intestine, taking antibiotics can change the normal balance of bacteria in your large intestine making it easier for C. difficile to grow and cause an infection. Old age and the presence of other serious illnesses may increase the risk of C. difficile disease.

How does C. difficile spread?
When a person has C. difficile, the germs in the stool can soil surfaces such as toilets, handles, bedpans or commode chairs. When touching these items, your hands can become soiled. If you then touch your mouth, you can swallow the germ. Your soiled hands can spread germs that can survive for a long time on other surfaces if not properly cleaned.
The spread of C. difficile occurs due to inadequate hand hygiene and environmental cleaning; therefore, proper control is achieved through consistent hand hygiene and thorough cleaning of the patient environment. Good hand hygiene i.e. washing hands thoroughly and often is the single-most effective way to prevent the spread of infectious diseases like C. difficile. For more information about Hand Hygiene and the Hospital’s participation in the “ Just Clean Your Hands ” program, click here.

How is C. difficile diagnosed?
As soon as a C. difficile infection is suspected, the patient will be asked to give a stool sample. The stool will be tested to determine if C. difficile toxin(s) are present. If the first test is negative, a second sample may be sent.

How is C. difficile treated?
Treatment depends on how sick you are. People with mild symptoms may not need treatment. For more severe disease, antibiotics are required.

What precautions are used to prevent the spread of C. difficile in the hospital?
Hospitalized patients with suspected or confirmed C. difficile disease will be managed with special procedures called `Contact precautions’ until the patients are free from diarrhea for at least two days. Patients’ activities outside the room may be restricted. A sign is placed on the door of the room to remind all health care workers and visitors who enter to wear a gown and gloves. Visitors should not eat or drink while in the room. Everyone must wash their hands with soap and water or sanitize their hands using alcohol-based hand rub after removing gloves and when leaving the patient’s room.

How does Guelph General Hospital control the spread of C. difficile?
A C. difficile patient room is cleaned twice daily with a hospital-grade disinfectant. Upon discharge of the patient or when `Contact precautions’ are discontinued, a special cleaning of the room is conducted.

Does Guelph General Hospital track C. difficile cases?
Yes, Guelph General Hospital has been tracking C. difficile through existing infection prevention and control surveillance programs. This allows early identification of patients with suspected or confirmed C. difficile associated disease so that `Contact precautions’ can be initiated in a timely fashion. A cluster of cases will be investigated and carefully reviewed to rule out or confirm the existence of an outbreak.