Clostridioides difficile

Overview

Clostridioides difficile (C. diff) is a bacterium that can cause severe diarrhoea and colitis, particularly in older adults and those who have recently taken antibiotics. Infections can lead to dehydration, prolonged illness, hospitalisation, and increased mortality. Preventing C. diff reduces the spread of infection, protects vulnerable residents, and decreases healthcare costs.

Further information: Preventing Infection Workbook - Page 57

Risk Factors

Recent antibiotic treatment (within 3 months).
Recent hospital admission.
Previous history of C. diff infection.
Bowel surgery or use of laxatives.
Use of Proton Pump Inhibitor (PPI) medication such as omeprazole.

Symptoms

Watery, offensive smelling diarrhoea, which may be bloody.
Abdominal pain or tenderness.
Loss of appetite.
Nausea.
Fever (high temperature).
Signs of dehydration, such as dry mouth, headaches, and reduced urination.

Transmission and Spread

C. diff spores can survive outside the body on various surfaces for extended periods. The most common mode of transmission is via the faecal-oral route, often through contaminated hands or surfaces. Proper hand hygiene and environmental cleaning are crucial to prevent the spread.

Prevention and Control Measures

1. Hand Hygiene

Always wash hands with soap and water, especially after using the toilet or handling contaminated items.
Alcohol-based hand rubs are not effective against C. diff spores; soap and water must be used.

2. Environmental Cleaning

Use chlorine-based disinfectants approved for C. diff spores to clean toilets, commodes, bathrooms, and high-touch surfaces.
Increase cleaning frequency during outbreaks or when residents have diarrhoea.
Ensure cleaning staff are trained in infection prevention protocols.

3. Antibiotic Stewardship

Only use antibiotics when clinically necessary and under GP supervision.
Encourage staff to report residents showing symptoms of diarrhoea promptly to medical staff.

4. Resident Management

Isolate residents with suspected or confirmed C. diff where possible.
Use dedicated toilets or commodes for affected residents.
Encourage hydration and monitor for signs of dehydration or deterioration.

5. Staff Education and Monitoring

Train all care home staff in hand hygiene, personal protective equipment (PPE), and cleaning protocols.
Monitor residents for new or worsening diarrhoea and escalate promptly to GP or infection prevention team.
Ensure PPE is worn when handling contaminated linen, waste, or assisting residents with diarrhoea.

Remember
Any current antibiotic treatment should be urgently reviewed by the resident's GP as soon as possible
When a resident is symptom free for 48 hours and has passed a formed stool, they are no longer infectious

Resources
Infection Prevention Control - C difficile Poster C-difficile-Care-Home-Poster-October-2022.pdf
PHW C difficile Patient Information Poster: phw.nhs.wales/services-and-teams/antibiotics-and-infections/infection-prevention-control/resources-for-healthcare-professionals/clostridioides-difficile/leaflets/c-diff-resources-poster/
PHW C difficile Patient and Carer Information Leaflet: phw.nhs.wales/services-and-teams/antibiotics-and-infections/infection-prevention-control/resources-for-healthcare-professionals/clostridioides-difficile/leaflets/c-diff-information-a4/

References and Further Guidance Links:
PHS info leaflet for staff / visitors and residents- Clostridioides difficile infection (CDI) Information leaflet
PHW Info leaflet for professionals- phw.nhs.wales/services-and-teams/antibiotics-and-infections/infection-prevention-control/resources-for-healthcare-professionals/clostridioides-difficile/leaflets/c-diff-information-digital/
UKHSA Guidance Updated- Clostridioides difficile infection: updated guidance on management and treatment
PHW C-diff Awareness Campaign- C. diff Infection Awareness Campaign - HEIW Clostridium difficile (C. diff) - NHS.UK: Clostridioides difficile (C. diff) - NHS Management of Clostridioides difficile infection in Wales
(All Wales Therapeutics and Toxicology Centre) awttc.nhs.wales/files/guidelines-and-pils/management-of-clostridioides-difficile-infection-in-wales-pdf/
HEIW: Antimicrobial Resistance and Stewardship resources: Antimicrobial Resistance and Stewardship - HEIW