C DIFFICILE

C. Difficile (Clostridium) is a species of gram-positive spores producing bacteria which are present in 2-5% of healthy people’s guts.  It survives in the gut usually asymptomatically.  It is passed by faecal. 

In 2007 in the United Kingdom, 8,324 people died from C. Difficile.  This compares to 1,593 who died from MRSA in the same year.  

The C. Difficile Bacterium has two forms, an active infectious form that cannot survive in the environment for prolonged periods and a non active, non-infectious form called a spore that can survive in the environment for prolonged periods. 

C. Difficile spores are found frequently in –  

• Hospitals.  
• Nursing Homes. 
• Extended Care Facilities.                        
• Nurseries for newborn infants.           

 

They can be found on bedpans, furniture, toilet seats, linen, telephones, fingernails, rings, floors and infants rooms.  Therefore these environments are a ready source for infection with C. Difficile.                       

Q.1      WHAT IS CLOSTRIDIUM DIFFICILE (C. Difficile) COLITIS?                            

Antibiotic associated C. Difficile Colitis is an infection of the colon caused by C. Difficile that occurs primarily in individuals who have been using antibiotics.  It is the most common infection acquired by patients while they are in hospital. 

More than 3 million C. Difficile infections occur in hospitals in the United States each year.  After a stay of only 2 days in hospital, 10% of patients will develop infections of C. Difficile.  It may also be acquired outside of hospitals in the community.    

Q.2      WHAT DOES C. DIFFICILE CAUSE?    

• If it overgrows in the colon, it causes Pseudomembranous Colitis – infection of colon causing diarrhoea.                                             

 

Q. 3     WHAT ARE THE SYMPTIOMS OF C. DIFFICILE COLITIS?                            

Patients with mild C. Difficile Colitis may have:  

• A low grade fever.       
• A mild diarrhoea (5-10 watery stools a day).                                                                   
• Mild abdominal cramps and tenderness.                                                                                                         

 

Patients with severe C. Difficile Colitis may have:                      

• High temperatures of between 102F – 104F.     
• Severe diarrhoea with blood.       
• Severe abdominal pain and tenderness.        

 

Not everyone infected with C. Difficile develops colitis.

C. Difficile spores lie dormant inside the colon until the person takes an antibiotic.  The antibiotic disrupts the other bacteria that are normally living in the colon and preventing C. Difficile from transforming into an active disease, causing bacterial form.  As a result, C. Difficile transforms into an infectious form and then produce toxins (chemicals) that inflame and damage the colon. 

The inflamination results in an influx of high blood cells to the colon.  The severity of the colitis can vary.  In the most severe cases, the toxins kill the tissue of the inner lining of the colon and the tissue falls off.  The tissue that falls off is mixed with white blood cells (puss) and give the appearance of a white membranous patch covering the inner lining of the colon.  This severe form of D. Difficile is called pseudomembranus Colitis because the patches appear like membranes, but they are not true membranes.                   

Q.4      WHAT KILLS C. DIFFICILE?        

• Metronidazole.        
• Vancomycin. 
• Linezolid.   

 

Q.5      WHAT DOES NOT KILL C. DIFFICILE?   

1. Alcohol based hand rubs.   
2. Many disinfectants (but bleach is effective).   
3. Broad spectrum antibiotics (which kill competing gut flora).                       

 

Q.6      WHAT AGGREGATES C. DIFFICILE? 

1. Continued prescription of broad spectrum antibiotics.      
2. Diarrhoea treatment (which slows the progress of toxins through the colon).          

 

Q.7      HOW IS ITS SPREAD PREVENTED?   

1. Prudent use of Broad spectrum antibiotics.   
2. Isolation and barrier nursing of infected patients.        
3. Effective cleaning of toilets and other environments with bleach to kill off spores.    
4. Good hand hygiene of healthcare workers.  

 

Q.8      THOSE AT RISK FROM C. DIFFICILE?  

• The elderly, particularly those in hospitals and nursing homes. 
• Post-surgical patients.        
• Immuno suppressed patients. 
• Those on broad spectrum antibiotics.      

 

In the United Kingdom in 2008, there were 40,705 instances of C. Difficile hospital infections with 5,931 deaths arising therefrom.       

Typical Injuries – C. Difficile            

1. Death – Usually of the elderly.            
2. Colectomy – Surgical resection of any extent of the large intestine.   
3. Diarrhoea and prolonged hospital admission.   

 

Negligent Acquisition      

Failures in barrier nursing –  

1. Did any other persons on the ward have C. Difficile or have isolation notices above their beds?    

 

1. Did any other patients have severe diarrhoea?             

                      

1. Were the toilets or any other areas contaminated with diarrhoea?                  

           

1. Prior to treating you and giving you medication or food, did health care staff either wash their hands or use alcohol rub?      

 

1. Did staff wash or use alcohol rub after treating one patient and then treating the next?              

 

1. Were there sinks and soap dispensers nearby and notices advising visitors to use them?     

 

After being diagnosed with C. Difficile were you….    

a)      Moved to a side room or otherwise into isolation (and how long was this after your diarrhoea commenced).   

b)      Identified as having C. Difficile by an isolation notice and treated as such.        

c)      Provided with your own toilet facilities.     

d)      Permitted to interact with other patients.