C. Difficile Associated Disease

Niagara Health posts its infection rates online on a monthly basis. The chart above shows the number of C. difficile cases per 1,000 patient days at each of our inpatient sites. The ‘total patient days’ represents the sum of the number of days during which patients occupied beds in a given time period.

The rate is calculated as follows:

Number of new hospital acquired cases of C. difficile in our facility x 1000
Total number of patient days (for one month)

Sometimes when patients are admitted to the hospital, they can get infections. These are called hospital-acquired or nosocomial 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.

C. difficile or Cdiff, also known as Clostridium difficile, is a bacteria that can be found in stool (a bowel movement). Cdiff disease occurs when antibiotics kill your good bowel bacteria and allow the Cdiff to grow. When Cdiff grows, it produces toxins that can damage the bowel and may cause diarrhea.

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. In severe cases, surgery may be needed and in extreme cases Cdiff may cause death. Cdiff is the most common cause of hospital infectious diarrhea.

C. difficile 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 Cdiff disease.

If a C. difficile infection is suspected, you will be asked to give a stool sample that will be tested for the bacteria and/or its toxins. Most importantly, patients and hospital visitors should pay particular attention to good hand hygiene and follow the instructions given to you by the health care staff.

The germs in the stool can soil surfaces like toilets, handles, bedpans and 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.

You may be placed in a private room until you are free from diarrhea for at least two days after treatment is finished. Your activities outside the room may be limited. Ask your nurse if you have any questions about hand hygiene. Hands must be washed after using the toilet or bedpan, before eating, before entering the room and before leaving the room. Signs are placed on the outside of your door called Contact Isolation. Staff and visitors must wear gowns and gloves if they expect to come in contact with you and upon entering the room. Sometimes equipment may be left in your room solely for you to use. Thorough cleaning of your room and equipment will be regularly done.

Treatment depends how sick you are with the disease. Mild diarrhea may stop as soon as the antibiotics are no longer taken. More serious diarrhea may require treatment. Your doctor will order an antibiotic (usually flagyl) to be taken by mouth.

Healthy people who are not taking antibiotics are at very low risk of getting Cdiff disease.

Wash your hands with soap and warm water for at least 15 seconds:

• after using the toilet
• after touching dirty surfaces
• before eating
• before preparing meals

Use a household cleaner diluted according to the manufacturer instructions or diluted bleach:

• wet the surface well and clean using good friction
• allow the surface to air dry
• pay special attention to surfaces that may be soiled with stool such as the toilet and sink. Remove stool first before cleaning.

Cleaning Clothes and Other Fabric

Wash clothes separately if soiled with stool:

• rinse stool off
• clean in a hot water cycle with soap
• dry items in dryer if possible

Regular cleaning, you can use the dishwasher or clean by hand with soap and water.

It is very important that you take all your medication prescribed by your doctor. You should not use any medication to stop the diarrhea (eg, Imodium). If diarrhea persists or comes back, contact your doctor.

Healthy people who are not taking antibiotics are at very low risk of getting the bacteria. Their best protection is to wash their hands before and after visiting patients in hospital and following the precautions posted. Other patients in the hospital are at greater risk of getting C. difficile infection.