Clostridium difficile

Clostridium difficile, also called C. difficile, is a bacterium. Spores from the bacteria can survive for long periods of time outside the body. C. difficile may also be found on various surfaces or in soil water.

A variable percentage of the population may be carriers of C. difficile bacteria:

• Very common in newborns and children age 2 and under;
• 8% of children over age 2;
• 2 to 5% of healthy adults;
• 10 to 20% of seniors.

While the bacteria are found in their bowel, carriers do not have health problems and do not need treatment.

C. difficile infection is caused when C. difficile bacteria multiply and produce toxins, causing bowel problems. Some C. difficile strains produce more toxins than others.

Seniors who are taking antibiotics and who are being treated in hospital or live in a residential and long-term care facility are most at risk of developing C. difficile–associated diarrhea.

The most common symptoms of C. difficile infection are:

• diarrhea, sometimes with blood, mucous or pus in the stool;
• fever;
• abdominal cramps.

As soon as a C. difficile infection is suspected, a stool test is done. The test will confirm if the bacteria are present and if they are causing the infection.

C. difficile infection is treated with antibiotics. The doctor will decide whether treatment is necessary and prescribe the appropriate antibiotic.

If the symptoms of the infection stop with treatment, repeat testing is not necessary. However, if the diarrhea continues or comes back in the following weeks, a medical consultation is required.

Most patients recover from the infection.

In vulnerable people, C. difficile infection can lead to life-threatening complications.

The possible complications are:

• dehydration;
• severe bowel inflammation. In some cases, that may require surgery to remove part of the colon.

C. difficile infection is contagious. Since the bacteria are found in the infected person’s stool, they may be transferred to hands or objects.

The bacteria are mainly spread by direct contact with contaminated hands, surfaces or objects. Surfaces such as the toilet flush handle, faucets, bed sides or door handles may be contaminated, since they are touched frequently by the infected person.

Hygiene measures at home

To avoid spreading C. difficile infection at home, take the following hygiene measures:

• Wash your hands often with soap and water. This is the simplest and most effective way to protect yourself against an infection. If you don’t have soap or water, use an antiseptic product. This measure must be applied by both the infected person and their family members;
• Frequently clean the room, the bathroom and any surfaces and objects that may be contaminated by the infected person. Use a household cleaning product and follow the manufacturer’s directions if you are using a chlorine-based product. Before cleaning, make sure any visible traces of fecal matter have been removed;
• Wash the infected person’s clothes and bed linen in warm or hot water with household laundry detergent.

You will find additional hygiene measures on the Preventing transmission of viruses and bacteria page.

Measures put in place in healthcare facilities

When a C. difficile infection occurs in a hospital or nursing home, various measures have to be put in place:

• Isolate the infected person in a private room or in a room with other patients infected with C. difficile, depending on the healthcare setting and the patient’s condition.
• Clean and disinfect the infected person's room and bathroom frequently.
• Require gloves and long-sleeved gowns for staff and visitors, depending on the situation.
• Post a sign on the door of the infected person’s room to remind staff members and visitors to wash their hands and follow the measures put in place.

These measures are generally maintained for at least 72 hours after the diarrhea has stopped.

The risk of developing C. difficile infection is very low for healthy people.

In most cases, the use of certain antibiotics is the main factor involved in the development of the infection.

Seniors who have been hospitalized or who live in a nursing home, however, at increased risk of developing C. difficile infection, especially if they have health problems.

Since 2004, surveillance of C. difficile–associated diarrhea has been mandatory in Québec hospitals. The surveillance program was established by the Ministère de la Santé et des Services sociaux and is part of the Provincial program for the surveillance of healthcare-associated infections. Healthcare-associated infections refer to infections acquired during an episode of care provided by a professional in the healthcare network, irrespective of the institution in which the care was provided.