C. difficile (Clostridioides difficile)

Clostridioides difficile, (formerly called Clostridium difficile), also called C. difficile, is a bacterium. Its spores allow it to live for long periods outside the body. C. difficile can contaminate different surfaces and survive there.

C. difficile infection is caused by the C. difficile bacterium, which multiplies and produces toxins. They irritate the colon, which causes intestinal problems, including C. difficile-associated diarrhea (CDAD).

A C. difficile infection most often appears with the following symptoms:

• diarrhea, sometimes containing mucus
• fever
• stomach cramps or pain
• loss of appetite
• nausea

If a C. difficile infection is suspected, your doctor will order a stool test to confirm that the bacterium is present.

C. difficile infection is treated with antibiotics. In the presence of symptoms and risk factors, including recently taken antibiotics, the doctor will determine if treatment is necessary and will prescribe the appropriate antibiotic. With treatment, most patients recover from this infection.

However, if the diarrhea persists or returns within a few weeks, it is necessary to see the doctor again.

In vulnerable people, a C. difficile infection can lead to complications that may be life threatening, that is:

• dehydration
• severe inflammation in the intestines requiring, in some cases, surgery to remove part of the colon.

C. difficile is ccontagious. In fact, given that it is present in the stool of an infected person, the bacterium can be found on objects and surfaces and can be transferred to the hands. When the hands come near the mouth, the bacterium is ingested and will lodge within the intestines.

The bacterium is mainly transmitted through direct contact with contaminated hands, surfaces and objects. Toilet flush handles, faucets, bed rails and door handles can be contaminated because they are often touched by the sick person.

Hygiene practices

To prevent the spread of C. difficile, adopt the following hygiene practices:

• Wash your hands often with water and soap. This is the easiest and most effective way to protect yourself against infection. If you do not have water or soap, use an antiseptic while waiting for access to a sink. This practice must be applied not only by the infected person but also by the person’s household members.
• If possible, reserve a toilet for the exclusive use of the infected person, and clean and disinfect it regularly.
• Frequently clean the room, bathroom, surfaces and objects that the infected person might contaminate. Use a household cleaning product and follow the manufacturer’s instructions. A chlorine-based product is recommended, for example, by using bleach: 1 part bleach diluted in 9 parts water. It is recommended to start by cleaning the surface and removing all visible traces of fecal matter before disinfecting it.
• Wash the infected person’s clothing and bed linen in a washing machine with warm or hot water and household laundry detergent.
• Help the infected person maintain good personal hygiene by bathing with soap and water or by having them take a shower.

If you have active C. difficile-associated diarrhea while receiving home care or attending an appointment in a healthcare facility or medical clinic, tell the healthcare personnel. They may need to use gloves and a protective gown to avoid spreading the bacteria to other people.

Measures in healthcare facilities

When C. difficile infection occurs in a hospital or long-term care centre, different measures are put in place, in addition to hand washing, such as:

• Isolate the infected person in a private room or in a room with other patients infected with C. difficile, depending on the facility and the patient’s condition.
• Clean and disinfect all healthcare equipment not reserved for the infected person, and clean and disinfect any item that will be taken out of the room (e.g., wheelchair, walker).
• Require staff and visitors to wear gloves and long-sleeved gowns, depending on the situation.
• These measures must be maintained until the person no longer has diarrhea and is considered to have recovered. It is not necessary to order a laboratory test to determine that the infection is over once the person stops having diarrhea. In addition, depending on the healthcare facility, the isolation period could be longer.

Information on C. difficile should be given to the infected person, including measures to follow once they return home. Before leaving the healthcare facility, patients must inform their doctor or the healthcare professional if another person at home is ill or has a weakened immune system. Additional measures may be needed at home to protect that person.

The surveillance of C. difficile-associated diarrhea has been mandatory in Québec hospitals since 2004. This surveillance program, introduced by the Ministère de la Santé et des Services sociaux, is part of the provincial program for the surveillance of healthcare-associated infections. These infections are acquired during episodes of care provided by a healthcare professional, regardless of the facility that administered the care.