Clostridioides difficile (C. diff) : University College London Hospitals NHS Foundation Trust

C. diff is a bacterium (a “bug”) that lives harmlessly in the bowel (gut) of approximately three per cent of people.
In healthy people C. diff lives in balance with many other good bacteria in the bowel and does not cause harm. If the balance of C. diff and good bacteria is disrupted (for example when taking antibiotics), the good bacteria may be killed and C. diff can then multiply rapidly and produce toxins.
It is the toxins produced by C. diff that cause inflammation in the bowel and diarrhoea. The presence of the toxin is used to make the diagnosis of C. diff infection.
C. diff is the major cause of diarrhoea in patients taking antibiotics.

C. diff is easily spread. It is present in diarrhoea in the form of “spores” (bacteria with a protective coating), which are designed to survive outside the human body.
These spores may contaminate the environment and can be found in areas such as toilets, commodes, bed frames and taps. The spores can survive for a long time in the environment unless they are killed by using special hygiene measures.
These spores may be a source of infection for other patients.
The spores can be picked up from the environment on hands, and can then be passed onto food and swallowed.

Hand washing with soap and water is an effective way of preventing the spread of C. diff. Alcohol hand gel is not effective against C. diff spores.
All staff and visitors should wash their hands with soap and water before and after any contact with a patient.
Patients, where possible should also wash their hands frequently, especially after using the toilet before eating. Patient hand wipes are also available.
To prevent it spreading to other vulnerable hospital patients, a patient with C. diff diarrhoea will be moved to a single room.
Staff will wear aprons and gloves when caring for a patient with C. diff.
Deep cleaning is undertaken, including on ward areas and toilets.
The use of antibiotics is carefully controlled, to avoid the development of C. diff as much as possible.

Any patient in hospital is potentially at risk of infection, particularly the frail elderly and those who are very sick.
Patients given antibiotics and proton pump inhibitors are most at risk of C. diff infection.

The main symptom is diarrhoea, which can be mild or severe.Patients may also experience stomach pain or cramps, loss of appetite, nausea and fever.

A small sample of diarrhoea is tested in the laboratory; a result can generally be obtained the same day.

Treatment will be based on symptoms. Generally the following measures will apply:

Patients with C. diff diarrhoea will be moved to a single room with adjoining toilet facilities if possible.
Staff will use aprons and gloves to prevent the spread of infection.
It is important to let staff know if diarrhoea occurs and a record will be kept to monitor the number of times diarrhoea occurs and what it looks like.
Dehydration (loss of fluid from the body) can be prevented by drinking plenty of fluid. Please check with your doctor if you have fluid restrictions.
You may eat a normal diet, although you should avoid any food that can worsen diarrhoea, such as fruit.
Any antibiotics or treatment used will be reviewed by your doctor as they may be contributing to the diarrhoea.
A specific antibiotic may be prescribed to treat the C. diff infection.
Treatment is generally effective. Some patients may have a recurrence of diarrhoea, which will require further treatment.
A very small number of patients with C. diff infection may develop severe infection of the large bowel known as “colitis” which may require surgery. However, this is very rare.