Clostridioides difficile (C. diff)

Key points

There are 2 types of results for C. diff testing:

• GDH positive or toxin negative: this is classed as colonisation and does not always require treatment but if symptoms persist speak to the microbiologist
• toxin positive, if toxins are present this is classed as C. diff infection (CDI) and antimicrobial treatment will be prescribed

Risk factors

• aged over 65
• current or recent antibiotics
• long stay in hospital or care home
• underlying digestive condition or recent surgery
• immunosuppression
• taking a PPI, for example, lansoprazole, omeprazole
• previous infection

Symptoms

The illness ranges from mild self-limiting diarrhoea to profuse, explosive watery stools.

Often diarrhoea is foul smelling and the affected individual may experience abdominal cramps and fever.

Occasionally CDI may lead to potentially fatal conditions such as pseudomembranous colitis, toxic mega colon and bowel perforation.

Stool sampling

Send a sample at the earliest opportunity for Bristol stool type (BST) 5, 6 or 7 stools if no other cause identified on diarrhoea assessment tool in quick guides.

Do not retest for C. diff if patients are still symptomatic or to see if clear of infection within a period of 28 days. If symptoms recur please speak to the microbiologist for advice.

If other infectious agents are suspected then a sample can be obtained.

Transmission

• Commonly affects patients who have recently been treated with antibiotics but can spread easily to others.
• C. diff spores can survive for long periods on hands, surfaces and objects.
• Spread via faecal or oral route where bacteria on the hands is ingested.

Treatment

• If clinically appropriate review and discontinue non-C. diff antibiotics to allow normal intestinal flora to be re-established.
• Speak to the microbiologist who will advise on treatment regime.
• Anti motility agents should not be prescribed.

IPC precautions

• Standard precautions required.
• Obtain sample and complete stool chart after every episode to monitor BST and frequency.
• Isolate patient until asymptomatic of BST 5, 6 or 7 for 48 hours.
• Use liquid soap and water for hand hygiene.
• Encourage the patient with hand hygiene especially after using the toilet.
• Treat linen as contaminated (red alginate bag) and waste as infectious (orange waste bag).
• Twice daily environmental cleaning with chlor-clean (1,000 ppm).
• Decontaminate patient equipment thoroughly with Clinell peracetic acid wipes or chlor-clean (1,000 ppm).
• Dedicated commode if room is not en-suite.
• Notify the IPC team of any confirmed inpatient cases:
  • Phone: 03000 214872
  • Email: rdash.ipcteam@nhs.net

Page last reviewed: September 23, 2024
Next review due: September 23, 2025