What is C. difficile?
C. difficile is an anaerobic, gram-positive bacillus that can exist in two forms: a dormant spore that has a tough protein coat, and a vegetative form that results from spore germination.3 The dormant spore is the infectious and transmissible form.4 Exposure to C. difficile spores can result in a C. difficile infection (CDI).
What are the symptoms of a C. difficile infection?
C. difficile can cause illness ranging from mild diarrhea to pseudomembranous colitis to toxic megacolon which is rare but life-threatening complication.5 In all cases, the major symptom of CDI is diarrhea. Mild cases may experience only watery diarrhea, while severe cases can include severe abdominal cramping, blood or pus in the stool, nausea, a swollen abdomen, kidney failure and an increased white blood cell count. Some patients require a colectomy — removal of the colon.6 Severe infection can lead to sepsis and death.7
How does C. difficile spread?
C. difficile is shed from feces. Contaminated environmental surfaces and skin can serve as a reservoir for C. difficile spores.8 Transmission occurs through the fecal-oral route. Spores can be shed by people with active C. difficile infection, as well as by asymptomatic carriers. Studies on the survival of C. difficile on hard surfaces such as those found in the healthcare environment showed that while the vegetative form dies within 24 hours, C. difficile spores can persist for months.9 This long survival period increases the risk of transmission from a contaminated surface that has not been properly cleaned and disinfected.
Why is C. difficile a concern?
C. difficile infections can be life-threatening. The risk of contracting a C. difficile infection increases in the elderly and in patients with previous antibiotic use, gastrointestinal surgery, immunocompromising conditions, and long stays in healthcare settings such as hospitals and nursing homes. About 1 in 6 patients who get a C. difficile infection will get it again within 2 to 8 weeks of initial infection.10
C. difficile Infection Control Measures
The CDC recommends the following steps for CDI prevention in healthcare:8
- Antibiotic stewardship: A program that promotes the appropriate use of antimicrobials11.
- Hand hygiene: Practice hand hygiene using soap and water; alcohol-based hand sanitizers do not inactivate C. difficile.
- Isolation: Rapidly identify and isolate patients with CDI in a private room. Dedicate equipment, as able, to the infected patient’s room.
- Diagnostic stewardship: Appropriate testing (e.g., test when indicated such as unexplained diarrhea).
- Personal Protective Equipment (PPE): Wear gloves and gowns when caring for C. difficile patients.
- Cleaning & disinfection: Clean CDI patient rooms daily and on discharge with an EPA-registered disinfectant with claims against C. difficile spores
- Interfacility communication: When a C. difficile patient transfers between facilities along the continuum of care, notify the receiving facility of the infection.