Patient Information Leaflet - Clostridium difficile

Clostridium difficile infection occurs when the bacteria enters the body 
through the mouth and are swallowed. Usually there is some imbalance of the normal bacteria in the bowel which allows Clostridium difficile to multiply. 

When this happens it produces a toxin that can affect the bowel and cause symptoms.

The symptoms may include:

• Diarrhoea which is often watery and has an unpleasant smell 
  Cramping abdominal pains
• Fever
• Loss of appetite, nausea

Symptoms may last a few days to several weeks.

Those at risk are:

• People who are taking, or recently finished taking antibiotics 
  People over 65 years of age
• People who have had bowel surgery
• People who have spent a long time in hospital or other types of 
  healthcare settings
• People with a low immune system e.g. undertaking chemotherapy 
• People who have a serious underlying illness

Some antibiotics change the balance of bacteria in the bowel allowing 
Clostridium difficile bacteria to grow in greater numbers. This can then cause symptoms.

If you have diarrhoea a sample will be required. The specimen will then be sent to the laboratory to be tested.

When Clostridium difficile causes diarrhoea the bacteria can contaminate the immediate environment, such as surfaces, toilets, floors and equipment where it can survive for long periods of time. It can then spread person to person on contaminated hands or from the contaminated environment and equipment if not cleaned properly.

The most important method of preventing spread is to wash your hands with soap and water after you have been to the toilet, before eating/drinking and before taking medication. Don’t forget to ask for help with this if you need it.

Alcohol hand rub on its own is not effective against Clostridium difficile. 
Do not be afraid to remind staff to clean their hands.

You may be moved into a single room as soon as possible to help reduce the risk of passing the infection to other patients, alternatively you may be nursed in a bay or small ward with other patients with the same infection.

Staff will take special infection prevention precautions such as cleaning their hands with soap and water, wearing an apron and gloves when they carry out any care or procedures in your room. 

Your room and any equipment will be cleaned by staff using a disinfectant on a regular basis.

Repeat stool specimens are not usually required, however, if your symptoms continue after treatment further investigations may be required, for example, X-rays or examination of the bowel using a specialised camera.

The doctor will assess the treatment options and decide which is the most appropriate. Clostridium difficile infection can be treated with specific antibiotics. Examples of these are metronidazole and vancomycin, which are usually taken orally for 10–14 days. You may need to be given fluids through a drip if you become dehydrated. Milder cases may not need any treatment although your doctor may decide to stop any antibiotic that you were previously on. Your condition will be monitored closely and it is important to inform staff if you feel your symptoms are not improving or are becoming worse.

Healthy people are unlikely to develop a Clostridium difficile infection, but in addition to respecting the general visiting rules, all visitors must follow simple hygiene precautions including cleaning their hands on entering the ward and washing their hands with soap and water before leaving your room. Advice will be given to your visitors on the wearing and removal of apron and gloves.

If you have any concerns at all about someone visiting please discuss this with your doctor or nurse. If they are visiting other patients in the hospital it is best if they see you last.

Any soiled clothing can be transported home in a plastic carrier bag 
and washed separately on the highest setting (dependent on care 
instructions). Household gloves should be worn when handling soiled 
clothing and hands thoroughly washed and dried after their removal.

Provided your doctor is satisfied with your progress you may be 
discharged home with instructions to complete any treatment prescribed 
for you.

If you are going to a nursing/residential home or Ward in the Community 
the nursing staff will discuss your hospital stay with them prior to your 
discharge.

If you are still taking the prescribed treatment for your Clostridium difficile 
you will need to complete the course.

Remember to wash your hands with soap and water especially after using the toilet and before eating.

Occasionally Clostridium difficile can reoccur after stopping treatment 
(days/weeks). It is important that if your symptoms return or persist that 
you seek advice from your GP without delay.

Care should be taken if you need antibiotics in the future, as this may 
trigger a return of symptoms, such as diarrhoea.

The leaflet contains an information card which you must keep and show to anyone who may prescribe or issue you with any antibiotic in the future. 

Further information is available from the Infection Prevention Team
Royal Stoke Site - 01782 676360