Thursday May 17, 2012
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FAQ's - Frequently Asked Questions
   
Clostridium difficile  
1. What is C. difficile infection?

C. difficile [pronounced Klo-STRID-ee-um dif-uh-SEEL], also known as "C. diff” [See-dif], is a germ that can cause diarrhea. Most cases of C. difficile infection occur in patients / residents taking antibiotics. The most common symptoms of a C. difficile infection include:
  • Watery diarrhea
  • Fever
  • Loss of appetite
  • Nausea
  • Belly pain and tenderness
2. Who is most likely to get C. difficile infection?

The elderly and people with certain medical problems have the greatest chance of getting C. difficile. The spores can live outside the human body for a very long time and may be found on things in the environment such as bed linens, bed rails, bathroom fixtures, and medical equipment. C. difficile infection can spread from person-to-person on contaminated equipment and on the hands of doctors, nurses, other healthcare providers and visitors.
3. Can C. difficile infection be treated?

Yes, there are antibiotics that can be used to treat C. difficile.  Occasionally, in severe cases, a person might have to have surgery to remove the infected part of the intestines. This surgery is needed in only 1 or 2 out of every 100 persons with C. difficile.
4. What are some of the things that hospitals are doing to prevent C. difficile infections?

To prevent infections, doctors, nurses, and other healthcare providers:
  • Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient. This can prevent  C. difficile and other germs from being passed from one patient to another on their hands.
  • Carefully clean hospital rooms and medical equipment that have been used for patients with C. difficile.
  • Use Contact Precautions to prevent C. difficile from spreading to other patients. Contact Precautions mean:
  • Whenever possible, patients with C. difficile will have a single room or share a room only with someone else who also has C. difficile.
  • Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with C. difficile
  • Visitors may also be asked to wear a gown and gloves.
  • When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands.
  • Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They can go to other areas of the hospital for treatments and tests.
  • Only give patients antibiotics when it is necessary. 
5. What can I do to help prevent C. difficile infections?
  • Make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water or an alcohol-based hand rub before and after caring for you.
  • Only take antibiotics as prescribed by your doctor.
  • Be sure to clean your own hands often, especially after using the bathroom and before eating.
6.  Can my friends and family get C. difficile when they visit me?

C. difficile infection usually does not occur in persons who are not taking antibiotics. Visitors are not likely to get C. difficile.  Still, to make it safer for visitors, they should clean their hands before they enter your room and as they leave your room and ask the nurse if they need to wear protective gowns and gloves when they visit you.
7.  What do I need to do when I go home from the hospital?

Once you are back at home, you can return to your normal routine. Often, the diarrhea will be better or completely gone before you go home. This makes giving C. difficile to other people much less likely. There are a few things you should do, however, to lower the chances of developing C. difficile infection again or of spreading it to others.  To protect against infections:
  • If you are given a prescription to treat C. difficile, take the medicine exactly as prescribed by your doctor and pharmacist. Do not take half-doses or stop before you run out.
  • Wash your hands often, especially after going to the bathroom and before preparing food.
  • People who live with you should wash their hands often as well.
  • If you develop more diarrhea after you get home, tell your doctor immediately.
  • Your doctor may give you additional instructions.
8.  Can pregnant health care workers (HCWs) be assigned to patients / residents who are symptomatic with C. difficile?

There are no occupational health and safety issues for workers pregnant or otherwise regarding C. difficile.  HCWs need to always follow Routine Practices during all care and ‘additional’ Contact Precautions when indicated to prevent and control transmission. This involves using gloves and gown for direct care or when there is the risk of soiling their clothing with the patient/resident’s contaminated environment.
9.  Should we do a C. difficile test on patients who have been treated for C. difficile infection to ensure we can safely take the patient off of Contact Precautions?

No. The C. difficile test does not test for the presence of the bacteria, rather, our laboratories test for presence of C. difficile toxins. C. difficile is a toxin-mediated disease, and the toxin can remain in the bowel for prolonged periods even after resolution of the infection. This can result in a "false positive" test. As such, a "test of cure" is not recommended. Furthermore, contact precautions are put in place to manage the environmental contamination related to C. difficile. Once the diarrhea has abated, environmental contamination is drastically diminished, and the patient / resident can be taken off of Contact Precautions. Decisions for additional precautions related to C. difficile are symptom-based rather than laboratory-based.
10.  Are there any special precautions that should be taken when handling dishes, linen and waste generated by a client who has C. difficile?

Page 11 of the PIDAC document titled ‘Best Practices for the Management of Clostridium difficile in all health care settings’ (January 2009) under heading 5.2, Contact Precautions, item (g) specifies that no special handling of trays, linen and waste is required for clients / patients / residents with C. difficile.
11.  When can a staff member that has been diagnosed with C. difficile return to work?

Staff members may return to work once symptoms of diarrhea have resolved for 48 hours and does not need a negative stool sample. Encourage hand hygiene, and to complete antibiotics as prescribed.
12.  Why does the stool sample have to be fresh?

For C. difficile toxin testing, the sample has to be fresh because the toxin breaks down in one to two hours and may result in a false negative test.   http://www.labtestsonline.org/understanding/analytes/cdiff/faq.html

13.  How do I know if a patient in my hospital with C. difficile has the "Quebec strain"?
    
It would be impossible to tell if this were the NAP1 strain without doing specialized laboratory testing. In fact, almost all laboratories in Ontario do not actually grow the organism to test for C. difficile -- they simply do toxin testing. A laboratory would need to grow the organism itself to do the genetic profile to determine whether it's the strain of concern or not; most laboratories do not have this capability. 
Even if it were the NAP1 strain, the care of the patient is not different. The precautions are the same, so it is not critical to find out the strain at all. In all cases you still need to monitor closely for severe disease, watch for recurrence of disease, and ensure that precautions are put back in place quickly if you have removed precautions and diarrhea starts again. Please refer to the PIDAC Best Practice Guidelines for further information on "Management of Patients with Clostridium difficile":

http://www.health.gov.on.ca/english/providers/program/infectious/diseases/ic_cdiff.html
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