Clostridium difficile, more commonly known as C.

diff, is a bacteria which lives in the

guts of five per cent of normal people. The level of C. diff in the gut is controlled by all
the other normal bacteria living there.

If a patient takes a course of antibiotics, there is a chance some of the gut bacteria will
be affected and the balance of bacteria in the gut may alter. If this happens, C. diff may
be able to multiply to large numbers and cause diarrhoea.

If a patient has diarrhoea due to C. diff, large numbers of C. diff bacteria will be
released from the gut into the environment and it is possible that C. diff can transfer to
other patients and cause further infection.

What type of illness does it cause?

The main symptom is diarrhoea, but stomach pains and fever may
also occur. In most people, C. diff is a mild but uncomfortable
diarrhoea which settles without complication. In a few people,
particularly the elderly, the diarrhoea is more severe and dehydration
may develop. Rarely, C. diff causes extensive damage to the gut wall
(called pseudomembranous colitis) which can lead to rupture of the
gut wall and risk of death

How is C. diff diagnosed?

The laboratory looks for the presence of C. diff toxin in a stool

sample. This test can remain positive for up to 6 weeks after infection
has cleared, so you will not be asked for a further sample to check the
infection has gone.

How is C. diff treated?

If possible, any antibiotics should be stopped and any dehydration

treated with fluid replacement. For mild diarrhoea this is usually
enough to settle the diarrhoea. In more severe cases, specific
antibiotics to treat C. diff may be needed. The main treatment for C.
diff is metronidazole which is usually taken by mouth for 7-10 days. If this does not
work, then another antibiotic called vancomycin may be given.

How is the spread of C. diff prevented?

If a patient develops C. diff diarrhoea they will be put into isolation to prevent other
patients from being exposed to C. diff. This will usually be in a single room or the
patient may be ‘barrier nurse’ in a bay. This means that staff will wear gloves and
aprons whilst caring for this patient and will ensure that they remove these gloves and
aprons and wash their hands thoroughly before tending to another patient. The patient
will also be given their own toilet facilities which will not be shared by other patients.

C. diff can produce spores which allow it to survive for long periods in the
environment- such as on floors, bed rails or around toilet seats. It is important that these
areas are rigorously cleaned to remove C. diff spores, so that it can not be picked up by
other patients in the area.

How can infection be prevented?

The key to preventing C. diff infection in the first place is the sensible use of antibiotics.
This is why doctors do not prescribe antibiotics for minor coughs and colds. When
doctors do prescribe antibiotics, they try to choose and antibiotic which will treat the
condition but without too much impact on the body’s normal bacteria. This is
sometimes a difficult balance to achieve if a patient is very unwell.

If a patient develops diarrhoea, the preventative measures mentioned above will help to
minimise the risk of spread to other patients.

A new strain of C. diff

In the last few years, a new, virulent strain of C. diff has emerged. This strain is called
the ‘027’ strain and is associated with more severe illness. This strain was responsible
for the highly publicised Stoke Mandeville Hospital outbreak in 2004. Unfortunately, it
is difficult to know which strain a patient is infected with when they first develop C.Diff
infection. Luckily, the ‘027’ strain is treated with the same antibiotics that treat normal
C. diff strains. Hospitals are now very vigilant for the appearance of the ‘027’ strain and
meticulous infection control precautions are put in place when any patient develops C.
diff infection.

C. diff at the Royal Free

In 2004 it became mandatory for all hospitals to report their C. diff rates. In that year
the Royal Free had the 19th lowest rate of C. diff in the country and 3rd lowest rate in
London. Royal Free has not suffered an outbreak of C. diff infection for over 5 years.
We have had very robust policies for minimising C.Diff infection in place for many
years. These include a strict antibiotic policy, infection control policies for isolation and
policies for enhanced cleaning for cases of C. diff.

More information

You can get more information on C. diff at www.hpa.org.uk