Protected: C.diff

C,diff. is a spore-forming bacterium. C. difficile is a major cause of antibiotic associated diarrhoea and colitis, healthcare associated infections (HCAI’s) that mostly affect elderly patients with other underlying diseases.

Certain antibiotics may change the natural balance of bacteria in the bowel; this enables C.diff to multiply and produce toxins that can cause diarrhoea. C. diff acquisition may result in asymptomatic carriage, loose stools or profuse diarrhoea which can result in life-threatening pseudo-membranous colitis and toxic megacolon. CDI is most common in people over the age of 65 years but any age group may be susceptible, with the exception of very young children (<2yrs).

• The main symptom is explosive diarrhoea which has a particularly unpleasant smell.
• Other symptoms include stomach cramps, fever, nausea and loss of appetite.
• Most people become only mildly ill and then recover fully.
• The vast majority of patients make a straightforward recovery.
• Some patients may become seriously ill and develop inflammation of the bowel (colitis). If the colitis is severe it can be life-threatening

If NIAS staff are aware that the patient has a previous history of C.diff then this should be communicated to EAC and ED staff when transferring the patient to ensure effective patient care and management.

NIAS staff should ensure that all patients who are symptomatic of Infective diarrhoea should be risk assessed for a C.diff infection.

C.diff can be ingested and spread between patients either through contact with a patient known C.diff infection / have current C.diff carriage  or by touching the environment that has been occupied by a patient with C.diff e.g. patient equipment, stretchers, hand rails, straps etc.

It can also be spread through staff’s hands if staff do not adhere to the 5 moments of Hand Hygiene (HH) using the 7 step technique. It is also essential that staff use PPE appropriately ensuring that gloves are used and changed appropriately with HH. This will help protect both staff and patients from transmission of C.diff.

• Hand Hygiene should be completed as per the 5 moments in line with usual practice. HH should be completed with Soap and Water.
• Eye protection should always be risk assessed and used with any patient where there is a risk of splashes including spitting and productive coughing.
• Gloves and Aprons should be worn.
• The patient should be transported via ambulance (eg. PCS) with no other patients present where possible. Individual cases can be discussed with the IPC team and a risk assessment can be made.
• All equipment and the ambulance should have a deep clean paying particular attention to touch points using a hypochlorite solution.
• Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.

Staff do not routinely need to be followed up after caring for a patient with C.diff. Adherence to all IPC precautions is essential.

The IPC team can be contacted for further advice if a patient with a known history of C.dfiff or a possible active C.diff infection has been identified. The team will be able to help staff risk assess the patient and precautions required and to provide support where required.