How to control the infection?
Aside from medical treatment, supervision and prevention are the most efficient methods of control. Patient isolation is essential. The wearing of protective clothing, gloves, masks, and gowns is mandatory for medical personnel and visitors. Personal hygiene is an absolute. The careful washing of hands with soap or disinfectant before eating, after using the toilet, bedpan or commode, or having touched any possibly contaminated object, such as shared magazines, newspapers is paramount. Care should be exercised when touching taps, toilet flushing devices, and door handles of toilets. Daily cleaning and disinfection of facilities and furnishings on a regular basis is fundamental.

Why has there been a C. Difficile epidemic?
There are three main reasons underlying this epidemic which has had at least 7000 victims and caused some 1200 deaths between April, 2003 and March, 2004. Since then the statistics are not yet available but it is known that the problem has not been resolved. Since its first major outbreak, towards the end of 2002, there has been a further outbreak that is more virulent and resistant to treatment. The number of identified cases has more than doubled. The significant delay in Quebec, in the supervision and treatment of nosocomial infections is alarming. It has taken more than two years, since the first outbreak, for appropriate measures of control to be initiated, where these strategies have been known for a long time. Thus, this lack of transparency in making aware the information for both patients and the public, and the delay in implementing appropriate strategies, is a cause for major concern.

Note that C.Difficile is not the only bacteria responsible for nosocomial infections. Other bacteria such as MRSA are also extremely threatening. Every year new strains of bacteria, resistant to treatment develop. It is therefore evident that there is a compelling need for a more aggressive, rigid and systematic approach to containing and preventing the transmission of nosocomial infections. Such preventative measures will reduce the risk of infection thereby protecting the health and security of patients, which should be one of the guiding principles in the health care system.

Infections that are acquired while a patient is in a hospital are referred to as nosocomial infections; a term derived from 'nosos' the Greek word for 'disease'. Nosocomial infections are diseases that we, as heath care professionals, give to our clients. Hospitals and clinics are places where sick people go with the expectation that they will get better. Unfortunately, there is a risk that clients may become infected because of their visits to these places. Often nosocomial infections become apparent while the patient is still in the hospital but in some cases symptoms may not show up until after the affected patient is discharged. About one patient in ten acquires an infection as a direct result of being hospitalized.

For more specialized information on C. difficile:

Visit the CDC site (Center for Disease Control, Atlanta, USA by clicking here.

Visit the Québec Ministry of Health and Social Services pages by clicking here.

Quebec Ministry of Health flyer on C. difficile: click here

Read the following article:

Clostridium difficile

What is Clostridium difficile?

C. difficile is a spore forming bacteria which can be part of the normal intestinal flora in as many as 50% of children under age two, and less frequently in individuals over two years of age. C. difficile is the major cause of pseudomembranous colitis and antibiotic associated diarrhea.

What are the risk factors for C. difficile-associated disease?

C. difficile-associated disease occurs when the normal intestinal flora is altered, allowing C. difficile to flourish in the intestinal tract and produce a toxin that causes a watery diarrhea. Repeated enemas, prolonged nasogastric tube insertion and gastrointestinal tract surgery increase a person's risk of developing the disease. The overuse of antibiotics, especially penicillin (ampicillin), clindamycin and cephalosporins may also alter the normal intestinal flora and increase the risk of developing C. difficile diarrhea.

What are the symptoms of C. difficile-associated disease?

Mild cases of C. difficile disease are characterized by frequent, foul smelling, watery stools. More severe symptoms, indicative of pseudomembranous colitis, include diarrhea that contains blood and mucous, and abdominal cramps. An abnormal heart rhythm may also occur.

How is C. difficile-associated disease diagnosed?

C. difficile diarrhea is confirmed by the presence of a toxin in a stool specimen. A positive culture for C. difficile without a toxin assay is not sufficient to make the diagnosis of C. difficile- associated disease. Endoscopic findings are useful in diagnosis of pseudomembranous colitis.

What is the treatment for C. difficile-associated disease?

As soon as C. difficile disease is diagnosed, current antibiotic therapy should be reassessed by the physician. Patients with severe toxicity or unresolved diarrhea may need to have their antibiotic treatment modified to use drugs not known to result in C. difficile diarrhea. Patients should be monitored for dehydration and electrolyte imbalance following prolonged bouts of diarrhea. Antidiarrheal agents such as Lomotil® or Imodium® have been shown to increase the severity of symptoms and should NOT be taken.

How can C. difficile-associated disease be spread?

Individuals with C. difficile-associated disease shed spores in the stool that can be spread from person to person. Spores can survive up to 70 days in the environment and can be transported on the hands of health care personnel who have direct contact with infected patients or with environmental surfaces (floors, bedpans, toilets etc.) contaminated with C. difficile.

How can C. difficile-associated disease be prevented?

Strict adherence to hand washing techniques and the proper handling of contaminated wastes (including diapers) are effective in preventing the spread of the disease. Environmental surfaces contaminated with C. difficile spores should be cleaned with an effective disinfectant (bleach). Limiting the use of antibiotics will lower the risk of developing C. difficile diarrhea.

Clostridium difficile