Clostridium Difficile Infection
Clostridium difficile (C. diff) bacteria can be very harmful. They affect the intestinal tract. They can cause symptoms ranging from mild diarrhea to severe inflammation of the large intestine (colon). C. diff infection is most common during the days and weeks after treatment with antibiotics. Anyone can become infected. But the risk is greatly increased for people in hospitals and for people living in nursing homes or long-term care facilities. This is because antibiotic use is common there. Germs also spread easily in these places.
What causes C. diff infection?
The stomach and intestines have hundreds of kinds of bacteria. Many of these bacteria actually help keep harmful bacteria like C. diff from causing problems. Small amounts of C. diff are normal in the intestine and don’t cause problems. When you take an antibiotic, the normal balance of good and bad bacteria may be affected. There may be too few good bacteria and too many harmful bacteria like C diff. In hospitals and nursing homes, C. diff may be spread from an infected person to others. This can happen when staff or visitors touch infected people or objects such as bed rails, stethoscopes, or bedpans and then touch other people or surfaces.
What are the symptoms of C. diff infection?
About half of people with C. diff infection have no symptoms. Yet they can still pass the infection to others. Others do have symptoms. These include:
Watery diarrhea, which may contain mucus
Pain and cramping
Some who are infected develop serious problems. Symptoms include:
Belly (abdominal) pain
Nausea and vomiting
Little or no diarrhea
How is C. diff infection diagnosed?
To confirm the infection, a sample of stool is tested for the bacteria or the toxins made by the bacteria.
How is C. diff infection treated?
Your healthcare provider will tell you to stop taking any antibiotics you have been prescribed, based on your healthcare needs. He or she may prescribe different medicines as needed. In certain cases, you may be given an antibiotic directed at the C. diff infection. Talk with your healthcare provider before stopping or starting any medicines.
Fluids are often given by IV (intravenously) through a vein. This helps replace fluids lost through diarrhea.
In rare cases you may need surgery if treatment doesn’t cure severe symptoms
To lessen symptoms:
Drink plenty of fluids to replace water lost through diarrhea. Talk with your healthcare provider or nurse about which fluids are best.
Follow your healthcare provider’s instructions for when and what to eat.
Unless your healthcare provider tells you to do so, don't take medicines for diarrhea.
Tell your healthcare provider if symptoms return. Even after treatment, C. diff may come back.
Your doctor may give you an additional medicine if your symptoms come back or you are at risk for another C. diff infection. This medicine is called bezlotoxumab. It is not an antibiotic, but it can help keep your C. diff symptoms from returning.
What are the complications of C. diff infection?
Low protein in the blood
Severe widening (dilation) of the large intestine
A hole (perforation) in the bowel
Low blood pressure
Inflammation or infection all over the body
How is C. diff prevented?
Hospitals and nursing homes take these steps to help prevent C. diff infections:
Limiting use of antibiotics. Giving antibiotics only when needed can help reduce C. diff infections.
Handwashing. Hospital staff should wash their hands before and after treating each person. They should also wash their hands after touching any surface in someone's' room. Soap and water work better than alcohol-based hand cleaners.
Protective clothing. Healthcare workers should wear gloves and a gown when entering the room of someone with C. diff infection. They should remove these items before leaving and then wash their hands.
Private rooms. People with C. diff should be in private rooms. Or they may share rooms with others who have the same infection.
Thorough cleaning. Equipment and rooms should be cleaned and disinfected every day.
Education. Everyone should be shown the best ways to avoid infection.
You can do the following to help prevent C. diff:
Take antibiotics only when you really need them. Antibiotics don’t help treat illnesses caused by viruses. This includes colds and the flu. Don’t ask for antibiotics from your healthcare provider if he or she says they won’t work.
When you are given antibiotics, take them as directed. Don’t take more or less than the dosage prescribed. Do not take them for shorter or longer than your provider tells you to, even if you feel better.
Wash your hands carefully. Do this after using the bathroom and before eating. Use plenty of soap and warm water. Alcohol-based hand cleaners may not work against C. diff germs.
Everyone can help prevent C. diff:
In a hospital or care facility:
Wash your hands well before and after visiting someone who has C. diff infection. Use soap and water. Alcohol-based hand cleaners may not work against C. diff.
If the staff asks you to, wear gloves. Take any other steps you are asked to follow to help prevent infection.
If instructed, wear gloves when caring for a family member with C. diff infection. Throw the gloves away after each use. Then wash your hands well.
Wash the person’s clothes, bed linen, and towels separately. Use hot water. Use both detergent and liquid bleach.
Disinfect surfaces in the person’s room. This includes the phone, light switches, and remote controls.
Practice good handwashing:
Use warm water and plenty of soap. Rub your hands together well.
Clean your whole hand. Wash under nails, between fingers, and up your wrists.
Wash for at least 15 seconds to 20 seconds.
Rinse. Let the water run down your fingers, not up your wrists.
Dry your hands well. Then use a paper towel to turn off the faucet and open the door.
October 08, 2017
Clinical Practice Guidelines for Clostridium difﬁcile Infection in Adults: 2010 Update. Cohen, S. Infection Control and Hospital Epidemiology. 2010, is. 31, ed. 5, pp. s431-55., Clostridium Difficile Infection in Adults: Clinical Manifestations and Diagnosis. UpToDate., Clostridium difficile infection: Prevention and Control. UpToDate.
Cunningham, Louise, RN,Fetterman, Anne, RN, BSN,Lentnek, Arnold, MD