C. difficile

• Clostridium difficile, is a spore-forming bacterium that causes diarrhea and other serious intestinal infections. It is the most common cause of infectious diarrhea in patients in hospitals and long-term care facilities in the industrialized world.
• Because C. difficile spores are shed in the feces, it is possible for surfaces in patient rooms, patient equipment, and personal items to become contaminated. These contaminated objects become sources of infection. Patients can become infected if they touch items or surfaces that are contaminated with fecal traces, and then touch their mouth or nose.
• C. difficile is most commonly spread by contact with the hands, often those of caregivers such as health care workers, who can unknowingly spread the bacterium during routine procedures between patients. C. difficile can also be spread through contaminated surfaces, objects, or equipment such as: bedrails, thermometers, toilet seats, wheelchairs, and commodes.
• The spores of C. difficile allow the survival of this organism in the environment for long periods of time. Furthermore, spores are also resistant to a number of common disinfectants and may survive in the hospital environment if cleaning has not been adequate. Much more needs to be understood about the role of the environment in the spread of C. difficile and how best to control it.
• In Canada, the number of cases and deaths associated with C. difficile has been increasing. It has been projected that nosocomial (hospital-associated) transmission would increase to 6-7 cases per 1,000 in 2007.

Why C. difficile is a problem

• In Canada, the number of cases and deaths associated with C. difficile has been increasing. It has been projected that nosocomial transmission would increase to 6-7 cases per 1,000 in 2007.
• Infections caused by C. difficile result in 15-25% of all episodes of antibiotic-associated diarrhea. For people with mild symptoms, no treatment may be required. For severe cases, medication and surgical interventions may be required.
• In severe cases, C. difficile can result in intense inflammation of the bowel (pseudomembranous colitis), toxic megacolon, perforations of the colon and bacterial bloodstream infection, which can be life-threatening. According to the CDC, these C. difficile-associated diseases are found at the following rates:
  • In acute care settings, 3-25 cases/10,000 patient days
  • In long-term care, 5-7% of patients carry the organism in their intestinal tract.
• Especially since the year 2000, an extremely virulent strain of C. difficile has been causing epidemics in health care settings. In 2003-04, a new strain, twenty times more virulent than those commonly observed, struck Quebec hospitals, leading to a 60% increase in the number of C. difficile-related deaths. In the year ending March 31, 2004, 1,270 people died in Quebec due to hospital-acquired C. difficile infections. During these Quebec outbreaks, the 30-day attributable mortality rate for C. difficile was 6.9%; over a 12-month period, it was 16.7%.
• This new, more virulent strain is now moving across Canada, resulting in a cluster of hospital deaths late in the year throughout Ontario.
• C. difficile is difficult to clear from the environment because once out of the human body, its spores are resistant to heat, cold, chemicals and disinfectants. In older facilities, C. diff is particularly difficult to eliminate.