Clostridium difficile may cause antibiotic associated diarrhoea in a person in hospital and at home.

Infection can sometimes occur after taking antibiotics needed to treat another illness. Antibiotics can alter the balance of gut bacteria allowing Clostridium difficile to multiply. Poisons (toxins) are released into the gut which leads to diarrhoea. Symptoms can range from mild diarrhoea, abdominal pain, nausea and fever to more severe symptoms which can occasionally be life threatening.

The Clostridium difficile bacterium can be found living in the bowels (gut) of a small proportion (less than 5%) of the healthy adult population. It can also live harmlessly in the bowels of babies and young children. Clostridium difficile bacteria are shed in faeces. The bacteria produce spores that can survive in the environment for a long time. A vulnerable person can develop symptoms by contact with contaminated surfaces.

Elderly patients with other underlying illnesses are most at risk of getting Clostridium difficile infection. The majority of people affected are those over 65 years of age, but symptoms can occur in anyone who has:

• been recently treated with antibiotics
• had abdominal surgery
• had a long stay in hospital or nursing home
• an immune system that is not working properly

Any patient who has liquid diarrhoea while in hospital will have a specimen sent to the laboratory to be tested for getting Clostridium difficile.

All patients symptomatic of diarrhoea are nursed in single bedded cubicle (isolation) until 48 hours symptom free.

Hands must be washed with a liquid soap solution after any physical contact with the patient or their environment. Alcohol based hand gel is not effective against Clostridium difficile spores.

Staff wear disposable aprons and gloves when caring for symptomatic patients. Visitors are not required to wear gloves and aprons but must comply with good personal hand hygiene practices on entering and leaving the single room.

Patients laundry can be taken home in a plastic bag, then washed separately from other household clothing in a washing machine set to the hottest cycle possible for the materials involved and then tumble dried/ironed whenever possible.

Clostridium difficile is treated with other antibiotics. It is important that the whole course of antibiotic treatment is completed even if the symptoms resolve. Once the diarrhoea has resolved the infectious period is over; occasionally symptoms can recur however most cases of Clostridium difficile diarrhoea make a full recovery.

No special precautions are required by a person who has had Clostridium difficile associated diarrhoea and who is clinically asymptomatic i.e. they no longer have diarrhoea. Clostridium difficile may be carried in the faeces for a prolonged period of time but providing each individual maintains good standards of personal hygiene after using the toilet they are not a risk to others.

If you have had Clostridium difficile associated diarrhoea and are admitted to any hospital you (or a relative) should tell the nursing and medical staff looking after you. If you have symptoms of diarrhoea you will be nursed in a single bedded cubicle and specimens taken to check for the presence of Clostridium difficile.

If you would like any further information, or have specific questions about Clostridium difficile please do not hesitate to ask the Ward or Department staff. The Infection Control Team is always happy to advise patients, relatives or carers who have particular concerns about Clostridium difficile and can be contacted via the ward or Department staff. Alternatively contact one of our Infection Control Nurses via our switchboard on (0191) 233 6161.