Clostridium difficile in Health Care Settings

Information for Health Care Professionals

Highlights:

• Think about C. difficile infection in patients presenting with diarrhea, especially among those with risk factors
• Ensure appropriate infection prevention and control practices are used consistently
• Familiarize yourself with the Provincial Infectious Diseases Advisory Committee (PIDAC) document "Best Practices Document for the Management of Clostridium difficile in all Health Care Settings"

C. difficile is a leading cause of healthcare associated diarrhea. Outbreaks of Clostridium Difficile Infection (CDI) have occurred in a variety of acute-care, long-term care and community settings.

C. difficile has been a known cause of health care associated diarrhea for about 30 years. C. difficile is a spore-forming, gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15-25% of all episodes of AAD.

Clinicians should consider C. difficile when patients, with risk factors, present with diarrhea.

• antibiotic exposure
• gastrointestinal surgery/manipulation
• long length of stay in healthcare settings
• a serious underlying illness
• immuno-compromising conditions
• advanced age

• new onset of diarrhea (e.g. ≥3 loose/watery bowel movements in a 24 hour period) that is unusual or different for the patient; and
• there is no other recognized etiology for diarrhea, such as laxative use, inflammatory bowel disease or other etiology.

The consistent use of Routine Practices is essential in providing care to all patients/residents.

• Initiate Contact Precautions
• Start appropriate empiric therapy
• Submit stool sample for laboratory confirmation

• Hand hygiene
• Environmental cleaning

Contact Precautions for C. difficile should continue until the patient/resident has had at least 48 hours without symptoms of diarrhea. Precautions should only be discontinued under the direction of Infection Prevention & Control.

For patient transfer, the relevant clinical information should be communicated to the appropriate health care professionals. Health care settings should establish a process for management of antibiotic use, including regular review of antibiotic utilization.

• Health Care Workers must not consume food or beverages in patient care areas.
• Health Care Workers, including those receiving antibiotics, are not at risk of acquiring C. difficile occupationally. Health Care Workers must always follow Routine Practices, specifically hand hygiene before and after contact with all patients, and use Contact Precautions when caring for patients with C. difficile.

• Best Practices Document for the Management of Clostridium difficile in all Healthcare Settings
• Your Regional Infection Control Network (RICN)