Clostridium difficile aka C. diff review for nurses & nursing students
Clostridium difficile (C.diff) is starting to become more and more common in the healthcare facilities. This bacterium causes symptoms that range from diarrhea to life threatening inflammation of the colon.
Older patients that are admitted into long term or acute care facilities usually become ill with C.diff. C.diff usually occurs after the use of antibiotic therapy. In recent studies, there seems to be an increase of C.diff in persons not usually considered high risk, examples include younger and healthier people without any current antibiotic use or recent hospitalizations.
Signs and Symptoms
While some patients have the C. diff bacterium in their colon, they may never become ill. That being said they can still spread the illness to others. It is important to note that C. diff will usually develop within a few months of taking antibiotics.
Mild to moderate C. Diff infection will consist of abdominal cramping, tenderness and watery stools for 2 or more days.
Severe C. diff infection is when the bacterium causes colitis (colon becomes inflamed), this may form areas of raw tissue that can produce pus (pseudo membranous colitis) or bleed. The following may be seen with severe infection:
- Pus or blood in stool
- watery stool 10-15 times per day
- dehydration requiring hospitalization
- abdominal pain
- loss of appetite
- weight loss
- renal failure
- CBC show increased white count
How do patients contract C. diff:
While C. diff is found in air, water, soil, feces (human and animal), and certain food products. It is essentially found in many places in our environment. There is also a small number of people who are carriers of the bacteria without ever becoming sick with the illness.
C. diff in the past has always been associated with occurring in healthcare facilities as a higher percentage of patients carry the bacterium, there are studies that have shown that there is an increasing rate of community-associated C.Diff infections that are occurring in the more non-traditional populations such as adults and children that do not have a history of recent hospitalization or recent antibiotic use.
C. diff is is passed in feces and is spread food, objects, and other surfaces when proper handwashing was not done. The spores produced by this bacteria can live for weeks or months. If touched by a person, they may may unknowingly swallow the bacteria.
The bacteria in the intestines help protect the patients body from infection. However, when the patient is taking an antibiotic to treat an infection, the antibiotics will kill the normal bacteria and well as the bacteria causing an illness. If the patient does not have an adequate level of normal healthy bacteria, C. diff will rapidly grow at an alarming rate. The most common antibiotics that can foster C. diff infection are fluoroquinolones, cephalosporins, clinadamycin, and penicillians.
C. diff produces toxins that attack the intestinal lining. These toxins produce plaques of inflammatory cells, they destroy cells, and the decaying cellular waste inside the colon causes watery stools.
There is a newer more virulent strain of C. diff that has occurred that produces more toxins than the other strains do. The newer strain is thought to be more resistant to certain medications and has manifested in persons who have not taken antibiotics or been in a healthcare facility.
Who is more at risk for getting C. diff?
Anyone can become ill with a C. diff infection, however the following factors can increase a patients risk:
- taking medication such as Protonix (proton pump inhibitors) that reduce stomach acid.
- Current or long term use of antibiotics.
- Recent hospitalization.
- Older age (usually over the age of 65)
Germs spread easily in healthcare facilities. As a result antibiotic use is common. C. diff can be spread on the hands, bed rails, bedside tables, toilets, sinks, telephones, remote controls, stethoscopes, cart handles, etc.
Other risk factors
- Colorectal Cancer
- weakened immune system either from medical condition or medical treatment (chemotherapy).
- Past history of C. diff can usually predispose the patient to more C. diff infections.
- Bowel perforation: results from damage to lining of large intestine. Once the bowel is perforated, bacteria enters abdominal cavity. This infection called Peritonitis can be life threatening.
- Dehydration: this is due to severe diarrhea. As a result, there could be significant loss of fluids and electrolytes. These losses can lead to major electrolyte imbalances and hypotension.
- Renal failure: kidney function can be compromised from the dehydration.
- Toxic Megacolon: the colon is unable to expel stool and gas. This causes distention and if left untreated can cause rupture of the bowel. This will require emergency surgery and could be fatal.
The tests the are used to diagnose C. diff are collected by stool samples. These test include:
- Polymerase chain reaction (expensive and not available at all labratoires).
- Enzyme immunoassay (usually results in several hours).
- Cell cytotoxicity assay (can take 24-48 hours for results).
- Stool culture (2-3 days for results)
Colon exam done by colonoscope or sigmoidoscope may be helpful by looking for areas of inflammation.
A ct scan and xray may be useful. These exams may detect expanding bowel or thickening of intestinal wall.
The initial step in fighting C. diff infection is to stop that antibiotic that may have triggered the illness.
- Antibiotics: Usually Flagyl (metronidazole) for mild to moderate infection. Vancomycin for more severe infections. More antibiotics will be used as research is done.
- Surgery: This is a possible option for those with severe symptoms. Of note, this surgery may involve removing the colon.
- Fecal Microbiota Transplant (FMT): This is a stool transplant. This treatment as of this writing is still experimental. The basic idea is placing a healthy persons stool into a person who suffers from recurrent C. diff infections in hopes of putting healthy bacteria into the affected persons colon.
- Probiotics: These organisms such as bacteria and yeast help to restore the healthy balance in intestine, and may help deter further recurrent C. diff infections.
- Hand – washing!!!!!!! Soap and water is more effective than alcohol based sanitizers. Sanitizers do not destroy C. diff spores effectively.
- Contact precautions: Patients with C. diff may be assigned to a private room or may share a room with a patient with the same illness. Staff and visitors should wear disposable gloves and gowns while in room.
- Cleaning equipment and room: all surfaces should be disinfected with a product that contains chlorine bleach as C. diff spores can survive on surfaces if not cleaned with chlorine bleach.
C. diff Podcast
The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.