Royal National Orthopaedic Hospital NHS Trust
Clostridium difficile
What is Clostridium difficile?
Clostridium difficile is a spore forming bacterium, which is present as one of the ‘normal’
bacteria in the gut of a small number of healthy adults. It is usually kept under control by
other bacteria that live in the gut that are essential for maintaining good health.
Although Clostridium difficile was first described in the 1930’s, it was not identified until the
late 1970’s as the cause of diarrhoea and colitis following antibiotic therapy. Lab tests have
identified over 100 different types of Clostridium difficile. One of these, type 027, is of
particular concern because it causes a greater proportion of severe disease and appears to
lead to higher mortality rates. Type 027 was found to be the main cause of infection in the
outbreaks of Clostridium difficile at Stoke Mandeville Hospital.
How do you catch Clostridium difficile?
Clostridium difficile can cause illness when antibiotics have killed off the ‘good’ bacteria in the
gut. Clostridium difficile is able to multiply in the intestine and produce toxins that damage the
cells lining the intestine, resulting in diarrhoea. A patient who has Clostridium difficile
diarrhoea excretes large numbers of spores, which can contaminate the general environment
around the patient’s bed. These spores can be transported on the hands of healthcare
personnel who have direct contact with infected patients or with environmental surfaces
(floors, bedpans etc) contaminated with Clostridium difficile.
What can we do to prevent infection?
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Hands should always be washed after any physical contact with a patient. Alcohol
gel does not kill the spores
Healthcare workers should avoid prescribing broad spectrum antibiotics, as far as
possible, so that patients’ natural protection is not weakened
Infected or suspected infected patients should be isolated and healthcare workers
looking after them should wear gloves and aprons
Environments should be kept clean at all times
What is the treatment?
Fortunately, most patients develop only a mild illness and stopping the antibiotics, if clinically
possible, together with fluid replacement, either by mouth or intravenous drip, usually results
in rapid improvement. Sometimes, however, it is necessary to give specific therapy against
Clostridium difficile itself. Two antibiotics are known to be effective in treatment.
Metronidazole taken by mouth is often prescribed as the first choice; if this is not effective
then another antibiotic, Vancomycin, also taken by mouth, can be tried. There is a risk of a
relapse of symptoms in about 20-30% of patients and further courses of these antibiotics
may be required.
What is the risk to health care workers and patients’ relatives?
Because most patients with this condition have recently received antibiotics, hospital staff
such as nurses and doctors, and patient's relatives are at little risk of catching the illness
themselves. However, should these people be receiving antibiotics then they may be at
some risk of infection, and therefore they should be especially scrupulous in their hand
washing.
Clostridium difficile at the RNOH
The Trust has had eight cases of Clostridium difficile since April 2007. They have all been
isolated cases with no outbreaks and no type 027. In all cases it is believed that the patient is
likely to have contracted Clostridium difficile due to antibiotic administration.
Kathryn Corder
Acting Director of Nursing
March 2008