C.diff modules

Question 1

What is C.difficile ?

Answer 1

A spore forming bacteria present in 2-5% of the population which can live with the normal bowel flora without causing harm

Question 2

What is a C.difficile infection ?

Answer 2

• Some antibiotics or enteral feeds can interfere with the balance of normal bowel flora (antibiotics kill both good and bad bacteria) if this is the case C/difficile can multiply and produce toxins which cause illness with symptoms such as diarrhoea
• Known as a C/difficile infection

Question 3

What are the antibiotics most associated with causing C.difficile ?

Answer 3

1. Clindamycin
2. Cephalosporins
3. Ciprofloxacin
4. Co-amoxiclav

The 4 C’s

Question 4

What is the main risk factor for the development of C/difficile ?

Answer 4

Previous exposure to antibiotics

Question 5

what is the most common cause of healthcare associated GI infection ?

Answer 5

C.difficile

Question 6

How may patients squire C.difficile in hospital?

Answer 6

Question 7

For a patient to get a C.difficile infection what 3 things must occur ?

Answer 7

1. Bowel flora must be altered
2. Bowel must be colonised with a toxic strain of C.difficile
3. C.difficile must then grow and produce its toxins

Question 8

What are the main risk factors for C.difficile infection?

Answer 8

Question 9

How long after antibiotic treatment commencement do symptoms of C.difficile occur and how late can they present ?

Answer 9

• Usually occur 4-9 days after antibiotic treatment
• Can occur upto 8 weeks after discontinuation of antibiotic treatment

Question 10

What is the most common symptom of C.diff infection ?

Answer 10

Diarrhoea

Question 11

what are the symptoms of mild C.diff infection (CDI)?

Answer 11

Usually only diarrhoea

Question 12

what are the additional symptoms for moderate and severe CDI ?

Answer 12

• abdo cramps
• fever
• Raised WCC
• Even more frequent stools

Question 13

When may other symptoms be present in CDI ?

Answer 13

In severe cases e.g. pseudomembranous colitis, toxic megacolon and peritonitis

Question 14

Is severe CDI always associated with diarrhoea ?

Answer 14

No - should be suspected in patients showing ileus (bowel obstruction) or sepsis with risk factors of CDI

Question 15

Define what is meant by diarrhoea

Answer 15

Question 16

How does CDI spread?

Answer 16

• C.diff produces spores which are released into the environment via faeces
• The main source is the faecal-oral route - indirect/direct contact with an infected person or surface and then touching their mouth/eating the spores

Question 17

When should treatment for CDI be started ?

Answer 17

Immediately - it should be initiated based on ssymptoms and severity of disease do not wait for microbiology results

Question 18

How frequently does recurrence of CDI occur ?

Answer 18

20% of the time

Question 19

What 5 things must you do to prevent cross transmission when an individual has known or suspected CDI?

Answer 19

1. Isolate patient if symptomatic - until 48hrs symptom free and bowels returned to normal. After this a terminal clean of patients room done
2. Review antibiotic regime
3. Use PPE correctly - gloves and apron should be worn prior to each care activity
4. Decontaminate equipment and patients immediate environment
5. Perform hand hygiene correctly (with warm liquid and soap not alcohol gel)

Question 20

when is a patient considered to be clear of a CDI ?

Answer 20

• Clear if asymptomatic for 48hrs and bowel habits have returned to normal (specimens to confirm this are not required or accepted by the lab)
• Precautions should continue until these criteria are met