Clostridium difficile

About the organism 

Clostridium difficile (C. difficile) is a spore-forming, gram-positive anaerobic bacillus that produces two large exotoxins (toxin A and toxin B), which cause diarrhea and colitis in susceptible patients whose normal colonic bacterial flora has been previously disrupted by prior antimicrobial treatment.

Diseases that result from C. difficile infection include pseudomembranous colitis, toxic megacolon, perforations of the colon, sepsis, and very rarely death.

The main clinical symptoms of C. difficile include:

  •  Watery diarrhea
  •  Fever
  •  Loss of appetite
  • Nausea
  • Abdominal pain/ tenderness

Risk factors of C. difficile infection include:

  • Patients with antibiotic exposure
  • Gastrointestinal surgery/ manipulation
  • Long length of stay in a healthcare setting
  • A serious underlying illness
  • Immunocompromising conditions
  • Advanced age

Infection prevention and control 

C. difficile is shed in feces and the ability of the organism to produce spores enables it to survive for months in the environment of healthcare institutions.  Any surface, device, or material (e.g., commodes, bathing tubs, and door knobs) that becomes contaminated with feces may serve as a reservoir for C. difficile spores. These spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item. Because C. difficile spores are not killed by alcohol, washing hands with of soap and water (while applying friction) is highly important. Environmental hygiene is also highly important as C. difficile spores will contaminate surfaces unless properly disinfected. C. difficile spores are removed best when using a bleach product in conjunction with friction.

Prevention and control of C. difficile spore transmission to patients can be accomplished through good hand hygiene, gloving, barrier precautions, and thorough environmental cleaning.

If a patient is positive for C. difficile, place the patient on contact plus precautions. 

  • Isolated patients should not share bathrooms, unless cohorted for same disease
  • Gloves and gowns are both required at all times upon room entry; change gown if soiled and remove gown before leaving patient's room
  • Change gloves after contact with infectious material that may contain a high concentration of microorganisms
  • Perform hand hygiene with soap and water for a minimum of 15 seconds after removing gloves and before leaving room
  • Visitors must follow standard precautions and must be screened for signs and symptoms consistent with C. difficile

More information can be found in the following policies:

Transmission based isolation policy.

Patient isolation grid. 

Patient deisolation grid.

More information about Clostridium difficile can be found on the Center for Disease Control and Prevention website.

Access C. difficile infection data on Statit: Statit user guide