Clostridioides difficile (C. diff)

Organism, Causative Agent, or Etiologic Agent
Clostridioides difficile (C. diff) 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.

Transmission
C. diff shed in feces and can live outside the human body for a very long time. C. diff may be found on things in the environment such as bed linens, bed rails, bathroom fixtures, and medical equipment. C. diff infection can spread from person-to person on contaminated equipment and on the hands of doctors, nurses, other healthcare providers and visitors.

Symptoms 
The most common symptoms of a C. diff infection usually include: watery diarrhea, fever, loss of appetite, nausea and belly pain and tenderness. An individual can also be a colonized with C. diff and have no symptoms.  

Prevention
The risk for C. diff infections is increased in patients with: antibiotic exposure, proton pump inhibitors, gastrointestinal surgery/manipulation, a long length of stay in healthcare settings, a serious underlying illness, immunocompromising conditions and advanced age. There are many prevention measures you can put in place early on to help lessen your chance of getting C.diff.

  • Be sure to clean your hands often, especially after using the bathroom and before eating.

In a healthcare setting you can prevent C. diff by:

  • Make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water.
  • If you do not see your providers clean their hands, please ask them to do so.
  • When you are prescribed antibiotics take all that come in the package, take them as listed on the instructions. If you do not understand the instructions, ask your pharmacist. Do not share or save antibiotics. Do not stop taking the antibiotics even if you feel better; finish all the antibiotics you are prescribed.

School Exclusion
There is no school exclusion for people specifically with a Clostridioides difficile infection. However, children in day care or schools with diarrhea should stay home until diarrhea stops for 24 hours without the use of diarrhea-suppressing medications.

Texas Trends
In 2013, the Texas legislature funded C. difficile prevention activities. The activities aim to improve laboratory identification, antibiotic utilization, and infection prevention protocols.
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Resources

Healthcare Safety Unit

Healthcare Safety Unit

Antimicrobial Resistance/Multidrug-Resistant Organisms