C. difficile

What is C. difficile?

C. difficile is one of the many types of bacteria that can be found in the bowel, and has been a known cause of health care-associated diarrhea for about 30 years.

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Where does C. difficile come from?

C. difficile is not new. Although people may associate it with health care settings, it doesn’t come from hospitals, long-term care homes or laboratories. It is found in the intestine, occurring naturally in 3-5% of adults (more commonly in the elderly) without causing symptoms.

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What causes C. difficile?

C. difficile can be picked up on the hands from exposure in the environment and can get into the stomach once the mouth is touched, or if food is handled and then swallowed. Once in the stomach, the bacteria usually will not cause any problems unless the other bowel bacteria are disturbed, which can happen when antibiotics are taken. The use of antibiotics increases the chances of developing C. difficile diarrhea as it alters the normal level of good bacteria found in the intestines and colon.

Without the presence of the normal bowel bacteria, the C. difficile bacteria may start to grow and produce a toxin that can damage the bowel and lead to watery diarrhea, fever and abdominal pain or tenderness.

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How does C. Difficile spread?

When a person has C. difficile, the bacteria in their feces can contaminate surfaces such as toilets, bedpans, commode chairs, and door handles (if feces is on hands). Other healthy individuals can contaminate their hands if they touch these items. If these individuals then touch their mouths without washing their hands, they can become infected.

The spread of C. difficile occurs due to inadequate hand hygiene and environmental cleaning. C. difficile produces spores that survive for long periods and are resistant to destruction by many environmental factors (e.g. temperature, humidity).

Good hand hygiene is the single-most effective way to prevent the spread of infectious diseases like C. difficile.

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What does hospital acquired infection mean?

Sometimes when patients are admitted to the hospital, they get infections while they are in the hospital. This is a hospital-acquired infection or a nosocomial infection, such as MRSA, VRE or C. difficile.

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How is C. difficile treated?

Treatment depends on how sick you are. People with mild symptoms may not need treatment. For more severe disease, antibiotics are required.

What reporting information is Baycrest providing?

On the last day of each month, Baycrest, along with all of Ontario’s hospitals, is required to publicly report the following:

• rates of new hospital-acquired C. difficile cases associated with the reporting facility,
• separately for each hospital site; and
• the number of new hospital-acquired C. difficile cases associated with the reporting facility.

For information on Baycrest's rates, please visit the Health Quality Ontario website.

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How are the rates calculated?

The C. difficile rate is calculated as follows:

Number of new hospital-acquired cases of C. difficile associated disease (CDAD) associated with the reporting facility x 1000 patient days divided by Number of patient days.

This rate represents the incidence rate of hospital-acquired CDAD associated with the reporting facility per 1000 patient days.

Rates will vary from month to month.

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Where will I be able to access this information?

For information on Baycrest's rates, please visit the Health Quality Ontario website.

How frequently will Baycrest report on C. difficile?

We will be reporting monthly, on the last day of every month.

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What is Baycrest doing to help reduce the incidence of C. difficile?

Based on best practices, Baycrest has a comprehensive identification and management policy that ensures a standardized approach to C. difficile. This approach includes:

• surveillance protocols – all staff are aware that any presence of diarrhea could be C.difficile
• and they follow strict early identification protocols
• extensive precautions;
  • intense environmental cleaning, which includes the use of a sporicidal disinfectant that kills C. difficile spores in ten minutes;
  • 48-hour, turn around time for C. difficile testing and treatment;
  • Contact precautions, which include handwashing, use of gloves, and personal protective gear.

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Are the elderly more likely to get C.difficile than younger people?

No, being elderly is only one risk factor associated with C. difficile. Other risk factors include:

• A history of antibiotic usage
• Bowel surgery
• Chemotherapy
• Prolonged hospitalization
• Serious underlying illness or debilitation

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Do chronic and long-term care hospitals, like Baycrest, have higher rates of C.difficile?

Currently, there is very little data on the rates of C.difficile in chronic and long-term care. One of the purposes of public reporting is to help us understand trends regarding C.difficile.