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Mid Essex Hospital Services NHS Trust
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Wednesday 23 April 2014
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About C Diff

About Clostridium Difficile

Click on the questions below for the answers to these commonly asked questions about Clostridium Difficile (C Diff):

 

 


What is C Diff?

 

C Diff is a nasty diarrhoea causing bug.  It is the most common cause of hospital diarrhoea.  Like many other germs it can live inside us without causing us any harm most of the time. In fact it can be found in the gut of up to one in every 33 healthy adults.  It is even more common in babies. 
 
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What are the symptoms?

 

Symptoms can range from nothing in some cases to diarrhoea of varying severity and severe inflammation of the bowel. Other symptoms can include fever, loss of appetite, nausea and abdominal pain or tenderness.
 
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What is C Diff 027?

 

There are many different strains of ‘Clostridium Difficile’. The 027 strain is the most recent mutation of the bug. It is particularly nasty because it produces 20 times as much toxin as other strains of C Diff and is resistant to many antibiotics.
 
The 027 strain first came to prominence in Canada.
 
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Is C Diff in the community?

 

C Diff is not simply a hospital acquired infection… people in the community also become ill from it without ever attending a hospital. Many people carry C Diff naturally in their gut. However, when people take antibiotics to kill off other infections C Diff (which is resistant to many antibiotics) can thrive in the gut as the bodies natural gut bacteria is killed off.
 
Evidence suggests that as 1 in 5 cases of C Diff originate in the community and not in hospital, though of course it is the hospitals that eventually care for the patients.
 
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Is this just a problem for our hospitals?

 

No. This is a nationwide issue. A truly accurate picture needs to bear in mind that if you treat more patients you will have more incidents of infection. 
 
This does not diminish in any way the seriousness with which we are approaching the issue but it should be borne in mind that big teaching Trusts treat very poorly people and very poorly people are more prone to infections of all kinds.
 
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How many deaths has C Diff caused?

 

The only recent information about deaths related to C Diff comes from the Office of National Statistics, (ONS). In 2004 they recorded 2,247 deaths nationally from Pseudo membranous Colitis (inflammation of the lining of the gut).
 
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Why isn’t it straightforward to attribute a death to C Diff?

 

Death certificates, (filled out by law after someone has died) are not always precise indicators of the cause of death. For example a patient may have terminal cancer and as a result of the antibiotics they are given they may suffer complications like C Diff or pneumonia. If the patient subsequently dies the death certificate will record what the patient died of and what the patient died with. 
 
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Who is at risk?

 

C Diff does not harm otherwise healthy people. (Many people are carriers but never experience symptoms). The problems occur when very poorly patients are treated with antibiotics (For example to ward off infections after surgery), C Diff can then take a hold as the other ‘competitor’ bacteria in the gut are killed off.
 
The elderly are most at risk. Over 80% of cases are reported in people over the age of 65. Patients with low immunity are also at risk as are patients who have undergone or are undergoing repeated enemas and/or gut surgery.  Children under the age of 2 years are not usually affected.
 
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How can it be treated?

 

C Diff can be treated with special antibiotics. In 20-30% of cases patients suffer a relapse and other treatments may be tried, including good bacteria which help to re-balance the gut.
 
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Why don’t our hospitals stop using antibiotics?

 

If hospitals stopped using antibiotics many more lives would be put at risk from post operative infections and conditions like meningitis and septicaemia.  
 
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Is this all about dirty hospitals?

 

No. C Diff is a unique bug. When it is hit with traditional cleaning methods which would kill most other bugs it can form ‘spores’ which are virtually immortal. In fact there is evidence from America that certain types of cleaning can exacerbate the problem. 
 
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What can patients/visitors do to prevent the spread of C Diff?

 

Follow this simple advice:

 

  • Hand washing is the simplest and most effective way of controlling the spread of germs.

  • Encourage relatives/friends to wash their hands or use the alcohol gel before touching patients, especially those who have had a surgical procedure or have an open wound.

  • Ask visitors to wash their hands before and after any physical contact with a patient or if their friend /relative has diarrhoea. This will reduce the risk of infection for both visitors and patients

  • To protect both patients and staff, relatives who are suffering from a cough, cold or diarrhoea should be discouraged from visiting. 

  • People should wash their hands regularly whether they are in hospital or not. Germs collect on your hands throughout the day and can be spread through contact with your mouth, nose and other people.

  • Avoid close contact with people who have infections as some germs can be spread throughout the air by sneezing and coughing.

 

The first thing to remember is that the risks of picking up C Diff are very low indeed and that even if someone is unfortunate enough to get the infection, most people make a complete recovery.
 
The next thing is to remember that C Diff spreads through contact, not through the air. So, old fashioned values like washing hands after using the toilet and before eating are important.
 
If people are worried and would like to discuss this with someone at the Trust they should call our infection control team on 01245 516579.

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Do patients make a full recovery?

In most cases yes, however in elderly patients suffering from other conditions, the infection can sometimes be life threatening.
 
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What should patients do if they have tested positive for C Diff and after being discharged from hospital have reoccurring symptoms?

 

Patients should go to their GP and seek advice.
 
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