Fact Sheet – Clostridium difficile (C. difficile)

What is Clostridium difficile (C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that causes diarrhea and more serious intestinal conditions like colitis (or inflammation of the colon). In the industrialized world, C. difficile is one of the most common diarrheal infections in hospitals and long-term care facilities.

How do people get C. difficile?

C. difficile bacteria are found in feces. People can get infected if they use their hands to touch surfaces contaminated with feces, and then touch their mouths or eyes. Healthcare workers can spread the bacteria to their patients if their hands are contaminated.

Healthy people don’t usually get C. difficile. People who have other illnesses or conditions requiring the use of antibiotics and the elderly are at greater risk of infection.

How does using antibiotics contribute to the development of C. difficile?

Using antibiotics increases the chance of developing C. difficile diarrhea. Treatment with antibiotics alters the normal levels of good bacteria found in the intestines and colon. When there are fewer of these good bacteria in our intestines and colon, C. difficile has the chance to thrive and produce toxins. When combined, the presence of C. difficile with a large number of patients receiving antibiotics in health care settings can lead to frequent outbreaks. In these settings, C. difficile infections can be limited through careful use of antibiotics and routine infection control measures. The Public Health Agency of Canada (PHAC) has developed these infection control guidelines such as proper hygiene and the proper use of antibiotics. These guidelines are a resource for the provinces, territories and healthcare organizations.

What are the symptoms of C. difficile?

Symptoms include: watery diarrhea, fever, loss of appetite, nausea, and abdominal pain/tenderness.

What can be done to prevent the spread of C. difficile?

PHAC publishes infection control guidelines as a resource for the provinces, territories and healthcare organizations. As with any infectious disease, frequent hand-washing is one of the best defences against the spread of C. difficile.

If you work or visit a hospital or long-term healthcare facility, wash your hands often, especially after using the toilet. Most healthcare facilities provide an alcohol-based hand sanitizer at the entrance. Be sure to use it.

When prescribed antibiotics, follow your doctor or healthcare provider’s instructions and the directions on the label. Keep taking the antibiotics as long as your doctor or healthcare provider recommends to kill all of the C. difficile bacteria.

If you have concerns about C. difficile and medication you are currently using, talk to your doctor or healthcare provider.

Is C. difficile fatal?

In rare cases, C. difficile can be fatal. More commonly, the infection causes diarrhea. Diarrhea can lead to serious complications, including dehydration.

How is C. difficile treated?

For people with mild symptoms, no treatment may be required. For severe cases, medication and surgical interventions may be needed.

What puts a person at risk of getting C. difficile infection?

Those at risk include the elderly, people treated with antibiotics, or cancer chemotherapy. In addition, patients taking stomach ulcer drugs known as proton pump inhibitors are at increased risk to contract C. difficile infection.

What is the Public Health Agency of Canada’s role in preventing and monitoring C. difficile?

PHAC publishes infection control guidelines as a resource for provinces, territories and healthcare organizations. The Agency has helped examine the outbreaks of C. difficile infection in a number of jurisdictions across Canada.

Through the Canadian Nosocomial Infection Surveillance Program (CNISP), the Agency recently completed a six-month surveillance study on C. difficile Infection (CDI, formerly C. difficile associated diarrhea or CDAD) in teaching hospitals across the country. The study focussed on patients suffering from CDI who had severe complications, including dehydration, surgeries, admissions to intensive care units and deaths.

PHAC’s National Microbiology Lab is also studying the bacteria to see if there is a way to tell the difference between mild and severe cases of CDI. They’re also looking at whether or not there is a strain that exists that is causing more serious disease in people than before.

In January 2005, PHAC also surveyed all hospitals in Canada to get a better understanding of their infection prevention and control practices for C. difficile. The survey results were used to inform and improve PHAC's surveillance activities and clinical care guidelines related to C. difficile.

In late Fall 2006, The National Notifiable Diseases Working Group (WG), an assembly of epidemiologists and laboratory experts from provinces and territories and from the Public Health Agency of Canada, recommended CDI be added to the list of Nationally Notifiable Diseases, as published in the Canada Communicable Disease Report, 2006: Volume 32, Number 19. The National Notifiable Disease List will take effect when associated case definitions are revised, approved and published, in December 2008.

A new ongoing surveillance project for CDI was initiated on January 1st, 2007 in 48 hospitals in nine provinces. PHAC is using the information from the 2005 and 2007 CDI surveillance project to refine the infection prevention and control recommendations for C. difficile in the Infection Control Guidelines. The recommendations for the prevention of C. difficile are found in "Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care" on the PHAC Web site.

The CNISP has conducted targeted surveillance in which it examined outcomes for patients with C. difficile. The patient outcomes (what happens after the person is infected) will be correlated with the laboratory specimen to determine if there is a relationship between the severity of illness and the NAP1 strain.