“Clostridium Difficile (C. difficile) is a Gram positive, spore forming anaerobic bacillus” (Ministry of Health, Canana, 2007). In other words, it is a bacteria that normally lives in places lacking in oxygen, which in the case of C. difficile is the large intestine. It has existed in the environment, and according to Dr. Pierik of Phillips University, Marburg, tits enzymes are ancient. However, it was not until the 1970s that toxigenic C. difficile was identified as a serious problem in human beings following the “widespread introduction of antibiotics into clinical practice” (UK Standards Group, 2003). C. difficile is now thought to be responsible for a spectrum of largely, but not exclusively, hospital acquired diseases, ranging from colonization with no symptoms, to diarrhea of varying severity, to life-threatening colitis. According to UK statistics, more people die of C. difficile that do of MRSA. The National Office of Statistics in the UK have confirmed (June, 2008) that more than 20 people per day die of MRSA and C. Difficile together. Comparative figures for Ireland are not known.

A small number of people go into hospital with C. difficile already present in their intestine. They may not have had any symptoms because the normal bacteria in the intestine has kept the C. difficile in check. However, if the condition suffered by the patient has to be treated with antibiotics, the positive bacteria may die, causing the C. difficile bacteria to multiply and cause an infection. However, many more patients become infected with C. difficile while in hospital. How does this happen? Patients may ingest the C. difficile bacteria through oral-fecal contamination, i.e. ‘traces of one patient’s feces enter another patient’s mouth’ (McCaughey, 2008). This happens as a result of inadequate cleaning. C. difficile can be picked up from dirty bedrails, tables, curtains, in fact anywhere their hands can reach not to mention toilets and all the fittings in them. Patients should wash their hands before eating, and those who are bed-ridden should be helped to do so.  

Symptoms

	Diarrhoea.
	There may also be stomach cramps, fever, nausea and loss of appetite.
	Some people get mildly ill and recover.
	Others become seriously ill and develop colitis. This can become severe and lead to perforation of the bowel. At this stage the disease is life-threatening.

The patients most at risk are those who have had:

	Bowel surgery
	Chemotherapy
	Prolonged hospitalization
	A history of antibiotic usage

As with most infection, those who are frail through serious illness or debilitation or increased age carry increased risk (HSE, 2007). Treatment involves antibiotics and extra days in hospital.

The prevention strategies for C. difficile are well known. These include robust hand hygiene practices in health care workers. This should be in place for patients as well. Environmental hygiene is also essential, and the training of cleaning personnel in infection prevention and control is of utmost importance. Antibiotic prescribing is also a matter that needs to be controlled as well. These strategies are not new, and have been recommended by microbiologists for many years now, to very little avail.

To find out what you can do before you go into hospital and while you are there to help reduce the chances you will get an infection see our “Patient Kit’ on this site.
You can read more about C. difficile on the following web sites (among others):
www.hospitalinfection.org,  www.hse.ie, www.dh.gov.uk, www.health.gov.co.ca.

The material on this site is for information purposes only, and is not meant as medical advice. If you have a health problem, please contact your general practitioner or other medical professional.