Clostridium difficile infection

Clostridium difficile infection
is a diarrhoeal disease

and it's a complication
of modern medical care,

a side effect of antibiotic treatment.
If somebody takes antibiotics,

one of the problems is they affect
the normal bacteria in the gut.

If disturbed, it gives the Clostridium
difficile organisms a chance to grow.

They produce a toxin
and this causes the diarrhoea.

This infection has spread mostly in
hospitals recently but not just there.

It can occur anywhere where
you have vulnerable patients

who are taking antibiotics.

So we have had cases
associated with community hospitals,

with some nursing homes and care homes,

and a relatively small number of cases
in people's own homes,

out in the general population.
That's much less common.

The spores are in the environment,

so cleaning is important
to remove those clostridial spores.

A high standard of cleaning
with chlorine-based disinfectants.

It also spreads via the hands,
so good hand hygiene,

particularly hand-washing in this case,

because the alcohol gels
aren't effective against the spores,

but hand-washing is very effective.

This infection
passes from person to person

by what we call "hand-to-mouth spread".

It's shed in the faeces
by patients who have diarrhoea.

Diarrhoea can be very profuse
and they contaminate the environment,

around the bed,
around the commode, around the toilet.

The spoors of this organism
can survive for a very long time,

months or years in the environment.

They can be picked up on fingers, on
hands and then they get into the mouth.

If the person who's acquired it is also
vulnerable, if they've had antibiotics,

they can then get the infection.

The symptoms of Clostridium difficile
infection are intestinal.

They range from mild diarrhoea,
which is a bit of an inconvenience,

to very severe diarrhoea,
which at worst can be life-threatening.

The way it's diagnosed is to take a
sample of faeces when diarrhoea starts,

send it to the laboratory, and they do
a test for Clostridium difficile toxins,

because it's the toxins
that cause the damage.

This test can be done
within a few hours,

so as soon as the patient is unwell,
the specimen is sent to the laboratory

and they can do the test
and get the answer back.

When somebody is suspected
of having Clostridium difficile,

they should be put into isolation
as quickly as possible,

preferably in a single room,
even while the diagnosis is being made,

because you want to minimise
the risk of spread to others.

When it's confirmed they'll either
stay in a single room or put in a ward

dedicated to the treatment
of Clostridium difficile infection.

But they will be isolated or segregated
from other vulnerable patients.

They'll then have specific treatment
for this infection.

They'll receive particular antibiotics.

They're called
metronidazole or vancomycin,

the choice is up to the hospital.

They'll also have other treatment
to control their diarrhoea,

to keep up their hydration,
their water balance,

to keep up their nutrition,

and generally
to improve their well-being.

But essentially specific treatment
will be given for this disease.

Clostridium difficile
can be a very severe infection.

Many people have a mild illness,

with some it can cause prolonged
diarrhoea, they can have relapses.

About 20% of cases relapse after
they've recovered from the first episode

and they can have several relapses.

Others can have
such severe damage to the intestine

that they to have surgery
to remove part of their intestine.

And, sadly, this disease
also carries a significant mortality,

especially in elderly, vulnerable
and otherwise ill patients.

It's very important that health care
professionals and the public

follow the guidelines that have been
issued for its prevention and control.

Reducing antibiotics, good hygiene, good
hand-washing, being aware of the disease

and for health care professionals
to make a quick diagnosis.

All of this is very important.

Clostridium difficile infection
is a problem in our hospitals

and has been for several years.

We are getting on top of this now.
The figures are coming down.

By following all the guidance
and good practice that we've established

we can really
get on top of this disease.