Clostridium difficile (C.diff)

The Trust is committed to preventing healthcare associated infections (HCAIs), including MRSA and C. difficile. Patient safety is our number one clinical priority and there is a highly active, Trust-wide infection prevention and control programme aimed at reducing infections and minimising risk.
In line with national guidance, the Trust is now screening all elective (planned) adult admissions and certain categories of day-case attendees and all emergency patients.
The Trust has policies describing how patients attending the hospital (either for a planned elective procedure or as an emergency admission) will be screened for MRSA. Implementation of the policy is monitored through the Trust Boards Assurance Framework. Copies of the policies are available on request.

What is Clostridium difficile?

Clostridium difficile (C.diff) is a bacteria that lives in the gut of around 1 in 30 healthy adults and children. When it multiplies, C.diff produces spores that are present in the faeces, can survive for a long time in the environment and are resistant to ‘normal’ disinfectants. The normal bowel contains millions of different types of bacteria which help break down and digest our food.

There are lots of these ‘good’ bacteria, but also some bacteria, such as C.diff, which can cause ill-health. The ‘good’ bacteria usually help keep C.diff in check.

How do you catch C.diff?

A few people carry C.diff, but remain in good health. People can become infected with C.diff if they touch items or surfaces (such as beds and equipment) that have been contaminated with C.diff spores and then touch their mouths.

If the ‘good’ gut bacteria are not able to keep C.diff in check, or if the body’s resistance to infection is lowered, C.diff can multiply and produce spores and toxin. The toxin can cause inflammation of the bowel. This most often happens when people take antibiotics to treat other infections (the antibiotics kill off the ‘good’ gut bacteria), or if patients’ immunity is lowered by chronic or serious ill-health, surgery or drugs.

What are the symptoms of C.diff?

Bowel symptoms range from mild tummy upset to moderate loose stools to severe painful bloody diarrhoea. Other symptoms include fever, loss of appetite, nausea and abdominal pain.

How is C.diff diagnosed?

C.diff is diagnosed by testing for C.diff toxin in a stool sample or by examination of the bowel lining with a special camera (sigmoidoscopy).

Are some patients more likely to be made ill by C.diff?

Elderly patients, patients who have received antibiotics and those whose resistance is lowered by chronic or serious ill-health, surgery or drugs are more likely to be made ill by C.diff.

Can C.diff be treated?

Mild illness usually responds well to stopping antibiotics and preventing dehydration by taking plenty of fluids. In more severe illness, anti-C.diff antibiotics are added. Most patients will improve within a few days and the diarrhoea symptoms typically resolve within two weeks. Anti-diarrhoea medication may make C.diff diarrhoea worse and is not recommended.

Is it possible to get C.diff more than once?

C.diff infection usually responds well to treatment, but approximately 20% of patients will experience recurrence of diarrhoea symptoms up to several weeks after treatment has finished. A further course of anti-C.diff antibiotics will be effective in almost all patients and other specialist treatments are available.

If your diarrhoea returns after treatment for C.diff infection, it is important to restart treatment promptly. If you have been discharged home, you should visit your GP as soon as possible, taking a stool sample with you (Sample containers can be obtained from your GP if you have not already got one).

Meticillin-Resistant Staphylococcus Aureus (MRSA)

What is MRSA?

MRSA stands for Meticillin-Resistant Staphylococcus Aureus. The MRSA germ belongs to the Staphylococcus Aureus (SA) bacteria family.

SA is a common germ. It lives harmlessly on the skin and in the nose of around a third of healthy people. When it does cause infection, ‘ordinary’ SA is sensitive to most commonly used antibiotics. MRSA is a particular type of SA that has developed resistance to most antibiotics. Only a very few antibiotics will kill MRSA.

What causes MRSA?

SA and MRSA cause problems only when they get into breaks in the skin (wounds, cuts, sores), into the blood stream (bacteraemia) or into normally sterile body cavities (such as the bladder). Infections are more likely, and can be particularly serious, in patients whose resistance to infection is lowered by long-term or serious frailty or ill-health, injury, surgery, or drugs. MRSA infections occur more often in patients with intravenous drips or catheters and in intensive care units. In rare cases, MRSA can be fatal. MRSA does not generally harm healthy people, including pregnant women, children and babies.

How can MRSA pass from one person to another?

People may carry the MRSA germ without knowing it and patients may have it before they are admitted to hospital. MRSA can be caught and passed on almost anywhere, not just in hospital. The MRSA bacteria is spread on hands and skin from person-to-person.

Staff, patients, relatives, and other visitors can help prevent the spread of MRSA by thorough, regular hand washing with soap and water and by the use of the alcohol gel found on our hospital wards and on entrances to wards.

Can visitors catch MRSA?

If visitors carry out hand washing before entering and leaving wards, they will largely protect themselves from becoming colonised with MRSA. Even if they acquire MRSA it will usually cause them no harm, they will probably be unaware of it, and it will be temporary and won’t need to be investigated or treated. Visitors who may have reduced resistance to infection because of their own chronic ill-health or frailty should discuss these risks with the clinical team looking after their relative.

Can MRSA be treated?

MRSA can usually be treated by one of a small number of antibiotics which kill it. Other medications, such as antiseptic wash and nasal ointments, are used to remove MRSA from the skin and nose of patients who are susceptible to serious MRSA infection.

Patients who have MRSA may be moved to a single room or a separate bay to assist their treatment and to help prevent cross-infection of other patients.

How do you know if you’ve got MRSA?

MRSA can cause a wide variety of symptoms and problems. Patients may be unaware that they harbour MRSA because it has caused them no problems. To identify such ‘colonised’ people many groups of patients are screened (by taking skin and nose swabs) before they come into our hospitals or during their stay. Where MRSA is found, patients may be treated in separate areas and offered antiseptic skin and hair washes and ointments to eradicate the MRSA and prevent potential problems.