C Difficile

Monthly infection report: March 2021

Number of new cases = 1

Number of patient days = 2,616

Excluding <1 year of age

Infection rate = 1/2,616 X 1,000 = 0.38

Reporting requirements

What is C difficile

Clostridium difficile (C difficile) is a bacterium (germ) that lives in a person's intestines. Many types of bacteria, good and bad, live in the intestine. When someone takes something that disrupts the good bacteria, like antibiotics, C difficile can thrive and produce toxins (poisons) that can cause an infection.

C difficile bacteria can turn themselves into a special form, a spore, which lives for a long time. Others can be infected if they accidentally ingest (eat) the spore. Contaminated hands spread the spores through touch, and then eating or preparing food.

About half of healthy newborns can carry C difficile in their stool but do not have any illness. This is called colonization. After the age of 5 years, this rate becomes similar to adults where 5% may carry the bacteria without symptoms.

Preventing the spread of C difficile at the hospital

Always wash your hands after using the washroom and before eating. Ask others, including doctors and nurses, to wash their hands before they touch you. If you have diarrhea that splashes onto a surface in your room or the washroom, tell your nurse immediately. It will need to be properly cleaned up.

Once you arrive home

Healthy people who are not on antibiotics are at very low risk of getting C difficile. There are precautions you can take at home. If you have C difficile, talk to your doctor if the diarrhea does not stop or comes back once you return home.

Hand washing

Wash your hands for at least 15 seconds:

After using the toilet.
After touching dirty or contaminated surfaces.
Before eating.
Before preparing meals.

Remind everyone in your home to wash their hands regularly. If your caregivers handle feces or other bodily fluids, they should wear gloves. They should also wash their hands when they take their gloves off.

House cleaning

You can use an all-purpose, regular household cleaner to clean surfaces when you have a C difficile infection. Make sure you rub surfaces well. Toilets and bathrooms need extra attention. If feces have splashed onto a surface, wipe clean first. After, use the household cleaner on the area. If possible, use a separate bathroom from the rest of the household until diarrhea stops.

Laundry

Wash clothing soiled with feces separately. First, rinse off the feces. Hot water and soap help remove the bacteria. Using a clothing dryer (instead of hanging clothes to dry) also helps.

Dishes

Wash dishes in a sink with soap and hot water or in the dishwasher. Don't share dishes or utensils while you have C difficile.

Medicine

Take all your medication as prescribed by your doctor. Do not use any drugs from the drugstore to stop your diarrhea (e.g., Imodium®).

C difficile infections

Information about contracting a C difficile infection.

Symptoms

Symptoms include mild to moderate diarrhea, abdominal cramps and fever. In children, diarrhea is the most common symptom.

Infection can produce a toxin that can cause swelling in the intestine. Your doctor will order a test that can identify the toxin. Some cases can be very severe. In rare cases, surgery is necessary when the intestine is badly damaged. In extreme cases, the infection can cause death.

Who is at risk?

People who have been on antibiotics are at greater risk of infection. If infected, older adults and those with serious illnesses or poor overall health are at a greater risk of having a more severe case.

New strain

C difficile has been a concern for more than 30 years, but recently a new strain was found that is causing more problems. As such, hospitals have been looking at C difficile more closely than ever before.

Treatment

Sometimes, stopping to take antibiotics can stop the C difficile infection. This can allow the normal, good bacteria to grow back and resume control. There are also special antibiotics for the C difficile infection. Always speak to your doctor for treatment direction.

Visiting the hospital

Healthy people who are not taking antibiotics are at very low risk of getting C difficile infection. You should still wash your hands after visiting someone in the hospital. Follow all precautions that the staff members explain. If you are caring for someone with an infection, wear a gown and gloves. Do not sit on the bed or commode (special) chair in the hospital room.

Special precautions

Patients who are sick with C difficile can spread the spores in their environment. A lot of hospital patients can be on antibiotics, which increases their chances of getting an infection if they get C difficile. To help protect everyone, we use special precautions including gowns and gloves. If you have the infection, we may move you to a single room. We may also give you a special commode or toilet to use while you have diarrhea.

Visitors who come to see you while you are on special precautions should not visit other patient rooms. You will need to stay in your room until your diarrhea stops.

What we are doing

We look closely at C difficile cases, which allows us to know if there's a problem in the hospital, and if so, how severe. We also educate our staff on C difficile and the importance of hand washing to prevent spreading diseases. If there is a cluster of cases of C difficile, our cleaning staff administers additional cleaning activities. Because we monitor the situation so closely, we can give the right medicine very early to treat infection.

Reporting C difficile

We are required to publish the rates of infection with C difficile in our hospital for children over the age of one. The Ministry of Health and Long Term Care requires this reporting.

What do the numbers mean?

You will see two sets of numbers on the website:

The number of new C difficile cases that occur each month.
The rate of C difficile infection.

We calculate the rate by dividing the number of new cases by the number of patient days used in the same month. We then multiply that number by 1,000. We do this so we can easily compare one month to another.

What is a patient day?

We count one patient day for each day that a patient (over the age of one) is admitted into a bed at CHEO. If one patient is in the hospital from September 1 to September 30, this counts as 30 patient days.

Why are we using patient days instead of the number of patients?

Patients who stay in the hospital for a long time have a higher risk of getting a health care acquired infection. If we calculated the number of patients instead, that would suggest that every patient has the same risk, which is false. To provide a more accurate calculation, patient days are used.

Why are the rates different in different hospitals?

Rates are affected by many factors, such as:

Size of the facility

In smaller facilities, a single case of C difficile can look very big when we put it in a rate. This is because the denominator used (patient days) is much smaller than in a bigger facility.

For example, if “Hospital A” with 30 beds was completely full for 30 days in a month, they would have 900 patients days for the month. If "Hospital B, "a much larger hospital, had 300 beds, and they were all full for the month, the denominator of patient days would be 9,000.

Kinds of patients seen

Some patients are at a greater risk of getting C difficile than others, such as patients who:

Have serious underlying immune system problems.
Have bowel diseases, such as Crohn's disease or ulcerative colitis.
Are over 65.
Take a lot of antacids (e.g., Tums®).

Types of treatment

Some hospitals' special programs use treatments that put patients at a higher risk of infection, such as chemotherapy, bowel surgery or extensive use of antibiotics. Therefore, hospitals can have a higher rate of infection simply because the patients are at a higher risk to begin with.

Presence of an outbreak in a hospital

If a hospital has a cluster of C difficile cases or an outbreak, the rate for the month may appear very high.