Clostridium difficile

C. difficile has made headlinesZoomZoom
© Robert Alain, SME, INRS-Institut Armand-Frappier

Article published in the Courrier Laval, April 16, 2006.

C. difficile has made headlines several times in the last few years. Fortunately, the incidence of the disease that it causes is declining. In Laval, for example, there were 25.7 cases for 10,000 days of presence spent in a hospital in September 2004; this number was down to 13.7 in February 2006!

C. difficile
This bacterium is part of the normal human flora. It can be found among the bacteria of the large intestine in 60% of all newborns and approximately 5% of adults.

C. difficile is shaped like a rodcalled a bacillus and contains a sphere-shaped spore. The spore can survive just about everything that is fatal to the bacterium, such as variations in temperature, oxygen and disinfecting agents routinely used for cleaning. When the spore returns to a favorable environment such as the large intestine, it “regenerates” the bacterium.

Transmission
The majority of diarrheas associated with C.difficile appear between 48 hours and 10 weeks after taking antibiotics prescribed in an ambulatory health service or a hospital. The bacterium was therefore contracted by fecal-oral transmission during the hospital stay or the patient was already a carrier and taking antibiotics destroyed the balance between the various bacteria in the intestine and C. difficile took over.

Symptoms
The diarrhea is usually abundant and smelly; a patient will have up to 20 bowel movements a day. Some patients will have such a severe infection that there will be no diarrhea but acute abdominal pain, a high fever, and a very high white blood cell count. Depending on the gravity of the case, various treatments can be used, such as taking the antibiotics Métronidazole or Vancomycin.

Prevention
At the Cité de la Santé in Laval, a series of measures aimed at reducing the incidence of the disease have been adopted. When a case is diagnosed, the patient’s room is disinfected with a bleach solution consisting of 1 part bleach in 20 parts water, to destroy the bacterium’s spores. The patient is moved into an isolation unit where all the material used is reserved for that patient, i.e., the instruments such as the stethoscope are assigned to each room and never leave it. Furthermore, the employees of the unit are specially trained and visitors must wear gloves and a lab coat and wash their hands.

Dr. Tuyen Nguyen, microbiologist and president of the Infections Committee at the Cité de la Santé in Laval, whom we wish to thank for his contribution to the writing of this article, insists on how important it is for visitors to wash their hands as soon as they arrive at the hospital as a means of protecting the patients. Distributors of alcohol-based gels are installed near all the elevators, in emergency, at outpatient clinics, and on the different flours. This gel effectively eliminates many bacteria and viruses, such as the influenza virus. Furthermore, to effectively eliminate the C. difficile spore, it is important, on leaving the hospital, to wash your hands with soap and water, especially after having visited patients suffering from diarrhea.