A presentation about clostridium difficile in the community given at the Wirral Community NHS Trust Infection Prevention & Control study day 2014

1. Clostridium difficile
A Community
Perspective
Helen Oulton
Head of Infection Prevention
and Control

2. Clostridium difficile
• Gram+ spore forming
anaerobic bacterium
• Faecal - oral route
• Survive in environment
for extended periods
• Hands, hands, hands!
• Resistant to alcohol
gel
• Resistant to some
disinfectants

3. Symptoms?
•Diarrhoea
•Abdominal pain
•Blood or mucus in faeces
•High temperature
•Loss of appetite
•Nausea

4. Risk Factors
• Age
• Severe underlying disease
• Immunosuppression
• Environment with close contact of others e.g. care home
• Antibiotic use (previous and current therapy)
• Hospitalisation
• Chemotherapy
• Recent gastrointestinal procedures
• Presence of a nasogastric tube
• Use of Proton Pump Inhibitors (PPIs)

5. Clostridium difficile

6. Patient A
• Day 1. Patient A, a 77 year old male admitted to
secondary care ? Urinary sepsis
• Day 2. CT - Pseudomembranous colitis
• Day 3. Patient died. Pseudomembranous colitis
recorded on Part 1 of death certificate

7. Pseudomembranous Colitis

8. Post Infection Review
• Serious untoward incident – STEIS
• No known Clostridium difficile positive result
• Multiple care services
• Timeline

9. Loperamide
• Anti motility agent thought to slow down the rate at which
the toxins produced by Clostridium difficile are cleared
from the gut

10. Post Infection Review
• No single electronic access to patient records
• Patient at increased risk of Clostridium difficile infection
(CDI) but CDI as cause of diarrhoea not considered
• Use of Loperamide
• Faecal sample not obtained in line with PHE guidance
• Communication between agencies

11. Contributory Factors
• Multiple courses of antibiotic therapy
• Previous episodes diarrhoea related to antibiotic therapy
treated with Loperamide (self-administered)
• Long term Proton Pump Inhibitors (PPI’s)
• Delay in diagnosis/treatment as patient declined
admission to hospital

12. Remember!
• Diarrhoeal illness is a common cause of consultation
within primary care with the majority of cases responding
to simple interventions e.g. oral rehydration, withdrawal
of medication
HOWEVER………………………

13. Be Clostridium difficile Aware
• Know the risk factors
• Confirm antibiotic history before prescribing
• Avoid anti motility drugs
• Prompt faecal sampling
• Rigorous infection prevention and control standards

14. The Future?

15. Any questions?