C. Difficile

Public Health Agency of Canada

• Fact Sheet - Clostridium difficile (C. difficile)

U.S. Centers for Disease Control and Prevention

• C. diff (Clostridioides difficile)

• Person-to-person transmission in the home setting is rare.
• Wash your hands often for at least 15-20 seconds with soap and water, mainly after using the toilet and before eating or preparing meals. Caregivers should wash their hands after providing care.
• Try to use a separate bathroom until 48 hours after your bowel movements have returned to normal. If you can’t use a separate bathroom, have the commonly touched surfaces in the bathroom cleaned before others use it.
• Use gloves to handle body fluids or dirty items. Discard disposable gloves or clean rubber gloves after use.
• No special precautions are needed to clean your home. The germ can be destroyed by most household cleaning products. Wet a clean cloth thoroughly with a properly diluted cleaning product (as per the manufacturer's instructions). Wipe surfaces starting from the cleanest area and moving toward the dirtiest area, paying special attention to areas such as the toilet and bathroom sink. Let the surfaces air dry. This will allow enough contact time with the cleaning product to kill the bacteria.
• To clean dishes, use the dishwasher or clean by hand with soap and water.
• To clean clothes and other fabrics, remove any visible stool, wash items separately, clean in a hot water cycle with soap and dry in the dryer on high heat, if possible. Dry clean when appropriate.

Individual cases not reportable to the Health Unit.

See the Infectious Disease Protocol, Appendix 1, for notification thresholds in hospital settings.

Schools and childcare centres should exclude children:

• if the stool is not contained in the diaper for diapered children.
• if the diarrhea is causing "accidents" for toilet-trained children.
• if the child is too ill to participate in activities or has fever with behaviour change.

It is not necessary to have a negative C. difficile stool test to return to school or childcare.

Note: Exclusion guidelines may differ for healthcare workers and food handlers. Follow the direction of your healthcare provider, or occupational health at your workplace.

In addition to routine practices, clients/patients/residents suspected or confirmed to have C. difficile infection in healthcare settings should be placed on contact precautions (including single room with dedicated toileting facilities and use of personal protective equipment [gown and gloves] while in the room) and all horizontal and frequently touched surfaces in the room of the client/patient/resident should be cleaned at least twice daily, and when soiled, with a sporicidal agent. See Provincial Infectious Disease Advisory Committee: Annex C - Testing, Surveillance, and Management of Clostridium difficile in all Healthcare Settings for additional IPAC information.

Additional resources for Infection Prevention and Control:

• PHAC: Clostridium difficile Infection – IPAC Guidance for Management in Long-term Care Facilities

• PHAC: Clostridium difficile Infection – IPAC Guidance for Management in Acute Care Settings

C. difficile testing is indicated for individuals with unexplained diarrhea (e.g., ≥ three unformed feces per day without underlying diarrheal condition such as laxative use) and with risk factors for C. difficile disease (e.g., systemic antibiotic therapy, hospitalization, advanced age, impaired immunity, gastrointestinal surgery). See Public Health Ontario: Clostridioides difficile – Antigen, PCR, Susceptibility, and Typing for additional information, including acceptance/rejection criteria for specimens.

C. difficile testing is not indicated for children under the age of one year, as a test of cure, or for testing of formed stools.

Refer to the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection for recommendations on the management of initial and recurrent episodes of Clostridium difficile infection (CDI).

The Canadian Paediatric Society: Clostridium difficile in paediatric populations document summarizes information relating to the role of C. difficile in childhood diarrhea and provides recommendations for diagnosis, prevention, and treatment targeted at clinicians caring for infants and children in the community and institutional settings.