Information on Clostridium difficile-Associated Disease (CDAD) for Health Care Workers
Updated: November 22, 2006
What is Clostridium difficile?
Clostridium difficile (C. difficile) is a type of bacteria associated with outbreaks of diarrhea among patients or residents in health care facilities. The disease is known as Clostridium difficile-Associated Disease (CDAD). Patients taking antibiotics or who have other serious health conditions may be at risk of contracting this disease. C. difficile is the most frequently identified cause of antibiotic-associated diarrhea. It accounts for about 15-25 per cent of all episodes of antibiotic-associated diarrhea.
Applicability
This alert outlines issues of importance for health care worker safety and cross-patient infection control.
Inspectors appointed under the Occupational Health and Safety Act may use the information in this alert in carrying out their duties under the act.
Symptoms
Symptoms of CDAD include:
- Watery diarrhea
- Fever
- Loss of appetite
- Nausea
- Abdominal pain/tenderness
Method of Transmission
- C. difficile is most often spread from person to person on the hands of health care personnel who have had contact with contaminated patients or their feces. It may also be spread from contact with contaminated environmental surfaces or equipment.
- Some patients may become carriers of C. difficile and never develop symptoms.
- Other patients who become carriers of C. difficile may not have symptoms until they start taking antibiotics. Diarrhea can occur within one week of starting antibiotic therapy. Antibiotics destroy the normal bacteria of the intestine, allowing C. difficile to overgrow in the gastrointestinal tract.
Prevention and Control
Some of the precautions that health care workers may consider are:
- Health care workers should not eat food or consume beverages in areas where patients are being cared for and should wash hands before eating.
- Ensure that proper "contact precautions", a specific type of infection control precaution, in addition to routine infection control precautions, are taken. The following precautions should be taken when caring for symptomatic patients:
- Wash hands frequently between entering patients' rooms
- Wear gloves when entering patients' rooms
- Wear gowns if direct contact with patients, their soiled clothing or environmental surfaces of patients' rooms is likely
- Dedicate equipment whenever possible
- Continue taking contact precautions for 72 hours after the patient's diarrhea has resolved
- Environmental cleaning:
- Use an approved hospital grade disinfectant for environmental cleaning
- Special attention to environmental cleaning is required. See the references below for details. Follow the special disinfection procedure at your health care facility for C. difficile for routine and terminal disinfection.
Health Care Workers, including those receiving antibiotics, are not at risk of acquiring C. difficile. occupationally. Health Care Workers must always follow Routine Practices, specifically hand hygiene before and after contact with all patients, and use Contact Precautions when caring for patients with C. difficile.
Additional control measures are detailed in the references below.
Administrative Issues
The employer in health care facilities, in consultation with the Joint Health and Safety Committee, may wish to evaluate the risk of C. difficile in their particular facility for the purpose of ensuring proper measures and procedures are in place for the protection of their workers.
Do You Have a Question About CDAD?
Please contact an Infection Control Professional in your health care facility or your Regional Infection Control Network (RICN).
References
Ministry of Health and Long-Term Care
Best Practices Document in the Management of Clostridium difficile in all Healthcare Settings 
[187 Kb/28 pages]
Videoconference
Prevention and Control of Transmission of Clostridium Difficile by the Ontario Hospital Association (related to the above document).
To view the following video, click on the link below and scroll down to June 21. Click on either Quicktime Player or Windows Media Player. You will have to register for free to view.
Prevention and Control of Transmission of Clostridium difficile
Public Health Agency of Canada (PHAC)
- Clostridium difficile (C. difficile): Questions and Answers
- Infection Control Guidelines--Hand Washing, Cleaning, Disinfection and Sterilization in Health Care (1998) [293 Kb/66 pages]
- Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care--Revision of Isolation and Precaution Techniques (1999) [1.19 Mb/155 pages]
- Prevention and Control of Occupational Infections in Health Care (2002)
