Epidemics of Clostridium difficile have had devastating effects in the northern hemisphere, and now this “hospital superbug” has made its way to New Zealand, with new, highly virulent strains wreaking havoc in hospitals and aged care facilities.
What is C difficile?
Clostridium difficile, or C difficile as it is more commonly known, is a common, highly contagious antibiotic–resistant intestinal bug plaguing hospitals and aged care facilities around the globe.
Clinically speaking, it is a type of spore-forming bacterium that once ingested by a patient releases spores that pass through the stomach unscathed because of their acid-resistance and germinate into vegetative cells in the colon, and multiply. The bacterium is thought to cause disease when competing bacteria in the gut have been wiped out by antibiotic treatment.
It typically causes diarrhoea and sometimes severe inflammation of the colon. In extreme cases the bug can cause perforations of the bowel. Infection recurs in roughly 30 per cent of patients.
Due to its nature, C difficile infection often presents itself in inpatient health care facilities, and is particularly problematic in aged care facilities, as older patients are particularly vulnerable to the infection.
Outbreaks can occur easily in these settings when patients or residents accidentally ingest spores of the bacteria while they are undergoing antibiotic treatment.
How did it find its way to New Zealand?
C difficile was identified in the 1970s as the major cause of antibiotic-associated colitis, but it wasn’t until early this century that the infection was held responsible for devastating outbreaks in North America and Europe.
In 2003 a highly virulent strain of C difficile was reported in Canada with approximately 1400 cases reported including a large number of deaths. A similar outbreak took place around the same time in the UK, and again a few years later. By 2008 C difficile was rife in Europe, and by 2010 it had found its way to Australia.
In recent years, the superbug has made its way here with the first confirmed case in Auckland in 2010.
Judy Forrest, principal of Bug Control New Zealand, says C difficile is currently one of the biggest concerns for infection within New Zealand and Australian aged care facilities.
Normal strains of the infection are common and cause mild diarrhoea, while the hypervirulent strain can be deadly.
In a C difficile workshop held earlier this year, Dr Sally Roberts said a newly recognized strain was causing severe community-onset C difficile infection in Australia and New Zealand.
Treatment and prevention
In terms of treatment, as antibiotics are often the trigger, doctors will often advise stopping the medication.
The tricky thing about C difficile is that the organism forms large numbers of heat-resistant spores that are difficult to kill through regular cleaning, which means they can remain viable in the facility for a long period of time.
Experts advise a thorough approach to hand hygiene and facility cleanliness.
In the event of an isolated case of C difficile, Judy Forrest says it is essential for staff to take immediate action to prevent further spread.
“Resident/s must be isolated using full contact precautions (gloves and long sleeved gown when entering room). C difficile spores are difficult to kill so good cleaning is essential. Increase cleaning of room to at least twice per day and use a product known to kill the C difficile spore such as available chlorine or other approved product.
“Strict attention to hand hygiene is also important. Alcohol-based hand rub doesn’t kill the spores so follow an alcohol-based hand rub with a soap and water hand clean as soon as practicable after attending to the resident,” says Forrest.
Experts also stress the importance of providing education and information to frontline staff on the prevention of C difficile.
Surveillance and investigation of infections is also important in order to build a picture of C difficile outbreaks.
Forrest says that if there are two or more cases facilities must contact their DHB and public health unit for guidance and further lab testing. Isolation precautions remain the same.