Residents colonised or infected with C. difficile who have risk factors for transmission, or whose basic personal hygiene practices may be compromised by cognitive or functional impairment are more likely to contaminate their environment. 

Hand Hygiene

Proper hand hygiene is essential.  If the resident's cognitive state is impaired, employees caring for them must be responsible for ensuring good hand hygiene is undertaken, especially after any toileting or contact with colonised/infected sites or devices.

Strict adherence to standard precautions is the recommended, safe practice for all resident contact regardless of whether or not infection is present. 

Effective hand hygiene is the single most important means of preventing the spread of C. difficile. 

Alcohol-based hand rubs/sanitiser are not recommended for C. difficile infection. 

Hands must be washed

When entering, or leaving the room

Before and after undertaking any procedure

Before and after putting on or taking off PPE

After touching resident equipment and surfaces

NB:  The use of gloves does not replace the need for hand decontamination. Hand hygiene should be performed before and after glove use. 

Points to remember when caring for a resident with C. difficile

Ensure a risk assessment is performed prior to bed allocation and/or at admission

Restrict the use of certain antibiotics

Contact precautions must be adhered to until 48 hours after diarrhoea ceases

Strict adherence to hand hygiene protocols must be followed

Enhanced environmental hygiene using chlorine-based disinfectant (1 in 1000 sodium hypochlorite solution in cold water) should be used to disinfect surfaces after initial cleaning with detergent and water

Quickly identify resident deterioration

Stop all unnecessary antibiotics

Monitor fluid balance: correct dehydration

Monitor diarrhoea: stool chart

Monitor signs of escalating infection: rising CRP, renal failure, falling albumin, rising WBC, and fever

Contact with others

Visits and outings may occur without risk to family and friends in most cases when the resident does not have diarrhoea. Family and friends must be reminded to wash hands frequently after contact with the resident or surfaces frequently used by the resident.