Clostridium Difficile (C. diff)

Grace. T
Aug 23
4 min read

Updated: Aug 26

Saving Grace Medical instructor taking precautions to prevent Clostridioides Difficile also known as C.Diff by washing her hands.

Clostridium Difficile (C. diff) Infection: A Nursing Student Guide

Clostridium difficile (pronounced Klo-strid-ee-um dif-uh-seel), commonly called C. diff, is a gram-positive, spore-forming bacterium that can cause serious gastrointestinal illness. For nursing students, it is important to understand how C. diff presents, spreads, and is managed in both hospital and community settings — not only to protect patients but also to safeguard yourself and your colleagues.

What is C. diff Infection?

C. diff infection (CDI) usually occurs after antibiotic use, which disrupts the gut microbiome and allows C. diff to overgrow. Its spores can survive in the environment for up to 5 months, making infection control a major concern in hospitals and long-term care.

Common Symptoms:

Watery diarrhea (≥3 loose stools in 24 hours)
Abdominal pain or tenderness
Fever
Loss of appetite
Nausea

Alberta C.diff Clostridium Difficile Protocol

In severe cases, CDI can progress to toxic megacolon, sepsis, dehydration, and even death. According to the CDC, CDI is responsible for about 15,000 deaths annually in the U.S., with a reported mortality rate of ~6%【CDC, 2024】.

Who is at Risk?

Patients most at risk include:

Older adults (>65 years)
Hospitalized or long-term care residents
Those on broad-spectrum antibiotics (e.g., clindamycin, fluoroquinolones, cephalosporins)
Immunocompromised patients
Post-surgical patients or those with gastrointestinal disease

Clinical tip for nursing students: Always review medication lists. If your patient develops sudden diarrhea while on antibiotics, CDI should be considered.

Can C. diff be Fatal?

Yes. Fatal outcomes are linked to:

Severe dehydration
Electrolyte imbalance
Organ failure
Underlying comorbidities

As a nurse, early recognition and reporting are critical.

Treatment Options

C. diff infection can often be treated effectively with targeted antibiotics:

First-line: Oral vancomycin or fidaxomicin
Alternative: Metronidazole (for mild cases if first-line not available)

Severe or recurrent cases may require:

Fecal Microbiota Transplant (FMT) – restoration of healthy gut flora
Surgery – rare, but colectomy may be necessary in fulminant cases

Prevention in Healthcare Settings

Hospitals follow strict infection prevention and control (IPC) protocols. As a nursing student, you are expected to know and practice these:

Hand hygiene: Soap and water is more effective than alcohol rub against spores.
Contact precautions: Gloves, gowns, and patient isolation when possible.
Environmental cleaning: Use sporicidal agents (e.g., bleach-based disinfectants).
Antibiotic stewardship: Use antibiotics only when clinically necessary.

Fight C.Diff and wash your hands with soap. Scrub in to stop C.diff in Edmonton Alberta.

Contact Precautions Explained

Patients should be placed in a single room or cohort with another CDI patient.
Nurses and visitors must wear gloves and gowns.
PPE must be removed before leaving the room.
Patients should avoid common areas until cleared.

Patient & Family Education

As future nurses, you play a vital role in teaching patients and families how to prevent recurrence and spread:

Take antibiotics exactly as prescribed.
Wash hands frequently (especially after toileting and before eating).
Clean bathrooms and surfaces regularly; close the toilet lid before flushing to reduce aerosol spread of spores.
Avoid sharing personal items such as towels, toiletries, or bedding.
Encourage visitors to wash their hands before and after visiting.

Case Study (Exam-Style) TEST YOURSELF

Scenario: A 74-year-old patient on broad-spectrum antibiotics for pneumonia develops watery diarrhea and abdominal pain. You notice their temperature is 38.5°C.

Which action should you take first?

A) Offer anti-diarrheal medication
B) Place the patient on contact precautions
C) Encourage oral rehydration and monitor intake/output
D) Continue current antibiotic therapy

ANSWER AT BOTTOM OF POST

Key Takeaways for Nursing Students

Always suspect C. diff in patients on antibiotics with new diarrhea.
Prioritize hand hygiene and contact precautions.
Patient teaching reduces recurrence and transmission.
Nurses play a major role in early detection, infection prevention, and patient advocacy.

References:

Centers for Disease Control and Prevention (CDC). Clostridioides difficile (C. diff). CDC.gov
Public Health Agency of Canada. Clostridium difficile infections. Canada.ca
Alberta Health Services. Infection Prevention & Control Guidelines. AHS.ca
McDonald LC, et al. Clinical Practice Guidelines for C. difficile Infection in Adults. IDSA/SHEA Guidelines, 2021.

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RESOURCES:

Author - Saving Grace Medical Academy Ltd

Jason T

Retired EMT - Heart & Stroke Foundation Senior Instructor

ANSWERS

Correct Answer: B. Rationale: Infection control comes first to prevent spread to others. Supportive care and physician notification follow. Anti-diarrheals are contraindicated in suspected C. diff as they can worsen toxin retention.