ARO Questions & Answers

C. difficile

What is Colostridium difficile (C. difficile)?

C. difficile is a bacterium that is the most common cause of infectious diarrhea in hospitalized patients in the industrialized world; it can also cause more serious intestinal conditions like colitis (inflammation of the colon). Approximately 1-3 percent of the human population is normally colonized or has the presence of C. difficile bacteria with no symptoms.

What are the symptoms of C. difficile?

Symptoms include: watery diarrhea, fever, loss of appetite, nausea, and abdominal pain/tenderness.

How is C. difficile treated?

For people with mild symptoms, no treatment may be required. For severe cases, medication and surgical interventions may be needed.

Is C. difficile fatal?

In rare cases, C. difficile can be fatal. More commonly, the infection causes diarrhea. Diarrhea can lead to serious complications, including dehydration.

How does using antibiotics contribute to the development of C. difficile?

When people receive treatment with antibiotics for other medical conditions, this changes the levels of bacteria that are normally found in the intestines or bowel. When there are fewer good bacteria in our intestines and colon, C. difficile has the chance to thrive and produce toxins.

What causes C. difficile?

C. difficile can be picked up on the hands from exposure in the environment and can get into the stomach once the mouth is touched, or if food is handled and then swallowed. Once in the stomach, the bacteria usually will not cause any problems unless the other bowel bacteria are disturbed, which can happen when antibiotics are taken. The use of antibiotics increases the chances of developing C. difficile diarrhea as it alters the normal level of good bacteria found in the intestines and colon. Without the presence of the normal bowel bacteria, the C. difficile bacteria may start to grow and produce a toxin that can damage the bowel and lead to watery diarrhea, fever and abdominal pain or tenderness.

How does C. difficile spread?

When a person has C. difficile, the bacteria in their feces can contaminate surfaces such as toilets, bedpans, commode chairs, and door handles (if feces is on hands). While healthy people don't usually get C. difficile, they can become infected if they touch contaminated surfaces and then touch their mouths or eyes without washing their hands. Healthcare workers can spread the bacteria to their patients if their hands are contaminated.

People who have other illnesses or conditions requiring the use of antibiotics and the elderly are at greater risk of infection. The spread of C. difficile occurs due to inadequate hand hygiene and environmental cleaning. C. difficile produces spores that survive for long periods and are resistant to destruction by many environmental factors (e.g. temperature, humidity). 

What puts a person at risk of getting C. difficile?

Those at risk include the elderly, people treated with antibiotics, or cancer chemotherapy. In addition, patients taking stomach ulcer drugs known as proton pump inhibitors are at increased risk to contract C. difficile infection.

What can be done to prevent the spread of C. difficile?

The presence of C. difficile in a large number of patients receiving antibiotics in health care settings can lead to frequent outbreaks. In these settings, C. difficile infections can be limited through careful use of antibiotics and routine infection control measures. As with any infectious disease, frequent hand-washing is one of the best defences against the spread of C. difficile.

  • If you work or visit a hospital or long-term healthcare facility, wash your hands often, especially after using the toilet. Most healthcare facilities provide an alcohol-based hand sanitizer at the entrance. Be sure to use it. If your hands are visibly soiled, use soap and water to wash them instead of an alcohol-based hand sanitizer.
  • When prescribed antibiotics, follow your doctor or healthcare provider's instructions and the directions on the label. Keep taking the antibiotics as long as your doctor or healthcare provider recommends to kill all of the C. difficile bacteria.
  • If you have concerns about C. difficile and medication you are currently using, talk to your doctor or healthcare provider.

The Public Health Agency of Canada (PHAC) has developed these infection control guidelines, including proper hygiene and the proper use of antibiotics. These guidelines are a resource for the provinces, territories and healthcare organizations.


What is MRSA (methicilin-resistant Staphylococcus aureus)?

MRSA is a strain of the staphylococcus aureus bacteria that is resistant to the antibiotic Methicillin and other similar antibiotic medications. Staphylococcus aureus normally lives on the skin and in the nose and generally causes no harm. However, occasionally, Staphylococcus aureus might be the cause of skin infections or more invasive disease. Staphylococcus is the single most common cause of hospital-associated infections.  People who acquire MRSA have typically had several hospitalizations, underlying medical conditions that affect their normal bacteria flora or weaken the immune system.


What is VRE (vancomycin-resistant Enterococcus)?

VRE is a strain of the enterococcus bacteria that is resistant to the antibiotic vancomycin and other similar antibiotics.  Enterococci are found in the bowel and are considered part of the ‘normal flora' or part of the bacteria normally living in the human body. However, Enterococci can cause skin and soft-tissue infection and infections of the blood.  

What does Sunnybrook do to prevent the spread of infections?

Sunnybrook is fortunate to have one of the most aggressive screening and monitoring programs for antibiotic resistant organisms. The hospital has a team of nine infection prevention and control officers as well as a dedicated medical and operations director who consult regularly in national and international forums on these issues. Sunnybrook has an active surveillance program that looks for and monitors the presence of infections throughout the hospital.