Best Practices for C.Difficile Testing to Optimize Patient Care

Best Practices for C. difficile Testing to Optimize Patient Care

Clostridium difficile (C. difficile, C. diff) is a spore-forming, anaerobic bacterium that can be life-threatening. Clostridium difficile infection (CDI) is a challenge for many U.S. hospitals, further complicated by the fact that many providers test for the bacterium in patients without the appropriate clinical presentation of disease. This can lead to false increases in an institution's C. diff rates—and it can harm patients through unwarranted antimicrobial use. The following information provides a deeper understanding of C. diff and actions to help control its impact within your institution.

1.Recognize symptoms and at-risk populations

Symptoms of C. difficile infection include frequent diarrhea, abdominal cramping, nausea, and fever. Recent use of broad-spectrum antibiotics is the biggest contributing factor for CDI, with hospitalized patients and nursing home residents at especially high risk.

2.Follow appropriate patient testing criteria

Testing should be limited to patients with clinically significant diarrhea, using the following criteria:

Three or more loose stools in 24 hours

Rule out other causes of loose stool (laxatives, medications, etc.)

Only test liquid stool

3.Understand C. difficile diagnosis

Labs use several test methods to identify C. difficile, including highly sensitive polymerase chain reaction (PCR) that checks stool samples for toxin nucleic acid. Positive tests indicate the presence of C. difficile, but CDI should be diagnosed and treated only when patients have signs and symptoms of infection. Testing in colonized, asymptomatic patients can result in misdiagnosis of CDI.

4.Understand Treatment for CDI

Patients are typically prescribed antibiotics and isolated in a private room for the duration of their hospital stay. Those with recurrent CDI that fails to respond to conventional therapies may undergo fecal transplantation to restore bacterial balance.

5.Prevent C. difficile Transmission

C. difficile is spread when spores from the bacterium are passed from contaminated feces to food, countertops, and other objects. These spores are challenging to kill, and can survive in the environment for months in the absence of proper cleaning techniques. Transmission prevention strategies include:

Limit patient contact

(infected patient should stay in a private room; caregivers should wear disposable gloves and gowns)

Clean hands

thoroughly with soap and water following any visit to a patient's room (alcohol hand gels do not kill C. diff)

Clean and disinfect

all surfaces and equipment in the patient-care environment with products containing chlorine bleach

Avoid unnec­essary antibiotics


Source: Buckel, W., Avdic, E., Carroll, K., Gunaseelan, V., Hadhazy, E., & Cosgrove, S. (2015). Gut Check: Clostridium difficile Testing and Treatment in the Molecular Testing Era. Infection Control & Hospital Epidemiology, 36(2), 217-221. doi:10.1017/ice.2014.19.

Additional resources

  • Clostridium Difficile Infection
    by Centers for Disease Control and Prevention
    People getting medical care can catch serious infections called healthcare-associated infections (HAIs). One type of HAI – caused by the germ C. difficile – was estimated to cause almost half a million infections in the United States in 2011, and 29,000 died within 30 days of the initial diagnosis.

  • 341 Days Without a C. difficile Infection
    by Lisa Beauch
    How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero

  • How to solve your C. Difficile diagnosis challenges
    How a holistic approach to C. difficile management can help hospitals reduce their CDI rates.

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How to Solve Your C. Difficile Diagnosis Challenges
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