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Clostridium difficile infection (CDI) in adults A Guide for Community Pharmacists Clostridium difficile (C diff) infection is a problematic infection associated with use of antibiotics and overgrowth of the organism leading to toxin production. There have been dramatic reductions in hospital acquired C. difficile but with changes in epidemic strains, we are now seeing more C. difficile in the community. 80% of cases are in the elderly (>65 years) with increasing risk associated with increasing age. C diff remains a debilitating and distressing preventable infection. In collaboration with Gloucestershire Hospitals NHS Trust guidelines for the assessment, diagnosis and treatment of C diff in the community have been developed. Healthcare workers should use the “SIGHT” mnemonic when managing suspected potentially infectious diarrhoea. Pharmacists can ask patients to contact their GP, stay at home and encourage hand washing to reduce risk of infection spreading. Avoid anti-motility drugs if you suspect CDI. How might Community Pharmacists and their Pharmacy Teams Help? S Suspect that the diarrhoea may have an infective cause where there is no clear alternative cause for diarrhoea (drugs e.g. laxatives, underlying bowel disease) i.e. extremely loose or liquid stool. If you suspect CDI ask patient to speak to GP, advise them not to visit surgery in first instance. If a patient turns up at your pharmacy, and you suspect an infective cause, advise patient that their symptoms may be contagious, and that they should contact their GP practice by telephone in the first instance. They should not be alarmed, but advised that some simple precautions will reduce the chances of others becoming infected. They should restrict their communications to the telephone. Isolate the patient immediately – request patients to return home and to restrict visitors to their home Ask the patient to keep contacts to a minimum, and if possible to remain at home. Appreciating that the patient is already “out and about”, they should be advised to minimise contacts, and wash their hands thoroughly if possible. Also any member of staff who has had contact with that patient should, upon the patient’s departure, immediately wash their hands thoroughly, using good hand washing technique, to reduce the risk of infection of staff and other patients / customers. There are numerous websites providing good hand-washing technique advisory posters which you can access and print out for staff. For cleaning worktops, a bleach based product is more effective than alcohol wipes. Ask patients, family and friends to wash hands to reduce risk of infection. Pass on this information to the patient, carer or relative Hand washing with soap and water should be carried out before and after each contact with the patient and the patient’s environment While you’re unlikely to go into a patient’s home, pharmacy staff should be mindful of any patients requesting symptomatic treatment for D&V. Even cases of non-C.diff diarrhoea can be minimised with hand washing. Advise any delivery drivers if they deliver to patients where you know of infection (e.g. if housebound and phoned to get some diarrhoeal treatments delivered (i.e. Oral Rehydration Therapy, NB not anti-motility drugs if C.diff is suspected)) Test the stool for evidence of toxigenic Clostridium difficile, by sending a specimen immediately Not relevant to community pharmacy. Included here to highlight what may occur at the GP practice in due course I G H T Please advise any potentially affected individuals to drink plenty of fluids in the meantime. Chris Llewellyn, Medicines Management Pharmacist, NHSG CCG 14/7/15