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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
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Please advise any potentially affected individuals to drink plenty of fluids in the meantime.
Chris Llewellyn, Medicines Management Pharmacist, NHSG CCG 14/7/15