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Registration Number: {{org_field_registration_no}}

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Clostridium Difficile (C. diff) Infection Prevention and Control Policy

1. Purpose

This policy sets out the arrangements at {{org_field_name}} for preventing, identifying, assessing and managing suspected or confirmed Clostridioides difficile (C. difficile) infection and for preventing transmission to other people.

The policy supports compliance with the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in particular Regulation 12: Safe care and treatment. Regulation 12(2)(h) requires the registered person to assess the risk of, and prevent, detect and control the spread of infections, including healthcare-associated infections.

{{org_field_name}} will have regard to the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance, current Care Quality Commission requirements, current UK Health Security Agency guidance, current Department of Health and Social Care infection prevention and control guidance for adult social care and relevant NICE guidance.

The purpose of this policy is to ensure that suspected or confirmed C. difficile infection is recognised promptly, appropriate infection prevention and control precautions are implemented without avoidable delay, appropriate healthcare advice and treatment are obtained, and any suspected outbreak is escalated and reported to the appropriate health protection service.

2. Scope

This policy applies to all staff involved in the care and management of people who have, or are at risk of, Clostridium Difficile infection. It includes guidance on prevention strategies, infection control procedures, staff training, and treatment protocols.

3. Related Policies

• Infection Prevention and Control Policy (CH17)
• Safe Care and Treatment Policy (CH11)
• Risk Management and Assessment Policy (CH18)
• Medication Management and Administration Policy (CH21)
• Confidentiality and Data Protection Policy (CH34)

4. Policy Statement

{{org_field_name}} is committed to minimising the risks associated with Clostridium Difficile infections by ensuring best practices in infection prevention, hygiene control, and safe care delivery. We aim to prevent outbreaks, protect vulnerable individuals, and ensure appropriate treatment in collaboration with healthcare professionals.

5. Understanding Clostridioides difficile Infection

Clostridioides difficile, usually referred to as C. difficile or C. diff, is a spore-forming bacterium that can cause infection of the bowel. C. difficile infection may cause diarrhoea and can cause serious complications, including colitis.

C. difficile spores can survive for prolonged periods in the environment and can be transmitted through contact with contaminated hands, equipment, surfaces or the environment.

People may be at increased risk of C. difficile infection where they:

• are currently taking, or have recently taken, antibiotics;
• are older or frail;
• have recently been admitted to hospital or another health or care setting;
• are immunocompromised;
• have significant underlying health conditions;
• have previously had C. difficile infection; or
• have other recognised clinical risk factors identified by the person’s healthcare professional.

The presence of diarrhoea in a person at risk of C. difficile infection must be taken seriously and acted upon promptly in accordance with this policy.

6. Prevention Strategies

Hand hygiene

• Staff providing care to a person with suspected or confirmed C. difficile infection, or having contact with the person’s immediate environment, must wash their hands thoroughly with liquid soap and running water before and after contact and after removing personal protective equipment.
• Alcohol-based handrub must not be used as an alternative to washing with soap and water when caring for a person with gastrointestinal symptoms, including suspected or confirmed C. difficile infection.
• People we support must be encouraged and, where necessary, assisted to wash their hands with soap and water after using the toilet, commode or bedpan and before eating.
• Visitors must be advised to wash their hands with soap and water when entering and leaving the affected person’s environment.

Environmental cleaning and disinfection

• The bedroom, bed space and immediate environment of a person with suspected or confirmed C. difficile infection must be cleaned and disinfected at least daily using a product with demonstrated sporicidal activity against C. difficile, in accordance with the manufacturer’s instructions and the organisation’s Control of Substances Hazardous to Health assessment.
• Toilets, commodes and bathroom facilities used by the affected person must be cleaned and disinfected with a sporicidal product. Dedicated facilities must be cleaned frequently and whenever visibly soiled. Where facilities have to be shared, they must be cleaned and disinfected after each use.
• Frequently touched surfaces and reusable care equipment must be included in the enhanced cleaning arrangements. Wherever reasonably practicable, equipment should be dedicated to the affected person. Where equipment is shared, it must be appropriately cleaned and disinfected before use by another person.
• When isolation precautions cease, or following transfer, discharge or death, the person’s room or care area and relevant equipment must receive thorough terminal cleaning and disinfection using an appropriate sporicidal product.

Antimicrobial stewardship

• Antibiotics must only be administered when they have been prescribed for the individual and must be administered in accordance with the prescription.
• Where C. difficile infection is suspected or confirmed, the person’s prescriber must be informed of all current antimicrobial medicines so that their continued clinical need can be reviewed.
• Staff must support antimicrobial stewardship by providing prescribers with accurate information about the person’s symptoms, recent antibiotic use, medical history and response to treatment and by administering prescribed antimicrobial medicines safely and correctly.

7. Recognising and Responding to Suspected C. difficile Infection

Staff must be alert to diarrhoea and other signs of illness, particularly in a person who has recently received antibiotics, has recently been in hospital or another health or care setting, has previously had C. difficile infection, or has other recognised risk factors.

Signs and symptoms may include:

• new or unexplained diarrhoea, particularly loose or watery stools;
• abdominal pain or cramping;
• fever;
• nausea or loss of appetite;
• dehydration;
• weakness or deterioration in the person’s general condition; and
• in older people, atypical deterioration such as increased confusion, reduced oral intake or unexpected decline.

A person who develops potentially infectious diarrhoea must be assessed promptly. Staff must not wait for symptoms to persist for 24 hours before taking action.

Following the first episode of potentially infectious diarrhoea:

• appropriate infection prevention and control precautions must be commenced immediately;
• the person should be supported to remain in their own room or other appropriate single-room accommodation, where practicable, while the cause of the diarrhoea is assessed;
• the person’s GP, NHS 111, out-of-hours service or other appropriate healthcare professional must be contacted promptly for clinical assessment and advice;
• the healthcare professional must be informed of recent or current antibiotic treatment, previous C. difficile infection and other relevant risk factors;
• where requested by the healthcare professional, a stool specimen must be obtained and sent for C. difficile testing without avoidable delay, in accordance with local arrangements; and
• the person’s bowel movements must be monitored and documented, including stool consistency using the Bristol Stool Chart where this forms part of local clinical arrangements.

Urgent medical assistance must be sought where the person’s condition is severe, deteriorates rapidly or significantly, or there are signs of serious dehydration, severe abdominal illness, sepsis or another medical emergency.

8. Isolation and Infection Control Measures

Isolation precautions

• A person with potentially infectious diarrhoea, including suspected or confirmed C. difficile infection, should be supported to remain in their own bedroom or another appropriate single room as soon as possible while the cause is investigated.
• Wherever possible, the person should have access to a dedicated toilet and handwashing facilities. Where this is not possible, a dedicated commode must be provided and safely cleaned and disinfected after use.
• The person’s dignity, wellbeing, mental capacity, communication needs and psychological needs must be considered throughout isolation. Staff must continue to provide safe care, meaningful contact and appropriate support.
• Isolation precautions should normally continue until the person has had no diarrhoea for at least 48 hours and has achieved a formed stool, or until their bowel habit has returned to their normal baseline where an underlying condition means formed stool would not ordinarily be expected.
• Where there is uncertainty about when isolation precautions can cease, advice must be obtained from the relevant healthcare professional, local infection prevention and control team or UKHSA Health Protection Team.

Personal protective equipment

• Disposable gloves and aprons must be worn for contact with a person with suspected or confirmed C. difficile infection and for contact with their immediate environment, body fluids, contaminated linen or waste.
• Gloves and aprons must be removed as close to the point of care as practicable, disposed of safely and followed immediately by handwashing with liquid soap and water.
• Personal protective equipment must be changed between people and between tasks where required to prevent cross-contamination.

Linen

• Linen used by a person with suspected or confirmed C. difficile infection, and linen contaminated with faeces or other body fluids, must be treated as infectious laundry.
• Infectious laundry must not be shaken, sorted in the person’s room, placed on the floor or carried against staff clothing.
• Infectious laundry must be placed immediately into the appropriate water-soluble bag, where compatible with the laundry system in use, and then into the designated outer impermeable bag or other approved infectious-laundry system.
• Infectious laundry must be kept separate from clean and used non-infectious laundry and laundered separately in accordance with the laundry process applicable to the care home, the textile manufacturer’s instructions and current health and social care laundry guidance.
• Staff must wear appropriate protective clothing when handling infectious laundry and must wash their hands after handling it.

Waste

• Waste contaminated with faeces or other body fluids from a person with suspected or confirmed C. difficile infection must be risk assessed, segregated, stored and disposed of in accordance with current healthcare waste requirements and the home’s waste management procedures.
• Waste must be placed into the correct waste stream at the point of use and managed by an appropriately authorised waste contractor where required.
• Staff must remove personal protective equipment safely and wash their hands with liquid soap and water following the handling of contaminated waste.

9. Hydration and Nutrition Management

• Encourage fluid intake to prevent dehydration.
• Provide electrolyte solutions if necessary to replace lost fluids.
• Offer a low-fibre, easily digestible diet to reduce irritation to the gut.

10. Treatment and Medical Intervention

• Any person with suspected or confirmed C. difficile infection must receive prompt clinical assessment by an appropriate healthcare professional.
• Treatment must be prescribed and reviewed by an appropriately qualified prescriber in accordance with current NICE guidance and the person’s individual clinical circumstances.
• For adults, current NICE guidance identifies oral vancomycin as the first-line antimicrobial treatment for a first episode of mild, moderate or severe C. difficile infection. Staff must administer treatment only as prescribed and must not independently initiate, discontinue or alter antimicrobial treatment.
• The prescriber must be made aware of the person’s current and recent medicines, particularly antibiotics and other medicines that may contribute to diarrhoea or affect the person’s clinical risk, so that these can be clinically reviewed.
• Anti-motility medicines such as loperamide must not be given to treat diarrhoea associated with suspected or confirmed C. difficile infection unless specifically directed by an appropriate clinician.
• Staff must monitor the person’s clinical condition, bowel movements, fluid intake, hydration and response to treatment and promptly report deterioration or failure to improve to the responsible healthcare professional.
• A person in the community with suspected or confirmed C. difficile infection must be referred for urgent hospital assessment where symptoms are severe or deteriorate rapidly or significantly. Emergency assistance must be sought where the person’s condition is immediately life-threatening.
• Where infection is recurrent, treatment is ineffective or the person is at increased risk of complications, specialist clinical advice must be sought by the responsible healthcare professional in accordance with current NICE guidance.

11. Staff Training and Responsibilities

• All staff must complete infection prevention and control training with a specific focus on C. diff.
• Staff must be competent in:
  • Hand hygiene techniques.
  • Safe use of PPE.
  • Recognising symptoms and responding appropriately.
  • Cleaning protocols to reduce contamination risks.

12. Documentation, Reporting and Record Keeping

• All suspected and confirmed C. difficile infections must be documented accurately in the person’s care records. Records must include relevant symptoms, onset and frequency of diarrhoea, action taken, healthcare advice received, infection prevention and control precautions, treatment prescribed, monitoring and the outcome.
• The person’s infection risk assessment and care plan must be reviewed and updated when C. difficile infection is suspected or confirmed and again when the person’s condition or infection-control requirements change.
• Where two or more cases of diarrhoea that are suspected or known to be infectious occur within a few days in the care home, the Registered Manager must report this promptly to the local UK Health Security Agency Health Protection Team or other locally designated health protection or infection prevention and control service and follow the advice provided.
• Any suspected outbreak must be documented, including affected people, dates of onset, symptoms, infection prevention and control measures, advice received, actions taken and subsequent developments.
• The service must cooperate with UKHSA, the local infection prevention and control service, commissioners and other relevant authorities in the investigation and management of an outbreak and must implement required infection-control measures and provide relevant information lawfully and promptly.
• A suspected or confirmed C. difficile infection or outbreak must not be notified to the Care Quality Commission solely because it is an infection or outbreak. The Registered Manager must, however, make a CQC statutory notification without delay where the circumstances meet a notification requirement under the Care Quality Commission (Registration) Regulations 2009, including where applicable a notifiable death, serious injury or another prescribed incident.
• Infection prevention and control records, audits and outbreak records must be retained in accordance with the organisation’s records management arrangements and applicable legal requirements.

13. Visitors and Reducing Transmission Risk

People living at {{org_field_name}} must continue to be supported to receive visitors in accordance with Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Where a person has suspected or confirmed C. difficile infection:

• visitors must be provided with appropriate information about the infection and the precautions necessary to reduce transmission;
• visitors must be advised to wash their hands thoroughly with liquid soap and water before entering and after leaving the affected person’s environment;
• where a visitor is providing personal care, appropriate gloves and aprons must be made available and the visitor must be shown how to use and remove them safely;
• wherever possible, visits should be facilitated in the person’s private room or another arrangement that reduces transmission risk while maintaining the person’s right to receive visitors;
• infection risk must normally be managed by appropriate precautions rather than by preventing visiting.

Visiting must not be subject to a blanket restriction solely because there is a case or outbreak of C. difficile.

Where exceptional circumstances create a significant risk to the health, safety or welfare of the person, other people using the service, staff or visitors, any proposed restriction must:

• be based on an individual and documented risk assessment;
• take account of advice from the UKHSA Health Protection Team or relevant infection prevention and control professionals where applicable;
• be lawful, necessary and proportionate;
• use the least restrictive option available;
• take account of the person’s wishes, needs, rights, care plan and mental capacity;
• involve the person and relevant family members, representatives or advocates as appropriate; and
• be reviewed regularly and removed as soon as the exceptional circumstances no longer apply.

A record must be maintained of the assessment, reasons for any restriction, people involved in the decision, measures considered to enable visiting safely and each review of the decision.

People receiving end-of-life care must continue to be supported to receive in-person visits in accordance with current CQC requirements.

14. Recovery, De-isolation and Recurrence

• Infection-control precautions must not be discontinued simply because the person reports feeling better.
• Isolation precautions should normally continue until the person has had no diarrhoea for at least 48 hours and has achieved a formed stool, or until their bowel habit has returned to their usual baseline where another condition means formed stool would not normally be expected.
• Where there is uncertainty about whether infection-control precautions can be discontinued, advice must be sought from the relevant healthcare professional or infection prevention and control service.
• Following the end of isolation precautions, the person’s bedroom or care area, toilet or commode, frequently touched surfaces and relevant reusable equipment must receive thorough terminal cleaning and disinfection using an appropriate sporicidal product in accordance with the manufacturer’s instructions.
• Staff must continue to monitor the person for recurrence of diarrhoea or other symptoms and promptly obtain healthcare advice if symptoms recur.
• The person’s care plan, infection risk assessment and relevant medicines information must be reviewed following recovery and updated to record the previous C. difficile infection and any continuing risk-management requirements.

15. Policy Compliance and Continuous Improvement

• Regular infection control audits will be conducted to ensure adherence to best practices.
• Staff will receive refresher training on C. diff infection prevention every 12 months.
• Learning from infection incidents and outbreaks will be used to improve procedures.

16. Policy Review

This policy will be reviewed at least annually and sooner where required following:

• a change to relevant legislation or regulations;
• a change to Care Quality Commission requirements or guidance;
• publication or revision of the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance;
• publication or revision of relevant UK Health Security Agency or Department of Health and Social Care infection prevention and control guidance;
• publication or revision of relevant NICE guidance;
• updated national guidance on the prevention or management of Clostridioides difficile infection;
• significant learning arising from an infection incident or outbreak; or
• evidence that the existing policy or procedures are no longer effective in managing infection risk.

The Registered Manager is responsible for ensuring that relevant changes are incorporated into practice and communicated to staff without waiting for the scheduled annual review where an immediate change is required for safety or legal compliance.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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