Issue number:
15/2010
Date Issued:
26 May 2010
Issued to:
Public Hospitals, Private Hospitals
Purpose:
Advice for hospitals

There has recently been a hypervirulent strain of Clostridium difficile infection (CDI) identified in a private hospital in Melbourne. The Department of Health wishes to provide information on testing for this strain and precautions required to minimise the risk of cross transmission of this disease.

CDI is a common infection experienced by patients in the health care setting. Onset usually follows a course of antibiotics that have caused other normal protective bacteria in the gut to be overwhelmed. Patients present with diarrhoea, associated with an inflamed large bowel.

The hypervirulent strain (NAP/027) has been in North America and Europe since 2003 and has been associated with increased mortality and morbidity.

Precautions

  • Strict adherence to hand hygiene using soap and water
  • Isolate patients who are incontinent with diarrhoea
  • Environmental cleaning with a sodium hypochlorite solution
  • Judicious use of antibiotics

More detailed information can be found at:

  • Healthcare Infection Control Special Interest Group
  • Clinical Practice Guidelines for Clostridium difficile Infection in Adults; 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)

Testing for hypervirulent strain

It is advised that specimens and/or C. difficile isolates from patients displaying criteria of severe disease should be tested for the hypervirulent strain. Severe disease should be considered if combinations of the following findings are present in the presence of CDI:

  • Age > 60 years
  • Temperature > 38.3°C
  • Serum albumin < 25 g/L
  • Peripheral white blood cell count > 15,000 cells/microL
  • Deteriorating renal function
  • Elevated serum lactate
  • Endoscopic evidence of pseudomembranous colitis or treatment in the intensive care unit
  • Subtotal colectomy performed
  • Toxic megacolon diagnosed

Testing

Health services with rapid testing equipment for MRSA

Hospitals with a BD SmartCycler Rapid MRSA System and Immuno GeneXpert IV-4 Site Laptop System can access rapid test kits for C. difficile testing and these can be purchased directly from the companies.

All health services

Melbourne Diagnostic Unit (MDU) has the capability and capacity to test for the hypervirulent strain of C. difficile and specimens from patients displaying the criteria of severe disease should be forwarded to MDU for testing.

Lance Wallace
Executive Director
Hospital & Health Service Performance