Hallmark is frequent watery, foul-smelling diarrhea (often 3 or more loose stools in 24 hours), abdominal cramping, fever, and leukocytosis.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client is diagnosed with Clostridioides difficile infection. Which infection-control precaution is essential?
Answer: A. C. difficile spores resist alcohol, so contact precautions with soap-and-water handwashing and a private room are required. Alcohol-based sanitizer alone does not kill the spores.
Question 2 of 3
A client has Clostridioides difficile. Which precaution is essential?
Answer: B. C. diff requires contact precautions with gown and gloves, and hand hygiene with soap and water (alcohol gel does not kill spores).
Question 3 of 3
The nurse is caring for a client with Clostridioides difficile (C. diff) infection. Which hand hygiene method is most effective after caring for this client?
Answer: B. C. diff produces spores that are NOT killed by alcohol-based hand sanitizer. The nurse must wash hands with soap and water, which physically removes the spores.
Keep the streak going with more questions like these, each with a full rationale.
What is clostridioides difficile?
It spreads by the fecal-oral route via spores that survive on surfaces and on alcohol gel. It is a leading healthcare-associated infection and can progress to toxic megacolon. Contact precautions plus soap-and-water handwashing are mandatory.
Key points to remember
- Hallmark is frequent watery, foul-smelling diarrhea (often 3 or more loose stools in 24 hours), abdominal cramping, fever, and leukocytosis.
- Recent or current broad-spectrum antibiotic use (clindamycin, fluoroquinolones, cephalosporins) is the classic trigger.
- The organism forms spores that resist alcohol-based hand sanitizer and persist on surfaces, driving transmission.
- Diagnosis is by stool testing for C. difficile toxin or its gene (PCR).
- Treatment is oral vancomycin or fidaxomicin, plus stopping the offending antibiotic; severe recurrent cases may need fecal microbiota transplant.
- Severe disease can progress to toxic megacolon and bowel perforation, which are life-threatening.
Common causes
- Post-antibiotic gut overgrowth
- Spore-forming, fecal-oral spread
Signs & symptoms
- Watery foul diarrhea, cramps
- Fever, ↑ WBC, dehydration
Nursing priorities
- Place the patient on contact precautions in a private room with dedicated equipment.
- Wash hands with soap and water (not alcohol gel) and wear gown and gloves for all contact.
- Discontinue the precipitating antibiotic as ordered and administer oral vancomycin or fidaxomicin.
- Monitor fluid and electrolyte status, replace losses, and track stool frequency and abdominal status.
- Clean the room and surfaces with a sporicidal bleach-based disinfectant.
Labs & values
Patient teaching
- Wash hands with soap and water after every bathroom use; hand gel does not kill the spores.
- Complete the full course of prescribed treatment and do not take over-the-counter antidiarrheals.
- Clean home bathroom surfaces with a bleach solution and report return of diarrhea after treatment ends.
Red flags: report now
- A distended, rigid, or tender abdomen with decreasing stool output may signal toxic megacolon and requires immediate provider notification.
- Signs of severe dehydration or hypotension and tachycardia indicate volume loss needing urgent fluids.
- Never give antidiarrheal/antiperistaltic agents (loperamide) in active C. diff; they trap toxin and worsen colitis.
- Worsening fever, rising WBC, or new severe pain warrants escalation.
References
Clinical references for this topic
