Prevention and control measures for Clostridium difficile in residential and long-term care facilities

  • Since August 2004, Clostridium difficile associated diarrhea (CDAD) has undergone ongoing surveillance in all Quebec hospitals with more than 1,000 admissions annually. The surveillance has monitored the evolution of CDAD levels in health care facilities and confirmed their decrease. From an average of 9.1 cases/10,000 patient days in 2005-2006, the average rate has dropped to 4.6 cases/10,000 patient days in 2016-2017 (SPIN, 2017).
  • Clostridium difficile (C. difficile) infection is nonetheless one of the main causes of nosocomial infectious diarrhea in Quebec health care facilities. Although the majority of cases occur in hospitals, some cases have been identified in residential and long-term care facilities and, based on epidemiological data available, outbreaks have also been reported there. Complications and deaths are more common in the older population.
  • In 2005, the Comité sur les infections nosocomiales du Québec (CINQ) published guidelines for managing CDAD in Quebec health care institutions, including a chapter aimed at long-term care facilities. In 2015, CINQ published a guide for managing hospital-based CDAD outbreaks.
  • This document’s purpose is to formulate recommendations for infection prevention and control (IPC) teams at residential and long-term care facilities (CHSLD) and for clinicians who practise there, to help them quickly recognize CDAD cases and apply the necessary measures for preventing and controlling transmission of C. difficile at these facilities.


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