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Ann R Coll Surg Engl. 2009 Sep;91(6):464-9. doi: 10.1308/003588409X432310. Epub 2009 Jun 25.

Clostridium difficile: how much do hospital staff know about it?

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  • 1Department of Colorectal Surgery, Weston General Hospital, Weston-super-Mare, Somerset, UK; Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.



The aim of this study was to determine the awareness of Clostridium difficile infection amongst healthcare professionals.


A total of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using a questionnaire consisting of 17 questions covering various aspects of C. difficile.


More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P = 0.001) were aware of the spectrum of illnesses caused by C. difficile. Seven (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6 (33%) consultants, 21 (53%) trainees (P = not significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P = 0.05) and 70% of nurses correctly answered that oral metronidazole is the drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P < 0.0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.


There is a significant lack of knowledge concerning C. difficile infection amongst healthcare professions, in particular amongst consultants and nurses in our hospital.

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