A pilot study to determining the feasibility of screening of hospital patients on admission for asymptomatic C. difficile in order to act to reduce subsequent disease incidence
Acceptability of screening for C. difficile
Overview: The study will be undertaken in the Medical Admission Units in Morriston Hospital. Screening all consenting adults (aged ≥18 years) admitted to the acute admission units in Morriston Hospital who do not, at the time of admission, have diarrhoea (defined as Bristol stool chart >4). The bacteria (i.e. germ) we will be screening for is Clostridioides difficile (a.k.a C. difficile or C. diff). If a patient has been confirmed to be carrying C. difficile, a simple intervention flagging the carriage status to clinical teams caring for patients and triggering increased scrutiny of antibiotic prescribing will be piloted. This is a similar approach to that adopted in national policies regarding Carbapenemase-producing Enterobacteriaceae (i.e. CPE). Screening for C. difficile: A faecal sample or rectal swab will be collected from patients as soon as practically possible after admission to the ward. Only one screening sample per patient will be required. Patients will be able to opt out of the screening. Patients who lack the capacity to consent will be excluded from the study, and a sample will not be collected. Patients will be provided with patient information sheets prior to verbal consent. Verbal consent will be obtained from the patients on the admission units prior to sample collection. The clinical staff responsible for providing care to the patients will ask the patients if they are willing to provide a faecal sample to identify C. difficile carriage. Patients will be required to complete a section of the patient information sheet confirming their verbal consent. Sample collection will be carried out using standard clinical procedures (these are used for similar microbiological screening e.g. CPE). Where rectal samples are collected, this will be done by trained clinical health care staff employed on the wards. Samples will be processed via existing Public Health Wales microbiology testing procedures, and results will be entered into patients' notes and re
1. All patients aged ≥18 years admitted to the acute admission units in the study site who do not, at the time of admission, have diarrhoea (defined as Bristol stool chart >4) 2. Willing to provide a faecal sample or rectal swab on the basis of a verbal consent process.
1. Patients who decline screening 2. Patients who have diarrhoea on admission to Morriston Hospital 3. Aged under 18 years old 4. Patients without the capacity to provide verbal consent 5. Other clinical emergency issues that require precedence over study inclusion