Screening for asymptomatic C. difficile to reduce disease incidence
Research type
Research Study
Full title
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
IRAS ID
354961
Contact name
Brendan Healy
Contact email
Sponsor organisation
Public Health Wales
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Clostridioides difficile (C. difficile) infection is a gastric infection, primarily affecting vulnerable and elderly patients, but increasingly seen in younger populations as well. It can cause severe diarrhoea, faecal incontinence, and long-term bowel issues, contributing to considerable morbidity, mortality, and healthcare costs. The infection may be transmitted between individuals and the environment, within hospitals or in the wider community, with some individuals carrying the bacteria asymptomatically. Triggers for symptomatic disease include antibiotic use and chemotherapy, making early detection crucial. However, some individuals carry the infection with no signs or symptoms.
To address this issue, we propose to carry out a pilot study in the admission units of Morriston Hospital in the Swansea Bay University Health Board. The study aims to assess the prevalence of asymptomatic C. difficile carriage at admission, evaluate its progression to symptomatic disease, and determine the feasibility and acceptability of screening patients upon hospital entry. It will also explore whether knowledge of a patient’s carrier status improves clinical management—particularly infection control practices and antibiotic stewardship.
All asymptomatic patients over 18 years old admitted to the unit will be invited to provide a faecal sample, with verbal consent obtained either from patients or their carers. Clear information will be displayed throughout the unit to inform patients about the study. Samples will be tested using existing NHS diagnostic microbiology services, with results communicated to the treating clinical teams and noted in patient records.
Staff will be trained to respond appropriately to positive carriage results. This pilot will provide key data on carriage rates and the potential for asymptomatic carriers to transmit the infection, informing wider policy and practice. The approach mirrors successful screening strategies for other infectious agents like MRSA and CPO, suggesting potential benefits for both patient outcomes and the healthcare system.REC name
Wales REC 3
REC reference
25/WA/0354
Date of REC Opinion
30 Jan 2026
REC opinion
Further Information Favourable Opinion