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C. difficile

Disclaimer: This resource has been prepared to help the workplace parties understand some of their obligations under the Occupational Health and Safety Act (OHSA) and regulations. It is not legal advice. It is not intended to replace the OHSA or the regulations. For further information please see full disclaimer.

What is C. difficile?

Clostridium difficile (C. difficile) is a common bacteria that can be found in the environment and the intestine. Many healthy adults will carry C. difficile and not have any symptoms. C. difficile infection in patients can lead to diseases ranging from mild inflammation of the colon to severe disease and, rarely, death. It is one of the most-common infections in hospitals and long-term care homes and has caused recent multiple outbreaks worldwide.

People can get infected from touching surfaces contaminated with feces, and then touching their mouths or eyes. Health-care workers can spread the bacteria to their patients if their hands are contaminated. Healthy people don't usually get C. difficile infections. C. difficile infection is not often a cause of work-related illness. However, workers on antibiotics, with chronic illnesses or taking cancer drugs may be at greater risk of C. difficile infections.

Antibiotic use changes normal bowel bacteria by killing the "good" bacteria in the bowel, allowing C. difficile to flourish and causing illness.

Prevention includes good hand hygiene, adherence to routine infection control practices and contact precautions, appropriate patient management and enhanced environmental cleaning with a disinfectant approved for use against C. difficile. The bacteria may remain in the health-care facility for a prolonged time unless thorough environmental cleaning is carried out.

What are the key health and safety duties of the employer?

Health-care facilities are required to comply with applicable provisions of the Occupational Health and Safety Act (OHSA) and the Regulation for Health Care and Residential Facilities (O. Reg. 67/93).

Employers, supervisors and workers have rights, duties and obligations under the OHSA.

Specific requirements for certain health-care and residential facilities may be found in the Health Care and Residential Facilities Regulation (HCRF).

  1. Under Section 8 and 9(1) of the HCRF, the employer must develop written measures and procedures to protect workers from infectious agents.

    The measures and procedures must be developed in consultation with the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR).

    Measures and procedures may include, but are not limited to:

    • Safe work practices
    • Safe working conditions
    • Proper hygiene practices and the use of hygiene facilities
    • Infection control
    • Use of appropriate antiseptics, disinfectants and decontaminants
    • Handling, cleaning and disposal of sharp objects and waste
  2. An employer – in consultation with and in consideration of the recommendations of the JHSC or HSR – shall develop, establish and provide training and education programs in health and safety measures and procedures to protect workers from exposure to infectious agents [HCRF subsection  9(4)].

    Infection prevention and control training may include:

    • Infection prevention, and control measures and procedures.
    • Hand hygiene
    • Environmental cleaning
    • Signs and symptoms of infection
    • What to do in case of illness.
  3. Employers must ensure workers required to use personal protective equipment (PPE) are trained in its use, care and limitation, and that the PPE is a proper fit and is stored in a convenient and clean location.

  4. Employers must provide notice of occupational illness. Health-care-associated C. difficile infections acquired by workers as a result of workplace exposures are occupational illnesses and must be reported to the Ministry of Labour, to the workplace joint health and safety committee, and to the trade union, if any, in accordance with the OHSA's Section 52(2) and the Regulation for Health Care and Residential Facilities Section 5(5).

What should workers do to protect themselves?

  1. Perform frequent hand hygiene with alcohol-based hand rubs, or soap and water.
  2. Follow routine infection control practices and contact precautions. Health-care workers, including those receiving antibiotics, are not at risk of acquiring C. difficile infection at work when routine practices and contact precautions are consistently followed.
  3. Wear gloves and gowns upon entering the room of patient with suspected C. difficile.
  4. Do not eat or drink in patient care areas.
  5. Report symptoms of C. difficile infection to your supervisor and occupational health department.


Disclaimer: This web resource has been prepared to assist the workplace parties in understanding some of their obligations under the Occupational Health and Safety Act (OHSA) and the regulations. It is not intended to replace the OHSA or the regulations and reference should always be made to the official version of the legislation.

It is the responsibility of the workplace parties to ensure compliance with the legislation. This web resource does not constitute legal advice. If you require assistance with respect to the interpretation of the legislation and its potential application in specific circumstances, please contact your legal counsel.

While this web resource will also be available to Ministry of Labour inspectors, they will apply and enforce the OHSA and its regulations based on the facts as they may find them in the workplace. This web resource does not affect their enforcement discretion in any way.