Deadly Diarrhea Germ Spreading Across All Types of Medical Facilities

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C. difficile infections a threat to patients getting nursing home and outpatient care, not just hospital care, according to CDC Vital Signs report

C. difficile infections are usually a regional problem since patients transfer back and forth between facilities, allowing the disease to spread.

People getting medical care can catch serious infections called health care-associated infections (HAIs). While most types of HAIs are declining, one – caused by the germ C. difficile – remains at historically high levels, according to a new Vital Signs report today from the Centers for Disease Control and Prevention. C. difficile causes diarrhea linked to 14,000 American deaths each year. Those most at risk are people, especially older adults, who take antibiotics and also get medical care. When a person takes antibiotics, good germs that protect against infection are destroyed for several months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands. C. difficile infections cost at least $1 billion in extra health care costs annually.

“C. difficile harms patients just about everywhere medical care is given,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “Illness and death linked to this deadly disease do not have to happen. Patient lives can be saved when health care providers follow the 6 Steps to Prevention, which include key infection control and smart antibiotic prescribing recommendations.”

People most at risk for C. difficile infections are those who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 or older.

The report shows that these estimates may only represent one part of C. difficile’s overall impact. According to the Vital Signs report, 94% of C. difficile infections are related to medical care in hospitals, nursing homes, doctor’s and dentists’ offices, and other health care settings. About 25% of C. difficle infections first show symptoms in hospital patients; 75% first show in nursing home patients or in people recently cared for in doctor’s offices and clinics.

Although the proportion of infection onset is lower in hospitals, these facilities remain at the core of prevention because many patients with C. difficile infections are transferred to hospitals for care, raising risk of spread within the facility. The Vital Signs report shows that half of C. difficile infections diagnosed at hospitals were already present at the time the patient was admitted, usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.

The report highlights three programs showing early success in reducing C. difficile infection rates in hospitals. Seventy-one hospitals in Illinois, Massachusetts, and New York decreased C. difficile infections by 20 percent in less than two years by following infection control recommendations. These promising results are consistent with similar efforts in England, a nation that dropped C. difficile infections by more than 50 percent during a recent three-year period.

“C. difficile infections are usually a regional problem since patients transfer back and forth between facilities, allowing the disease to spread,” said L. Clifford McDonald, M.D., CDC medical epidemiologist and lead author of the study. “Health departments have the ability to work with many types of health care facilities, and have a unique opportunity to coordinate local, comprehensive prevention programs to reduce the occurrence of these infections.”

Patients get C. difficile infections most often within a few months of taking antibiotics and also receiving medical care. Antibiotics are lifesaving medicines that stop infections, but they also destroy the body’s good bacteria for several months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands. Infection risk generally increases with age; children are at lower risk for C. difficile infection. Identifying C. difficile infection early and stopping its spread to other people can save lives.

Patients can help stop C. difficile by:

  • Taking antibiotics as prescribed by a doctor. Antibiotics can be lifesaving medicines.
  • Tell your doctor if you have been on antibiotics and get diarrhea within a few months.
  • Wash your hands after using the bathroom.
  • Use a separate bathroom if you have diarrhea, or be sure the bathroom is cleaned well if someone with diarrhea has used it.

For Clinicians: 6 Steps to Prevention

1. Prescribe and use antibiotics carefully. About 50% of all antibiotics given are not needed, unnecessarily raising the risk of C. difficile infections.
2. Test for C. difficile when patients have diarrhea while on antibiotics or within several months of taking them.
3. Isolate patients with C.difficile immediately.
4. Wear gloves and gowns when treating patients with C. difficile, even during short visits. Hand sanitizer does not kill C. difficile, and hand washing may not be sufficient.
5. Clean room surfaces with bleach or another EPA-approved, spore-killing disinfectant after a patient with C. difficile has been treated there.
6. When a patients transfers notify the new facility if the patient has a C. difficile infection.

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report(MMWR). Vital Signs is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, prescription drug overdose, HIV/AIDS, motor vehicle passenger safety, health care–associated infections, cardiovascular health, teen pregnancy, access to health care, and food safety.

For more information about preventing C. difficile, visit http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html. Information about tracking HAIs infections can be found at http://www.cdc.gov/nhsn and at http://www.cdc.gov/hai/eip/index.html.

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