Most C. diff Infections Are Not Hospital-Acquired

Derrick Crook and others have explored the cause of the dramatic drop in incidence in the colonic infection, Clostridium difficile, in English hospitals since 2010.[1] They found that only 20% of cases of hospital-acquired C. diff infections result from patient to patient transmission of the organism – the rest are acquired from reservoirs outside the hospital. So the great majority of C. diff infections are not hospital-acquired.

The dramatic drop in incidence of C. diff enteritis was preceded by a precipitous drop in prescribing of quinolone antibiotics in both general practice and in hospitals. Moreover, the drop in incidence can be entirely explained by the decline in quinolone-resistant species of C. diff; the incidence of quinolone-sensitive C. diff infections remains unchanged.

The drop in C. diff infections in English hospitals turns out to have nothing to do with hand-washing and hospital hygiene.[2] Moreover, washing hands in alcohol is of no value as far as this organism is concerned because C. diff spores are resistant to this disinfectant.[3]

— Richard Lilford, CLAHRC WM Director


  1. Eyre DW, Cule ML, Wilson DJ, et al. Diverse Sources of C. difficile Infection Identified on Whole-Genome Sequencing. New Eng J Med. 2013; 369(13): 1195-205.
  2. Benning A, Dixon-Woods M, Nwulu U, et al. Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase. BMJ. 2011; 342: d199.
  3. Jabbar U, Leischner J, Kasper D, et al. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol. 2010; 31(6): 565-70.

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