Preventing the Spread of C. diff Bacteria

In a nutshell…
“C. diff” bacteria can infect the human gut, causing a life-threatening illness. People with weakened immune systems and those who have recently taken antibiotics are most at risk for infection. Understanding how C. diff exists in the environment and spreads can help you avoid serious illness.


C. diff exists as stable spores outside of the human body. Inside the gut, the bacterium acts as an “opportunistic” organism causing infection in patients who are vulnerable as a result of previous illnesses or immune system deficiencies.

“C. diff” is the antimicrobial-resistant bacteria Clostridioides difficile.1 It causes symptoms ranging from diarrhea to life-threatening colon inflammation. According to the Centers for Disease Control and Prevention (CDC), C. diff causes about half a million illnesses and nearly 15,000 deaths annually. People of any age may become sick. C. diff infections cost Americans about $5.4 billion annually. C. diff is passed from person to person by the oral-fecal route. That is why it is important to wash hands thoroughly after using the bathroom and before preparing or eating meals. 

Although most healthy adults who contact C. diff do not get sick, they may pass the bacteria to others who may. People most vulnerable to C. diff have weakened immune systems or have recently taken antibiotics. These conditions provide the “opportunity” for C. diff infection, along with being at least 65 years of age; having been hospitalized recently; or having had a previous infection with C. diff, or exposure to it.

C. diff is a Very “Difficult” Bacterium

Difficile” is French for difficult, an apt label for this pathogen. Outside the human body, C. diff exists as stable spores. These can last on surfaces and in soils for months to years. Once in the human digestive system, spores are activated and are resistant to most commonly used antibiotics for intestinal diseases, thus making treatment “difficult.” Fidaxomicin and vancomycin are antibiotics prescribed for first-time C. diff infections. These antibiotics kill C. diff in the gut and reduce toxins from the bacterium. For recurring cases, patients may receive “fecal microbiota transplants.” These can help restore healthy gut bacteria.2

A Word about Hand Sanitizers

C. diff spores are resistant to alcohol, which is the active ingredient in many hand sanitizers. For that reason, hand washing with soap and water is the preferred method of removing C. diff. According to an article in Harvard Health Publishing, while soap doesn’t kill the spores, vigorous scrubbing with soap and water and thorough rinsing can physically remove many of them.

C. diff may be spread when an infected patient is moved, for example, from a long term care facility to an acute care facility with no advance notice of the patient’s infection. Infected hospital patients must be isolated. They should be given their own bathrooms. Caregivers must wear gloves and gowns. To decontaminate surfaces in patient rooms, hospitals apply disinfectants that kill the organisms and spores.  The Environmental Protection Agency has a list of approved products. CDC notes a solution of one part chlorine bleach and nine parts water (10% concentration) is effective against C. diff on frequently touched surfaces. Clothing and linens contaminated with C. diff should be washed with chlorine bleach, if possible.

Raising Awareness of C. diff 

The C. diff Foundation has designated November “Clostridium difficile Awareness Month.” The foundation’s website is promoting C. diff education, noting that “Most patients and their families, until being told they have a C. difficile infection, have little to no knowledge of this infectious disease.” 

Meanwhile, ongoing measures to control infection are critical. And that brings us to some good news. In a 2018 report, CDC noted a 12% decrease in C. diff infections between 2017 and 2018 in US acute care hospitals. That’s a trend in the right direction in anybody’s book. 

Barbara M. Soule, RN, MPA, CIC, FSHEA, FAPIC is an Infection Preventionist and a member of the Water Quality & Health Council.

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1Clostridioides difficile used to be known as Clostridium difficile, according to the CDC. It appears that the former name continues to be used in some instances.

2Heimann, Cruz Aquilar, Mellinghof, Vehreschild (2018). Economic burden and cost-effective management of Clostridium difficile infections. Med Mal Infect, 48 (1) 23-29. Abstract available online: