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Clostridium difficile (C. diff), is causing infections beyond its traditional stronghold in the hospital, extending to ambulatory settings and long-term care, the Centers for Disease Control and Prevention reports. lopa patient safety concern in all types of medical facilities, not just hospitals as traditionally thought, according to a new Vital Signs report today from the Centers for Disease Control and Prevention. While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. difficile infection rates and deaths climbed to historic highs. “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.” C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people 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 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the health care system. However, the Vital Signs report shows that these hospital estimates may only represent one part of C. difficile’s overall impact. According to Vital Signs, 94 percent of C. difficile infections are related to medical care. About 25 percent of C. difficle infections first show symptoms in hospital patients; 75 percent 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 since 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 (present on admission), usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.