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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

C. diff infections move beyond the hospital

Clostridium difficile is moving beyond its traditional stronghold in the hospital to cause infections in long term care and ambulatory settings, the Centers for Disease Control and Prevention reports. While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. diff infection rates and deaths climbed to historic highs. The infection is linked to about 14,000 U.S. deaths every year. Those at highest 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% 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. diff 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 CDC reports that these hospital estimates may only represent one part of the overall impact. According to the CDC, 94% of C. diff infections are related to medical care. About 25% of 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 since many patients with C. diff infections are transferred to hospitals for care, raising risk of spread within the facility. The report notes that half of C. diff 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.