title: Vital signs: preventing Clostridium difficile infections.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is a common and sometimes fatal health-care-associated infection; the incidence, deaths, and excess health-care costs resulting from CDIs in hospitalized patients are all at historic highs. Meanwhile, the contribution of nonhospital health-care exposures to the overall burden of CDI, and the ability of programs to prevent CDIs by implementing CDC recommendations across a range of hospitals, have not been demonstrated previously.
  
  
  METHODS
  Population-based data from the Emerging Infections Program were analyzed by location and antecedent health-care exposures. Present-on-admission and hospital-onset, laboratory-identified CDIs reported to the National Healthcare Safety Network (NHSN) were analyzed. Rates of hospital-onset CDIs were compared between two 8-month periods near the beginning and end of three CDI prevention programs that focused primarily on measures to prevent intrahospital transmission of C. difficile in three states (Illinois, Massachusetts, and New York).
  
  
  RESULTS
  Among CDIs identified in Emerging Infections Program data in 2010, 94% were associated with receiving health care; of these, 75% had onset among persons not currently hospitalized, including recently discharged patients, outpatients, and nursing home residents. Among CDIs reported to NHSN in 2010, 52% were already present on hospital admission, although they were largely health-care related. The pooled CDI rate declined 20% among 71 hospitals participating in the CDI prevention programs.
  
  
  CONCLUSIONS
  Nearly all CDIs are related to various health-care settings where predisposing antibiotics are prescribed and C. difficile transmission occurs. Hospital-onset CDIs were prevented through an emphasis on infection control.
  
  
  CONCLUSIONS
  More needs to be done to prevent CDIs; major reductions will require antibiotic stewardship along with infection control applied to nursing homes and ambulatory-care settings as well as hospitals. State health departments and partner organizations have shown leadership in preventing CDIs in hospitals and can prevent more CDIs by extending their programs to cover other health-care settings.
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity*; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000517:prevention & control; D003428:Cross Infection / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D017048:Health Care Costs / Q000639:trends; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D017053:Infection Control / Q000379:methods*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010356:Patient Isolation; D011159:Population Surveillance; D012307:Risk Factors; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents