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C. difficile Transmission: Routes and Prevention in Healthcare and Community

Clostridioides difficile (formerly Clostridium) spreads via the fecal-oral route. Spores are hardy, resist alcohol, heat, and many disinfectants.

Ingestion of spores: Contaminated hands → mouth; contaminated food/water (rare).
Environmental surfaces: Bedrails, commodes, equipment, floors — spores persist months.
Healthcare worker hands: Primary vector between patients.
Airborne dispersal: Aerosolization during bed-making, flushing — minor but documented.

Antibiotic exposure (clindamycin, fluoroquinolones, cephalosporins, penicillins) — disrupts microbiome.
Age ≥65, hospitalization, immunosuppression, PPI use, IBD, tube feeds.

Antimicrobial stewardship: Narrow spectrum, shortest duration, avoid high-risk classes.
Contact precautions: Gown/gloves for CDI patients.
Hand hygiene: Soap and water (mechanical spore removal) — alcohol gel insufficient.
Environmental cleaning: EPA-registered sporicidal (bleach 1:10, peracetic acid, hydrogen peroxide). UV-C adjunct.
Diagnostic stewardship: Test only with clinical diarrhea (≥3 unformed stools/24h); no test of cure.

Rising (~30-40% of cases). Risk: recent antibiotics, outpatient healthcare exposure, PPIs. Same prevention principles apply.