Clostridium difficile has become a major problem as a nosocomial patho
gen that is associated with the use of antibiotics. In the prevention
and control of C. difficile disease it is important that programmes ar
e directed at primary and secondary prevention. The three main element
s of prevention are: (i) restricted use of antibiotics; (ii) strict en
teric precautions when looking after patients with diarrhoea; and (iii
) meticulous cleaning of clinical areas. Although poor handwashing is
known to play a key role in the spread of infection, there is evidence
that compliance with handwashing protocols is low in many hospitals.
Infection control teams need to continue to develop creative education
programmes to improve compliance with simple infection control proced
ures. Consideration needs to be given to ensure that patients have acc
ess to handwashing and are well informed about infection prevention. F
urther work needs to be carried out to establish the efficacy of disin
fectants in the environment and the identification of a user-friendly,
effective sporicide. The importance of both thorough cleaning with de
tergents to reduce the number of spores in the environment, and clean
equipment for each patient should continue to be emphasized.