healthcare-associated infections (HAI) program

Clostridioides difficile Infection (CDI) Prevention for Public Health and Healthcare Providers

Clostridioides difficile (C. difficile) is a spore-forming, toxin-producing bacteria that causes diarrheal disease, most commonly in patients with recent healthcare exposure and antibiotic use. C. difficile is able to cause disease and spread rapidly because it is naturally resistant to many of the antibiotics used to treat other infections.

C. difficile infection (CDI) is one of the most common healthcare-associated infections (HAI) identified in hospitals in the United States. California hospitals track and report CDI as described in the HAI in CA Hospitals Public Report. The CDPH HAI Program identifies where CDI is most problematic in the state and provides CDI prevention assistance. Public health and healthcare providers should coordinate efforts to address CDI prevention across the continuum of healthcare.

For CDI information for patients and families, see Clostridioides difficile Infection (CDI).




CDI Surveillance

  • ​Ensure accuracy of CDI surveillance data by implementing protocols to limit CDI testing to patients with clinically significant diarrhea without other identified causes.
  • Implement a laboratory alert system for the immediate notification of positive CDI tests.
  • ​Be aware of CDI incidence in healthcare facilities and communities. All California acute care hospitals are required to report healthcare facility-onset CDI to CDPH via the National Healthcare Safety Network. These data are reported annually and can be sorted by county. Raw data are available via the Open Data Portal.

​CDI Prevention​

  • ​Isolate patients with diarrhea pending CDI confirmation.
  • Use Contact precautions for the duration of diarrhea, plus 48 hours.
  • Perform hand hygiene before and after patient care, and after glove removal.
  • Use Environmental Protection Agency (EPA) approved sporicidal agents and ensure quality cleaning and disinfection of reusable equipment and the environment. Use the CDPH HAI Program: Environmental Cleaning and Disinfection Information guide to environmental cleaning and disinfection in healthcare facilities for patients, visitors, and staff.
  • Identify opportunities for improvement. Use the CDPH HAI Program Facility CDI self-assessment tool (PDF) periodically to assess your facility CDI prevention practices. Alternatively, you may use the Core Infection Prevention assessment tool (PDF) to assess your facility core infection prevention strategies. Additional assessment modules (for ventilator (PDF) use and MDRO (PDF)) are available to use in conjunction with the Core Infection Prevention tool.
  • ​Understand and provide guidance about CDI prevention and control measures to healthcare providers.

​Adherence Monitoring

  • ​Monitor adherence to CDI prevention practices of hand hygiene, Contact precautions, and environmental cleaning and disinfection. Measuring adherence and providing feedback to staff are critical to a successful infection prevention program. Use the CDPH HAI Program tools for adherence monitoring.
  • ​Conduct onsite visits at healthcare facilities with high CDI incidence or outbreaks to assess implementation of infection control strategies. CDC has infection control assessment tools for hospitals, skilled nursing facilities, outpatient settings, and hemodialysis facilities.  Contact the HAI Program for more information on performing infection control assessments focused on CDI prevention.

​Antimicrobial Stewardship

  • Implement antimicrobial stewardship program (ASP) strategies specific to CDI prevention. Antibiotic exposure is the major risk factor for CDI when a patient is also exposed to the C.difficile bacterium or spores. Use the CDPH CDI-Targeted ASP Strategies guide (PDF) to identify strategies for collaboration between infection preventionists and ASP leaders.

Interfacility Communication

  • ​Communicate CDI status to receiving facilities ahead of time to ensure appropriate care is maintained when transferring a patient with CDI. A template CDPH Interfacility Infection Control Transfer Form (PDF) is available. Examples of other forms can be found on the CDC HAI Prevention Toolkits webpage. 
  • ​Set expectations for facilities to effectively communicate CDI status when transferring patients to another healthcare facility. A template CDPH Interfacility Infection Control Transfer Form is available via the Interfacility Transfer Communications Guide page


  • A sample line list template (EXCEL) is available upon request and can be used for information gathering when an outbreak is suspected.

  • Contact the for any suspected or confirmed CDI outbreaks for which you need additional assistance.

​Regional Prevention



For additional information, contact the HAI Program at

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