In theory, clostridium difficile (aka C. diff) does not seem like a tough problem to solve. Yes, it’s a deadly bacterial infection that sickens almost a half-million people and contributes to some 29,000 deaths every year, the vast majority in hospitals and other healthcare settings. And yes, it has recently become both more common and more deadly.

But the weapons needed to defeat this bug are inexpensive and straightforward: soap, gloves, disinfectants, and the proper use of antibiotics.

So it’s particularly frustrating that even as several serious hospital-acquired infections (including those caused by central-line catheters) have declined, C. diff continues to plague some of the nation's most prestigious medical centers.  

“Far too many patients are getting infected with dangerous bacteria in healthcare settings,” said Tom Frieden, M.D., director of the Centers for Disease Control and Prevention.

About a third of the more than 3,100 hospitals we evaluated received a low rating for C. diff infection control, meaning their infection rates were worse than the national benchmark. And 19 of the nation’s largest teaching hospitals were among those to receive low marks, including some of the most recognized ones, such as Baylor University Medical Center in Dallas, the Cleveland Clinic in Cleveland, Cedars-Sinai Medical Center in Los Angeles, and Mount Sinai Hospital in New York City.

“Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” says Lisa McGiffert, director of Consumer Reports' Safe Patient Project. “But even they seem to be struggling against this infection.” Only two large teaching hospitals—Mount Sinai Medical Center in Miami Beach, Fla., and Maimonides Medical Center in Brooklyn, N.Y.—earned one of our top two scores in preventing the infection.

So, why is C. diff proving so difficult to control? “There are a number of things that have to work together to keep the infection under control,” says Edward Chapnick, M.D., director of the Division of Infectious Disease at Maimonides. “Yes, the tools are simple, but they have to be deployed exactly the right way over and over and over again,” he says. “And that’s not so easy, especially in big hospitals with hundreds of beds and lots of different people.”

The CDC has laid out a list of methods for tackling C. diff that includes detailed protocols for hand hygiene and room cleaning as well as suggestions about nurse-to-patient ratios and the importance of hospital leadership.

But the agency lacks the authority to mandate such protocols, and it’s unclear how many hospitals are taking the initiative on their own. For example, the biggest risk factor for C. diff infection is antibiotic overuse. But the CDC reports that so far, only 39 percent of all hospitals have an antibiotic stewardship program in place.

C. Diff Prevention: Lowest-Rated Teaching Hospitals in the U.S.

Listed below are the 19 large teaching hospitals in the country that got our lowest or second-lowest rating in preventing C. diff, meaning they had an infection rate worse than the national benchmark. All of the hospitals are teaching hospitals with at least 500 beds and 200,000 patient days over the reporting period. (Hospitals are listed alphabetically; those with a footnote also received a low score in preventing C. diff when we last looked at this measure, in March 2016.)

Guide to the Ratings. These Ratings reflect how hospitals performed in a snapshot in time, based on data hospitals reported to the CDC between October 2014 and September 2015. The data are released ​periodically throughout the year. The CDC adjusts to account for factors such as the hospital's size, whether it’s a teaching hospital, and how common C. diff is in the community around the hospital. Note that hospitals can receive a low score in this measure but do well against other infections, such as methicillin-resistant staphylococcus aureus (MRSA) or surgical-site infection, or do well in this measure but poorly in others. See our complete hospital ratings as well as more about how we rate hospitals.

C. Diff Prevention: Highest-Rated Teaching Hospitals in the U.S.

Only two large teachings hospitals—those with at least 500 beds—earned one of our top two scores against C. diff, meaning that their C. diff infection rates were at least 50 percent better than the national benchmark.



Maimonedes Medical Center1Brooklyn, N.Y.
Mount Sinai Medical Center

Miami Beach, Fla.

  1. Hospital also received a high score in preventing C. diff six months ago, in a previous CR analysis.

What Hospitals Say

Representatives of some of the low-scoring teaching hospitals in our ratings say that institutions like theirs face special challenges in combating C. diff. 

For example, several hospitals that we spoke with, in both March 2016 (when we last rated hospitals on this measure) and now, argued that teaching hospitals tend to see sicker patients than nonteaching hospitals and that many of their patients are already infected with C. diff on admission.

In March, Craig Civale, a spokesman for Baylor University Medical Center, told us that his hospital “routinely admits very complex patients with multiple conditions." A spokeswoman for Cedars-Sinai Medical Center, echoed those sentiments. And when we communicated with her for this update, she added that her hospital sees an unusually large number of older patients, who are not only at increased risk of contracting the infection but who are often already infected with C. diff when they enter the hospital.

It's also possible that higher C. diff rates simply reflect better reporting on the part of teaching hospitals, though the CDC does adjust the data to reflect that possibility.

In any case, hospital officials acknowledge that C. diff. is a serious problem, and the ones we spoke with for this update said that since March, they have stepped up their efforts to combat the infection.

Baylor told us that it has developed new protocols to ensure that antibiotics are prescribed appropriately. And the hospital now isolates any patient admitted with signs or symptoms of C. diff, even if they haven’t yet tested positive. It has also started using a daily disinfectant that has been EPA-approved to combat C. diff.

At Cedars-Sinai all patients with diarrhea are now tested for C. diff, a spokeswoman for the hospital said. The antibiotic stewardship program has been expanded for both inpatients and outpatients, and the hospital says it is already seeing a reduction in C. diff cases between 2015 and 2016.

In a March 2016 statement to Consumer Reports, the Cleveland Clinic noted that the hospital is “committed to continuous improvement in quality and safety.” When contacted about the updated ratings, a spokeswoman said that this comment still stands. 

C. Diff. Image: Washing hands with soap.

Keep It Clean

The vast majority of C. diff infections—94 percent, according to the CDC—occur in hospitals and other healthcare settings, for several reasons.

The first has to do with the microbe itself. C. diff is a hardy species that can survive for weeks on a range of surfaces, including doorknobs and bed rails. Once those germs get into the intestinal tracts of people with compromised immune systems (exactly the kind of people you find in abundance in a hospital), they grow, spread, and sicken patients.

Combating C. diff, which is found in fecal matter and is easily passed from person to person, requires intense vigilance. Rooms must be cleaned with stringent, EPA-approved cleaners that contain germ-killing agents (such as bleach) every time an infected patient passes through.

And to prevent its spread by healthcare workers, hands must be gloved as often as possible and, once the gloves are removed, washed thoroughly and regularly, again and again.

Yet a 2014 University of Iowa study found that less than a third of healthcare workers in intensive care units always wash their hands. And in a Consumer Reports survey of 1,200 recently hospitalized people, only half reported “always” seeing their doctor or nurse wash their hands.  

“Doctors and nurses get busy,” says Louise-Marie Dembry, M.D., professor of medicine and epidemiology at Yale University and president of the Society for Healthcare Epidemiology of America. “Sometimes they simply forget to rewash their hands when they walk into a new patient’s room.”

They also get apathetic. “Fatigue develops, just like with anything else,” says Chapnick at Maimonides. “Screen-saver messages, email reminders, we’ve tried all of those things. People start to not see them after a while," he says. "It’s not that they don’t care. It’s just that they’re human.”

In his hospital, Chapnick has found that real live dialogue—people in charge of infection control constantly talking to hospital staff about hand-washing and other behaviors—works best.

Use Antibiotics Properly

Another reason, and a particularly important one, that C. diff has persisted in hospitals has to do with the misuse of antibiotics.

“Those drugs are obviously lifesaving when used appropriately,” said Erik Dubberke, M.D., associate professor of medicine in the Division of Infectious Diseases at Washington University in St. Louis and a spokesman for the Infectious Diseases Society of America. “But they can also make you vulnerable to C. diff.”

Antibiotics can kill off deadly infectious bacteria. But they can also kill off the “good” bacteria that normally grow in your stomach, which in turn can allow bad bacteria like C. diff to thrive.

That is especially true with “broad spectrum” antibiotics, such as ciprofloxacin (Cipro and generic) and levofloxacin (Levaquin and generic), that act against a wide variety of disease-causing bacteria at once (as opposed to targeting just one specific species).

About half of all hospitalized patients receive antibiotics, even though up to 50 percent of such prescriptions are unnecessary or inappropriate, according to the CDC.

The agency is currently working to get all U.S. hospitals to implement antibiotic stewardship programs by 2020. Stewardship programs include a number of provisions—such as putting one pharmacist in charge of antibiotic use and holding one administrator accountable for infection rates—that have been shown to work at reining in use of these precious medications.

The Joint Commission, a nonprofit that certifies and accredits healthcare organizations, plans to make such programs a requirement for accreditation for all hospitals in January 2017.

What You Can Do

If you (or family members or friends) are in the hospital, here’s what you can do to reduce your risk of developing a C. diff infection:

  • Make sure you really need that antibiotic. If your doctor wants to give you an antibiotic, ask why. If the doctor suspects an infection, he or she should do a rapid culture, if possible, to quickly pinpoint the possible bacteria and prescribe the most effective antibiotic at the lowest dose.
  • Insist on hand-washing and gloves. Ask everyone who walks into your room whether they’ve washed their hands with soap—if they’re doing it at your sink, make sure they scrub for 40 to 60 seconds. Also check that they are wearing gloves. Rubbing on alcohol-based hand sanitizer is not strong enough to destroy C. diff, Dembry said.
  • Watch out for heartburn drugs. Hospital patients are sometimes prescribed heartburn drugs called proton-pump inhibitors, such as esomeprazole (Nexium and generic) and omeprazole (Prilosec and generic) to prevent heartburn or bleeding in the stomach. But those medications can also increase the risk of C. diff infections taking hold in your stomach because lower acid levels make it easier for the bacteria to pass through the gut unharmed into the lower intestine, where they thrive. So if your doctor suggests you take one of those drugs while in the hospital, ask why.
  • Ask about the hospital’s protective measures. Hospitals should order a C. diff test for any patient who has diarrhea (three loose stools within 24 hours), the CDC says. Anyone with diagnosed C. diff should be put in a single room, and healthcare providers should wear gloves and gowns when treating that patient.

C. Diff Prevention: Lowest-Rated Hospitals by State

This chart shows all hospitals in the U.S., including teaching and nonteaching hospitals, that received Consumer Reports’ lowest rating for preventing C. diff infections. That means they had an infection rate more than twice the national benchmark for these infections. Hospitals are sorted alphabetically within states. We are also noting bed size to make it easier to compare similar hospitals.

Hospital Name




Eden Medical CenterCastro Valley100-199 beds
Feather River HospitalParadise50-99 beds
Kaiser Permanente Moreno Valley Medical CenterMoreno Valley50-99 beds
Kaiser Permanente Riverside Medical CenterRiverside200-299 beds
Marina Del Rey HospitalMarina Del Rey25-49 beds
Menifee Valley Medical CenterSun City50-99 beds
Olympia Medical CenterLos Angeles200-299 beds
St. Rose HospitalHayward100-199 beds
Sutter Coast HospitalCrescent City25-49 beds
Sutter Tracy Community HospitalTracy50-99 beds


Mt. San Rafael HospitalTrinidad6-24 beds
Pagosa Springs Medical CenterPagosa Springs6-24 beds
St. Anthony North Health CampusWestminster100-199 beds


Beebe HealthcareLewes100-199 beds


Baptist Medical Center BeachesJacksonville Beach100-199 beds


Southern Regional Medical CenterRiverdale200-299 beds


Crawford Memorial HospitalRobinson50-99 beds
Franklin Hospital DistrictBenton25-49 beds
Good Samaritan Regional Health CenterMount Vernon100-199 beds
Herrin HospitalHerrin100-199 beds
Hillsboro Area HospitalHillsboro25-49 beds
HSHS St. Mary's HospitalStreator50-99 beds
Katherine Shaw Bethea HospitalDixon50-99 beds
Massac Memorial HospitalMetropolis25-49 beds
Morris Hospital & Healthcare CentersMorris50-99 beds
OSF Saint Paul Medical CenterMendota25-49 beds
St. Joseph Memorial HospitalMurphysboro25-49 beds


Clark Memorial HospitalJeffersonville100-199 beds
Dearborn County HospitalLawrenceburg50-99 beds
Margaret Mary HealthBatesville25-49 beds
Monroe HospitalBloomington25-49 beds
St. Vincent Clay HospitalBrazil25-49 beds


Mercy Iowa CityIowa City200-299 beds


Ellsworth County Medical CenterEllsworth6-24 beds


Ephraim McDowell Regional Medical CenterDanville100-199 beds


Acadia General HospitalCrowley100-199 beds
Byrd Regional HospitalLeesville50-99 beds
West Carroll Memorial HospitalOak Grove6-24 beds


Houlton Regional HospitalHoulton25-49 beds


Lawrence General HospitalLawrence100-199 beds


MidMichigan Medical Center-ClareClare25-49 beds


Banner Churchill Community HospitalFallon25-49 beds
North Vista HospitalNorth Las Vegas100-199 beds
Saint Mary's Regional Medical CenterReno200-299 beds
St. Rose Dominican Hospitals - Siena CampusHenderson200-299 beds


Gerald Champion Regional Medical CenterAlamogordo50-99 beds
Lovelace Medical CenterAlbuquerque200-299 beds


Vidant Roanoke-Chowan HospitalAhoskie50-99 beds


Mercy Willard HospitalWillard6-24 beds
Wayne HospitalGreenville50-99 beds


Craig General HospitalVinita50-99 beds
Grady Memorial HospitalChickasha50-99 beds
Hillcrest Hospital - SouthTulsa100-199 beds
Oklahoma Heart Hospital South CampusOklahoma City25-49 beds


Santiam Memorial HospitalStayton25-49 beds


Allegheny General HospitalPittsburgh300-399 beds
Allegheny Valley HospitalNatrona Heights200-299 beds
Canonsburg General HospitalCanonsburg100-199 beds
Guthrie Towanda Memorial HospitalTowanda200-299 beds
St. Luke's Hospital - Miners CampusCoaldale50-99 beds


Regional Medical Center


200-299 beds


Tennova Healthcare Volunteer Community HospitalMartin50-99 beds


Cuero Community HospitalCuero25-49 beds
El Campo Memorial HospitalEl Campo25-49 beds
Resolute HealthNew Braunfels50-99 beds
Seton Edgar B. Davis HospitalLuling25-49 beds
Titus Regional Medical CenterMount Pleasant50-99 beds


Northwestern Medical CenterSaint Albans50-99 beds


Bedford Memorial HospitalBedford100-199 beds
LewisGale Hospital PulaskiPulaski50-99 beds


St. Anthony HospitalGig Harbor50-99 beds


Plateau Medical CenterOak Hill25-49 beds
Summersville Regional Medical CenterSummersville100-199 beds

Guide to the Ratings. These Ratings reflect how hospitals performed in a snapshot in time, based on data hospitals reported to the CDC between October 2014 and September 2015. The data are released ​periodically throughout the year. The CDC adjusts to account for factors such as the hospital's size, whether it’s a teaching hospital, and how common C. diff is in the community around the hospital. Note that hospitals can receive a low score in this measure but do well against other infections, such as methicillin-resistant staphylococcus aureus (MRSA) or surgical-site infection, or do well in this measure but poorly in others. See our complete hospital Ratings as well as more about how we rate hospitals.