National CDI Burden

Clostridium difficile infections (CDIs) are a substantial burden in the United States, causing tens of thousands of deaths, hundreds of thousands of infections and costing our health care system billions in excess costs. In particular:

  • CDIs is one of the leading causes of infectious disease death in the US
  • 475,000 CDIs occur annually
  • 100,000 nursing home infections annually
  • 29,000 people die within 30 days of diagnosis
  • $4.8 billion in excess health care costs are attributable to CDIs


Federal Policies & Programs

As the CDI epidemic has grown, the federal government has instituted a number of policies and activities to combat it, including:

White House National Strategy to Combat Antibiotic Resistance

In March 2015, the Obama administration released a 5-year plan to tackle antibiotic resistant bacteria, including CDIs. Based on the September 2014 policy recommendations by the President’s Council of Advisors on Science and Technology (PCAST), the National Action Plan includes 5 goals:

  1. Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections
  2. Strengthen National One-Health Surveillance Efforts to Combat Resistance
  3. Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria
  4. Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines
  5. Improve International Collaboration and Capacities for Antibiotic-resistance Prevention, Surveillance, Control, and Antibiotic Research and Development

You can learn more by reading the following documents:


Centers for Disease Control & Prevention Programs

  • National Health Safety Network: NHSN is the nation’s most widely used healthcare-associated infection tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.
  • Emerging Infections Program: EIP engages a network of state health departments and their academic medical center partners to help answer critical questions about emerging HAI threats, advanced infection tracking methods, and antibiotic resistance in the United States. Information gathered through this activity will play a key role in shaping future policies and recommendations targeting HAI prevention.
  • 2020 National and State Healthcare-Associated Infections (HAI) Progress Report


Centers for Medicare & Medicaid Programs

  • Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. The site allows you to compare two or more hospitals based on an array of patient-centered data, including their CDI rates.
  • Starting in January 2015, acute care hospitals participating in Medicare and Medicaid are required to report positive C. diff lab results as part of CMS’ Hospital Inpatient Quality Reporting Program.
  • CMS is currently finalizing the addition of CDIs and MRSA infections to its value-based purchasing program. The VBP imposes financial penalties on hospitals that perform poorly with regard to hospital-acquired conditions.


State-based Policies & Programs


At the state-level, policies and programs to address CDIs are inconsistent. Still, it should be noted that many states have established or increased their CDI prevention and reporting programs since 2008. The following top-line statistics are drawn from a study of HAI state laws published in the Infection Control & Hospital Epidemiology:


  • Only 20 states mandate CDI data reporting by hospitals
  • 11 of those are independent state mandates
  • 9 incorporate CMS requirements into a state law


CDI Reporting Laws by State

To learn more about the laws in your state, please visit our In Your State database.