Twenty-one percent of the patients in a large hospital acquired Clostridium difficile diarrhea and colitis during their hospital stay. Epidemiological studies provided the following information. What is the most likely mode of transmission of this bacterium in hospitals? How can transmission be prevented?

Rate of infection for patients:
Single room 7%
Double room 17%
Triple room 26%

Rate of environmental isolations of C. difficile:
Bed rail 10%
Commode 1%
Floor 18%
Call button 6%
Toilet 3%

Hands of hospital personnel after contact with patients that were culture-positive for C. difficile:
Used gloves 0%
Did not use gloves 59%
Had C. difficile before patient contact 3%
Washed with nondisinfectant soap 40%
Washed with disinfectant soap 3%
Did not wash hands 20%