Clostridium difficile has become a major problem as a nosocomial pathogen that is associated with the use of antibiotics. In the prevention and control of C. difficile disease it is important that programmes are directed at primary and secondary prevention. The three main elements of prevention are: (i) restricted use of antibiotics; (ii) strict enteric 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 procedures. Consideration needs to be given to ensure that patients have access to handwashing and are well informed about infection prevention. Further work needs to be carried out to establish the efficacy of disinfectants in the environment and the identification of a user-friendly, effective sporicide. The importance of both thorough cleaning with detergents to reduce the number of spores in the environment, and clean equipment for each patient should continue to be emphasized.