This article examines risk factors, pathogenesis, symptoms and management of Clostridium difficile infection, which is the major cause of enteric infections among people aged over 65 years in healthcare settings. Symptoms range from mild to profuse watery diarrhoea, which may be accompanied by severe life-threatening inflammation of the intestine. Transmission is by the faecal-oral route, via the hands of health workers and from environmental reservoirs. Eradication is difficult because C. difficile forms spores that survive for months in dust and on surfaces. Strategies to prevent and control C. difficile include thorough hand hygiene, isolation precautions, environmental cleaning and restricted use of broad spectrum antibiotics.