The infection Clostridium difficile is now 'endemic throughout the health service, with virtually all trusts reporting cases', a leaked Department of Health memo has warned.

The document, sent from DoH director of health protection Liz Woodeson to ministers, provides a 'stocktake' of the NHS's efforts to combat healthcare-associated infections, in particular MRSA.

But the memo warns that the risks posed by C. difficile loom much larger: 'There are far more cases of [C. difficile] than MRSA infections - and more people die from it.

'Although there have been some high-profile outbreaks - most notably at Stoke Mandeville - it is endemic throughout the health service, with virtually all trusts reporting cases.'

Investigations have shown that at least 33 people of 334 infected with C. difficile died from the infection during the outbreak at Stoke Mandeville Hospital in Buckinghamshire, which ended in 2005.

But the memo claims that the problem is widespread. It also warns that the bug is harder to tackle than MRSA, given that it generates airborne spores which contaminate the environment around the patient. It also warns that some anti-MRSA measures, such as alcohol handrubs, do not work against C. difficile.

The note quotes figures showing that in 2004 there were an estimated 360 deaths from MRSA while there were an estimated 1,300 deaths from C. difficile. In 2005-06 there were 7,087 cases of MRSA and 51,690 cases of C. difficile.

In a section about how best to handle the MRSA target, Ms Woodeson acknowledges that the battle to combat MRSA 'doesn't seem to be having much impact on C. difficile, which is a far bigger problem.'

The memo is critical of the attitude of some trusts, stating: 'We suspect there are some that simply see [C. difficile] as an unavoidable fact of hospital life.'

Much of the document, which was written on 20 October, focuses on the likelihood that the NHS will not achieve the national MRSA target.

Options to 'handle' this suggest switching to a system of local targets - which the memo acknowledges could be seen as a 'cop out' - or introducing a new combined target, either bringing together C. difficile and MRSA or introducing a general target to reduce healthcare-associated infection.

Last month the DoH announced that NHS organisations would be required to set local targets on C. difficile.