<prompt> Clostridium difficile can be spread through all EXCEPT-Oral - fecal routeDirectHand to hand contactNeedles  <response>: Ans. d NeedlesRef: Microbiology by Ananthanarayan and Paniker 8th ed. 251, 263, 634 The organism is carried by about 3 of the general population and about 30 of the hospitalised patients in their gastrointestinal tract. It is usually transmitted by the feco-oral route and direct contact and hand to hand transmission are important modes of transmission in the hospitalized patients. Clostridium difficile causes pseudomembranous colitis. 