Clostridium difficile transmission and mortality rates are far higher in nursing homes and other healthcare settings than the most recent government statistics suggest, an investigation has found.

The Centers for Disease Control and Prevention estimated in March that c. diff kills 14,000 people a year, based on death certificate records. However, a USA Today analysis of records from the federal Agency for Healthcare Research and Quality found over 30,000 c. diff fatalities per year. The newspaper’s analysis looked at hospital billing rates rather than death certificates, which do not always list the cause of death as complications from c. diff.

The report suggests around 500,000 people contract the disease each year.

Experts say that U.S. officials could get a better handle on c. diff by requiring nursing home and hospitals to report c. diff infections and antibiotic usage rates to federal regulators, a tactic that has helped healthcare facilities in Europe reduce c. diff rates. One focus will likely be on environmental services for healthcare facilities, as the newspaper reported that many hospitals have cut housekeeping budgets up to 25% in recent years.

U.S. hospitals will be required to report their rates of c. diff in 2013, but there are no such regulations — yet — for nursing homes.