The pathogens flourish in these settings because people in a weakened condition are most susceptible to them. Gut flora is a term for all the bacteria that normally inhabit the intestine. They include enterococci, which become a problem when they get into the blood stream where they can cause septic shock and multiple organ failure. A likely scenario for someone to get the infection would be a case of ruptured appendix or a complicated abdominal surgery in which enterococci leak from the intestine. The organism is present in feces, and with incontinent patients or those with severe diarrhea it's not hard for contamination to occur.
Fecal matter can get on bedclothes or on someone's hand.
The organisms are relatively hardy - they can live on bedside railings, doorknobs, any surface for days to weeks. Health care workers must wear gloves and gowns when entering the room, the patient needs to have a dedicated stethoscope, thermometer, etc., and everyone must wash their hands carefully before entering and leaving. If that happens, we'll be left with nothing to treat staph, and it is a much more virulent organism. Enterococci are very good at transferring genetic material to other organisms, she adds, even to bacilli that are very different from them structurally and genetically. It's been accomplished in the lab.