Crowded wards, a shortage of nurses and financial problems led to 1,176 people contracting Clostridium difficile over two and half years at three hospitals in Kent.
Alan Johnson, the Health Secretary today described the failures as a "scandal", and said he would send the damning report to all hospital bosses in Britain so lessons would be learned.
Though the superbug was rife on the wards, managers failed to act. Isolation units were not set up, nurses were so rushed they did not have time to wash their hands and patients were left in soiled beds. Bedpans were not decontaminated properly and beds were not cleaned as well as they should have been.
The health watchdog, the Healthcare Commission, concluded that the infection probably or definitely killed at least 90 patients and was a factor in the deaths of a further 241.
Fourteen patients who died were found to have C.diff but it did not contribute to their deaths. In total 345 people died with the infection.
....The report said some patients at the hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust should have made a full recovery from their initial illness. But they caught the bug and died. Police will determine if there are grounds for criminal charges.
In May 2004 the chief executive of the trust, Rose Gibb, told the BBC she had known about the cleanliness problem for six months. But by September last year the hospitals were in the grip of their second outbreak.
Ms Gibb resigned on Friday before the release of the report. The commission found cases where the patient probably died as a result of their C.diff infection but it was not mentioned on the death certificate.
The number of people who died also turned out to be far higher than declared to the media and the commission.