Time to wipe away C. difficile from patients’ hands?

A US study has found that around 15% of patients with C. difficile infection have C. difficile contaminated hands, and that removing these spores from patients’ hands is challenging.

The study was performed in a 500-bed US hospital. Around 50 patients with C. difficile infection were enrolled in the study, and randomised to either hand hygiene using either alcohol-based hand rub (ABHR) or hand washing using soap and water. The hands of patients were sampled both before and after hand hygiene. 7 (15%) of the patients had contamination with C. difficile before hand hygiene; C. difficile persisted despite hand hygiene on the hands of all three patients in the ABHR arm, and on 2/4 patients in the soap and water arm. It is important to note that patients with limited mobility (and so had to wash their hands at the bedside rather than at the sink) were less likely to clear hand contamination with C. difficile. Interestingly, C. difficile was recovered from the hands of 3 (6%) of patients who didn’t have C. difficile contamination before hand hygiene!

The level of hand hygiene identified on patients with symptomatic C. difficile was lower than in a previous study (15% in this study vs. 32% in the previous study). However, the study illustrates the persistence of C. difficile on the hands of patients, and highlights the challenges of delivering effective hand hygiene to patients with limited mobility. A recent study found that wipes designed for patient hand hygiene were as effective as soap and water for removing microbes in a laboratory setting. These wipes would be a useful way to improve patient hand hygiene, especially for patients with limited mobility.