C. Diff Contamination of Health Care Workers’ Hands

Caroline Landelle, PharmD, PhD Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, FranceMedicalResearch.com Interview with:
Caroline Landelle, PharmD, PhD
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France

MedicalResearch.com: What are the main findings of the study?

Dr. Landelle: The main findings point to the fact that nearly one in four healthcare workers’ hands are contaminated with Clostridium difficile spores after routine care of patients infected with the bacteria, before performing hand hygiene. This is the first study focusing upon the carriage of viable C. difficile spores on healthcare workers’ hands. C. difficile exist in 2 possible forms: vegetative and spore. Vegetative forms of C. difficile are killed when exposed to air, whereas their spores are resistant to oxygen, desiccation, and most disinfectants, and may persist in the hospital environment for long periods of time; thus, bacterial spores could be the principal form of transmission. Furthermore, contamination of exposed healthcare workers’ hands is statistically associated with direct exposure to fecal soiling and contact without the use of gloves.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Landelle: No. In 3 previous studies, the proportion of HCWs’ hands which were contaminated with both vegetative and spore forms of C. difficile after care of patients infected with C. difficile, varied between 14% and 59%. The hand contamination rate of 24% recorded in our study, is consistent with these prior results, taking into account that our study aimed at gathering only spores. Direct exposure to fecal soiling and contact without the use of gloves, are consistent risk factors for the contamination of healthcare workers’ hands.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Landelle: This real-life study suggests that recommendations for the care of patients infected with C. difficile, should include donning gloves, and washing hands with soap and water instead of alcohol-based hand rub after glove removal, even in non-outbreak situation.

The best way to protect patients from the cross-transmission of micro-organisms, is to encourage healthcare workers to practice good hand hygiene during health care. Although this is a simple and cost-effective intervention, physicians are notoriously poor in complying with hand hygiene recommendations.

Patients should also be encouraged to wash their hands with soap and water.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Landelle: The exact number of spores required to cause an infection is unknown; thus, the exact risk of transmission of C. difficile infection by a healthcare worker whose hands are contaminated with spores, is also unknown. Moreover, in order to determine how long spores can remain viable on healthcare workers’ hands, further study is required.

Citation:

Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France

Landelle C, Verachten M, Legrand P, Girou E, Barbut F, Buisson CB.

Infect Control Hosp Epidemiol. 2014 Jan;35(1):10-5. doi: 10.1086/674396.
Epub 2013 Nov 26.