Healthcare workers caring for those with Clostridium difficile should wash their hands with soap and water rather than counting on gloves only or rubbing their hands with an alcohol-based solution after providing care. Researchers are making the recommendation after finding that almost 25 percent of healthcare workers have hands that are contaminated with C. diff spores after they provide routine care for people infected with the bacteria. Those who use alcohol-based solutions may be passing on the bacteria to others, they add.
"Because [C. diff] spores are so resistant and persistent to disinfection, glove use is not an absolute barrier against the contamination of healthcare workers' hands," says Caroline Landelle, PharmD, PhD, lead author of the study, published in the January issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. “Effective hand hygiene should be performed, even in non-outbreak settings."
Researchers compared hand contamination rates among healthcare workers caring for people with C. diff with healthcare workers caring for non-colonized people after routine care and before hand hygiene. All those with C. diff were being treated with infection control measures that consisted of:
- placing people into single-bed rooms with dedicated equipment;
- wearing disposable gowns with full-length sleeves and a pair of gloves on entering the room;
- hand hygiene with alcohol-based hand rub before wearing gloves, before and after body fluid exposure, and hand-washing with medicated soap and water followed by use of alcohol-based hand rub after glove removal; and
- daily room cleaning with a hypochlorite-based disinfectant.
Contamination of healthcare workers' hands occurred with high-risk contact (for instance, washing people, digital rectal exam, bed linen change, colonoscopy) or when workers didn't use gloves. Hand contamination also was associated with the duration of high-risk contact and was more common among nursing assistants (42 percent) than among other healthcare workers (19 percent for nurses and 23 percent for physicians), likely because nursing assistants had more high-risk contact.