86. A Randomized Trial of Soap and Water Hand Wash Versus Alcohol Hand Rub for Removal of Clostridium difficile Spores from Hands of Infected or Colonized Patients
Session: Oral Abstract Session: New Considerations in C. difficile Prevention and Treatment
Thursday, October 3, 2013: 8:42 AM
Room: The Moscone Center: 300

Title:  A Randomized Trial of Soap and Water Hand Wash Versus Alcohol Hand Rub for Removal of Clostridium difficile Spores from Hands of Infected or Colonized Patients

Authors:  Sirisha Kundrapu MD, Venkata C.K. Sunkesula MD, MS, Abhishek Deshpande, MD, PhD, and Curtis J. Donskey MD.

Abstract

Background:   Hand washing with soap and water is more effective than alcohol hand rub for removal of Clostridium difficile spores artificially applied to hands of volunteers. However, limited data are available on levels of spore contamination on hands of patients and previous studies have not evaluated the effectiveness of hand washing by patients.

 

Methods:   We conducted a randomized trial to compare the effectiveness of hand washing and alcohol hand rub for removal of spores from hands of patients with C. difficile infection (CDI) or asymptomatic carriers of toxigenic C. difficile. Swabs were collected from whole hands before and after hand wash or hand rub and colony-forming units (CFU) of C. difficile were quantified.

Results: Fifty hand washes with soap and water and 50 alcohol rubs were performed on 40 total patients (2-4 hand hygiene assessments per patient), including 25 CDI patients and 15 asymptomatic carriers. Prior to hand hygiene, 31(31%) of hand cultures were positive with an average of 15 colony-forming units (CFU) of C. difficile recovered (range, 1 to 100); the number of colonies recovered from hands were similar for CDI patients and asymptomatic carriers (P = 0.9). As shown in the figure, hand washing significantly reduced the percentage of positive cultures (A) and the number of colonies recovered (B) from contaminated hands, whereas alcohol hand rub did not. Twenty-nine patients (73%) were not aware that alcohol is ineffective for removal of C. difficile spores.  

Conclusion:   CDI patients and asymptomatic carriers frequently had spore contamination on their hands. Soap and water washing was effective for reducing the burden of spores on hands, whereas alcohol hand rub was not. CDI patients should receive education on the importance of hand washing for removal of spores.     

Figure. Effectiveness of soap and water hand wash versus alcohol rub for removal of C. difficile spores from hands of patients

 

Sirisha Kundrapu, M.D., Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Infectious Diseases, Case Western Reserve University, Cleveland, OH, Venkata C.K. Sunkesula, M.D., M.S, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, Abhishek Deshpande, M.D., Ph.D., Medicine, Case Western Reserve University, Cleveland, OH and Curtis J. Donskey, MD, Case Western Reserve University, Cleveland, OH

Disclosures:

S. Kundrapu, None

V. C. K. Sunkesula, None

A. Deshpande, None

C. J. Donskey, GOJO: Consultant, Research grant

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