Acquisition of Clostridium difficile on Hands of Healthcare Workers Caring for Patients with Active or Resolved C. difficile Infection
Background: Current practice guidelines for management of Clostridium difficile infection (CDI) recommend that contact precautions can be discontinued after diarrhea resolves. However, it is known that patients with CDI often continue to shed spores for several weeks after successful treatment. We hypothesized that healthcare workers frequently contaminate their hands while caring for patients with recently resolved CDI who are no longer in contact precautions.
Methods: During a 4-month period, we cultured hands of healthcare workers for toxigenic C. difficile before and after providing care for patients with active CDI, recent CDI (within 6 weeks after end of treatment with no recurrent CDI symptoms), remote CDI (6-24 weeks after treatment), or no history of CDI; cultures after care were collected prior to hand hygiene. Healthcare workers wiped their hands with a sterile, pre-moistened gauze pad that was placed into a sterile specimen cup and cultured by broth enrichment. Bivariate analysis was used to identify factors associated with positive hand cultures.
Results: Hand cultures were collected during 93 encounters with 53 patients (1 to 3 healthcare workers per patient). As shown in the figure, acquisition of hand contamination was common when caring for patients with active or recent CDI, and less common when caring for patients with remote or no CDI. Factors associated with acquisition on hands included nursing job description and extensive interaction with patient and/or environment. Acquisition of spores on hands was common during care of CDI patients despite glove use.
Conclusion: Healthcare workers frequently acquired C. difficile spores on their hands while caring for patients with active or recent CDI. Hand contamination during care of CDI patients was common despite glove use, suggesting that hand washing with soap and water may be beneficial. Extending the duration of contact precautions may be a useful strategy to reduce transmission by patients with recent CDI.
V. C. K. Sunkesula,
S. Kundrapu, None
M. E. Tomas, None
M. Nerandzic, None
S. Knighton, None
C. J. Donskey, None