Background: Soap and water is more effective than alcohol-based hand rub (ABHR) at removing Clostridium difficile spores from hands. Our institution mandates that healthcare workers (HCW) use soap and water after contact with the patient or their environment for any Clostridium difficile infection (CDI); CDC and SHEA recommend this only in outbreak settings for three main reasons: lack of evidence that preferential soap and water use reduces CDI, concerns that inconsistent messaging may result in decreased hand hygiene overall, and that glove use obviates soap and water use. The objective of this study was to investigate hand hygiene practices after caring for CDI patients.
Methods: CDI cases from July 2016 December 2017 residing in any of 4 units in the hospital (1 medical ICU, 1 stepdown, 2 med/surg) were identified. These units have an electronic hand hygiene (eHH) monitoring system. Using radio frequency identification badges worn by HCW and sensors on each dispenser, handwashing opportunities and washes are recorded. eHH after CDI patient contact and any patient contact were collected. eHH adherence (using an ABHR or soap dispenser within 1 minute of room exit) was calculated overall and stratified by soap and water vs. ABHR. The primary outcome was eHH adherence using soap and water vs ABHR after contact with a CDI patient. The secondary outcome was eHH adherence after CDI patient contact compared to all patients with and without CDI.
Results: A total of 1,061,288 exit eHH opportunities were recorded. Seventy-three CDI cases were identified (none in December 2017), and 16,404 (2%) exit eHH opportunities were linked to rooms with CDI patients. eHH adherence after CDI patient contact (78%) was significantly higher than for any patient contact (73%) (p < 0.001). Mean eHH adherence using soap and water after CDI patient contact was 29%; no changes in trend were noted over time (Figure 1).
Conclusion: Low adherence to mandated soap and water use after CDI patient contact was observed; however, HCW maintained a high level of overall adherence. This may indicate that concerns of inconsistent messaging reducing overall adherence may not be founded. ABHR may be used more often than soap and water after CDI patient care because our glove use is high; further investigation will be necessary to determine if this is the case.
A. Miller, None
H. Young, None