The Hands Have It

Preventing patients from acquiring Clostridium difficile is a major component of efforts to control the recent epidemic of C. difficile disease. Although environmental contamination with bacterial spores is a major factor in cross-transmission, healthcare workers (HCWs) also appear to play a role through contamination of their hands. To explore this concern, investigators in Europe assessed the frequency of hand contamination after HCWs cared for patients who were known to have C. difficile infection (CDI) and were on contact precautions that included use of gowns and gloves.

The study involved 66 HCWs who provided care for 7 CDI patients and 44 who cared for 16 non-CDI control patients. For 8 weeks, the HCWs were observed while in patient rooms. After they left the patients' rooms — and before they performed hand hygiene — their ungloved hands were sampled.

C. difficile spores were recovered from 16 (24%) of the exposed HCWs' hands versus zero of the control HCWs' hands. Hand contamination was associated with more-frequent contact with CDI patients or the environment, performance of activities with greater risk for fecal contact, and longer duration of such activities. Another risk factor for hand contamination was patient contact without gloves, which occurred in 30 (8%) of 386 encounters, even though the HCWs knew that they were being observed.