PA-PSRS recently received a query from a reader about the article “Clostridium Difficile: A Sometimes Fatal Complication of Antibiotic Use” that appeared in the June 2005 PA-PSRS Patient Safety Advisory. The query involved the efficacy of alcohol-based hand rubs in preventing the transmission of C. difficile (C. diff).
As stated in the article, according to the Centers for Disease Control and Prevention (CDC), gloves are worn when caring for patients with C. diff diarrhea. After glove re-moval, hands can be washed with either of two methods: non-antimicrobial or antimicrobial soap and water, or disinfected with alcohol-based hand rub. Either handwashing approach is effective in reducing contamination by the vegetative state of C. diff. Because technique is important in the decontamination process, both handwashing techniques are presented in Figure 1 of the article.
Even during outbreaks of C. diff-related infections, the reason that CDC advises to wash with soap and water after removing gloves is that frequent use of alcohol-based hand rubs may dry the healthcare workers’ skin, making it vulnerable to breakdown. However, as also specified in the article, no agent used in antiseptic handwash or antiseptic hand rub preparations is reliably capable of killing the spore form of C. diff. Spores can be physically removed by washing hands vigorously with non-antimicrobial or antimicrobial soap and water. Healthcare workers, therefore, may prefer to use this handwashing method rather than alcohol-based handwashes or hand rubs when C. diff is suspected or diagnosed.
The strategy referred to under the Cleaning/Disinfection section applies to environmental surfaces, rather than to provision of patient care. Environmental surfaces are inhospitable to micro-organisms. C. diff., therefore, is more likely to form spores in order to survive on environmental surfaces. Alcohol-based environmental disinfectant cleaning products do not kill these spores.