Take extra precautions to prevent C. difficile infections

I work at a hospital where the infection control officer advocates universal use of alcohol-based hand gels to prevent transmission of infectious pathogens. I previously had been told alcohol-based gels might be insufficient to kill C. difficile. Is this true?

C. Nelson, Atlanta

Dr. Hospitalist responds: You bring up an important question. The role of hand hygiene as a measure to control hospital-acquired infections has become increasingly visible. This is long overdue. The thought of healthcare providers transmitting diseases because they didn’t clean their hands is abhorrent.

Many institutions around the country have adopted policies similar to your hospital’s, encouraging the use of alcohol-based hand gels over the use of soap and water. Hospitals have done this for several reasons:

• Healthcare providers are more likely to use alcohol-based gels than cleanse with soap and water;
• Rubbing your hands with gel takes less time than washing with soap and water;
• Hospitals can place gel dispensers in convenient locations outside each doorway, whereas there are only so many faucets and sinks on any given floor; and
• Even those who do wash their hands with soap and water often do not spend enough time adequately cleaning them.

Alcohol-based gels are effective against a wide range of bacteria that cause hospital-acquired infections, particularly against Staph, including MRSA. But C. difficile may be different. The control of C. difficile in hospitals is difficult because the organism can produce highly resistant spores, which can survive for long periods of time in a hospital environment, such as in mattresses, equipment, furniture, etc. Alcohol-based gels might be less effective against C. difficile spores than other organisms that cause healthcare-associated infections. Providers caring for patients with C. difficile should wear protective clothing, such as gloves and gowns, as well as clean their hands with soap and water.

For additional information on this subject, I suggest you check out Morbidity and Mortality Weekly Report’s “Guideline for Hand Hygiene in Health-Care Settings” (Oct. 25, 2002). You can access it online at the Infectious Disease Society of America’s Web site at www.idsociety.org/ content.aspx?id=4434#hh. TH