Effectiveness of Alcohol-Based Hand Rubs for Removal ofClostridium difficileSpores from Hands

Abstract

Background.: Alcohol-based hand rubs (ABHRs) are an effective means of decreasing the transmission of bacterial pathogens. Alcohol is not effective againstClostridium difficilespores. We examined the retention ofC. difficilespores on the hands of volunteers after ABHR use and the subsequent transfer of these spores through physical contact.Methods.: NontoxigenicC. difficilespores were spread on the bare palms of 10 volunteers. Use of 3 ABHRs and chlorhexidine soap-and-water washing were compared with plain water rubbing alone for removal ofC. difficilespores. Palmar cultures were performed before and after hand decontamination by means of a plate stamping method. Transferability ofC. difficileafter application of ABHR was tested by having each volunteer shake hands with an uninoculated volunteer.Results.: Plain water rubbing reduced palmar culture counts by a mean (± standard deviation [SD]) of 1.57 ± 0.11 log₁₀colony-forming units (CFU) per cm², and this value was set as the zero point for the other products. Compared with water washing, chlorhexidine soap washing reduced spore counts by a mean ( ± SD) of 0.89 ± 0.34 log₁₀CFU per cm²; among the ABHRs, Isagel accounted for a reduction of 0.11 ± 0.20 log₁₀CFU per cm²(P= .005), Endure for a reduction of 0.37 ± 0.42 log₁₀CFU per cm²(P= .010), and Purell for a reduction of 0.14 ± 0.33 log₁₀CFU per cm²(P= .005). There were no statistically significant differences between the reductions achieved by the ABHRs; only Endure had a reduction statistically different from that for water control rubbing (P= .040). After ABHR use, handshaking transferred a mean of 30% of the residualC. difficilespores to the hands of recipients.Conclusions.: Hand washing with soap and water is significantly more effective at removingC. difficilespores from the hands of volunteers than are ABHRs. Residual spores are readily transferred by a handshake after use of ABHR.