A new study suggests it is not uncommon to find the superbug Clostridium difficile on the hands of health care workers, highlighting a possible route through which the diarrhea bacteria spreads in hospitals.
While studying a French hospital setting, study leader Dr. Caroline Landelle, from Geneva University Hospitals and Medical School, in Switzerland, and colleagues, found around 1 in 4 health care workers' hands were contaminated with C. difficile spores after they had been carrying out routine care on infected patients.
The study was published recently in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), which recommends after caring for patients with C. difficile infections, health care professionals in routine care settings should clean their hands with alcohol-based rubs, and use soap and water in outbreak settings.
However, there is a view that many health care workers could be passing on C. difficile to patients, even after routine alcohol-based hand rubbing, pointing to a need for routine hand washing with soap and water after treating any infected patient, regardless the setting.
This new study, the first of its kind, supports this view, as Dr. Landelle explains:
"Because C. difficile spores are so resistant and persistent to disinfection, glove use is not an absolute barrier against the contamination of health care workers' hands. Effective hand hygiene should be performed, even in non-outbreak settings."
SHEA is planning to release an update to their Compendium of Strategies to Prevent Healthcare-Associated Infections this year.
Levels of C. difficile infection in hospitals remain high
According to the US Centers for Disease Control and Prevention (CDC), although most serious health care-associated infections in the US are declining, levels of C. difficile, which is linked to 14,000 American deaths a year, remain stubbornly high.
Patients most at risk of infection by the diarrhea-causing germ are those receiving antibiotics and medical care, and older patients especially.
Dr. Landelle and colleagues note that length of hospital stay and prior occupancy of patient rooms are also risk factors.
C. difficile spores found on 24% of health care workers treating infected patients
For their study, the team compared hand contamination of health care workers caring for patients infected with C. difficile with that of workers caring for non-infected patients.Contamination samples were taken from the hands of health care workers after rubbing their fingers and palms in alcohol shortly after patient care.
When they examined the contamination samples, the researchers found C. difficile spores on 24% of those taken from the hands of health care workers treating infected patients and none on those taken from workers looking after uninfected patients.
A study found that almost a quarter of health care workers have C. difficile bacteria on their hands after treating infected patients, leading researchers to call for better hand hygiene in hospital settings.
Contamination occurred with high-risk contact, for instance when the health care worker did not wear gloves, or when they washed patients after fecal soiling, or following a digital rectal exam, changing soiled bed linen, or carrying out a colonoscopy.
Hand contamination was also linked to duration of high-risk contact and was more common among nursing assistants (contamination rate 42%) than other workers (physicians 23%, nurses 19%).
In a comment accompanying the study, Aurora Pop-Vicas, Assistant Professor of Medicine at Brown Alpert Medical School in Providence, RI in the US, who also serves as Infection Control Officer for RI's Memorial Hospital, notes: "this study offers a vivid insight into why C. difficile might be so stubbornly persistent in our hospital [...]" and adds:
"[...] much work remains to be done in implementing what is known about the prevention of the spread of this bacteria through horizontal transmission. Additional measures include improvement in antimicrobial stewardship programs and effective environmental cleaning within health care institutions."
Meanwhile a team in the UK has found bacteria-eating viruses that fight C. difficile. Researchers from the University of Leicester isolated a group of virus-eating bacteria or bacteriophages that specifically target the superbug.
Written by Catharine Paddock PhD