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Hand Hygiene with Soap and Water Is Superior to Alcohol Rub and Antiseptic Wipes for Removal of Clostridium difficile

Published online by Cambridge University Press:  02 January 2015

Matthew T. Oughton ,
Vivian G. Loo ,
Nandini Dendukuri ,
Susan Fenn  and
Michael D. Libman
Matthew T. Oughton*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Vivian G. Loo
Affiliation:
Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada Department of Microbiology, McGill University, Montreal, Quebec, Canada
Nandini Dendukuri
Affiliation:
McGill University Health Centre, McGill University, Montreal, Quebec, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Susan Fenn
Affiliation:
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Michael D. Libman
Affiliation:
Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada Department of Microbiology, McGill University, Montreal, Quebec, Canada
*
Department of Medicine, McGill University, Division of Infectious Diseases and Department of Microbiology, Sir Mortimer B. Davis-Jewish General Hospital, Room G-143, 3755 chemin Côte-Ste-Catherine, Montreal, QC, CanadaH3T 1E2 ([email protected])
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Abstract

Objective.

To evaluate common hand hygiene methods for efficacy in removing Clostridium difficik.

Design.

Randomized crossover comparison among 10 volunteers with hands experimentally contaminated by nontoxigenic C. difficile.

Methods.

Interventions included warm water with plain soap, cold water with plain soap, warm water with antibacterial soap, antiseptic hand wipes, alcohol-based handrub, and a control involving no Intervention. All interventions were evaluated for mean reduction in colony-forming units (CFUs) under 2 contamination protocols: “whole hand” and “palmar surface.” Results were analyzed according to a Bayesian approach, by using hierarchical models adjusted for multiple observations.

Results.

Under the whole-hand protocol, the greatest adjusted mean reductions were achieved by warm water with plain soap (2.14 log10 CFU/mL [95% credible interval (Cri), 1.74-2.54 log10 CFU/mL]), cold water with plain soap (1.88 log10 CFU/mL [95% Cri, 1.48-2.28 log10 CFU/mL), and warm water with antibacterial soap (1.51 log10 CFU/mL [95% Cri, 1.12-1.91 logu, CFU/mL]), followed by antiseptic hand wipes (0.57 log10 CFU/mL [95% Cri, 0.17-0.96 log10 CFU/mL]). Alcohol-based handrub (0.06 log10 CFU/mL [95% CrI, -0.34 to 0.45 log10 CFU/mL]) was equivalent to no Intervention. Under the palmar surface protocol, warm water with plain soap, cold water with plain soap, and warm water with antibacterial soap again yielded the greatest mean reductions, followed by antiseptic hand wipes (26.6, 26.6, 26.6, and 21.9 CFUs per plate, respectively), when compared with alcohol-based handrub. Hypothenar (odds ratio, 10.98 [95% Cri, 1.96-37.65]) and thenar (odds ratio, 6.99 [95% Cri, 1.25-23.41]) surfaces were more likely than fingertips to remain heavily contaminated after handwashing.

Conclusions.

Handwashing with soap and water showed the greatest efficacy in removing C. difficile and should be performed preferentially over the use of alcohol-based handrubs when contact with C. difficile is suspected or likely.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 939 - 944
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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