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Contamination of Healthcare Workers' Hands with Clostridium difficile Spores after Caring for Patients with C. difficile Infection

Published online by Cambridge University Press:  10 May 2016

C. Landelle ,
M. Verachten ,
P. Legrand ,
E. Girou ,
F. Barbut  and
C. Brun Buisson
C. Landelle*
Affiliation:
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
M. Verachten
Affiliation:
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France
P. Legrand
Affiliation:
Department of Bacteriology-Virology, CHU Albert Chenevier–Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris–Est Créteil, France
E. Girou
Affiliation:
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France
F. Barbut
Affiliation:
National Reference Laboratory for Clostridium difficile,Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
C. Brun Buisson
Affiliation:
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France Medical Intensive Care Unit, CHU Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris-Est Creteil, France
*
Infection Control Program, Geneva University Hospitals and Medical School, CH-1211 Geneva 14, Switzerland ([email protected])
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Abstract

Objective.

We determined the percentage of healthcare workers' (HCWs') hands contaminated with Clostridium difficile spores after caring for patients with C. difficile infection (CDI) and risk factors associated with contamination.

Design.

Prospective study.

Setting.

A French university hospital.

Methods.

We compared the hand contamination rate among HCWs caring for patients with CDI (exposed group; n = 66) with that among an unexposed group (n = 44). Spores of C. difficile were recovered from the hands of HCWs after rubbing their fingers and palms in alcohol shortly after patient care. Associations between hand contamination and HCW category, type (patient or environment), and risk level (high or low risk) of HCW contacts and their respective duration as well as use of gloves were analyzed by bivariate and multivariate analysis.

Results.

C. difficile spores were detected on 24% of HCWs' hands in the exposed group and on 0% in the unexposed group (P < .001). In the exposed group, logistic regression, which adjusted for high-risk contact (ie, exposure to fecal soiling), contact with the environment, and contact with or without use of gloves, revealed that high-risk contact (adjusted odds ratio [aOR] per 1 contact increment, 2.78; 95% confidence interval [CI], 1.42–5.45; P = .003) and at least 1 contact without use of gloves (aOR, 6.26; 95% CI, 1.27–30.78; P = .02) were independently associated with HCW hand contamination by C. difficile spores.

Conclusions.

Nearly one-quarter of HCWs have hands contaminated with C. difficile spores after routine care of patients with CDI. Hand contamination is positively associated with exposure to fecal soiling and lack of glove use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 10 - 15
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Barbut, F, Petit, JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 2001;7:405–410.Google Scholar
2. Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med 2006;145:758–764.CrossRefGoogle ScholarPubMed
3. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. New Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed
4. Shaughnessy, MK, Micielli, RL, DePestel, DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201–206.CrossRefGoogle ScholarPubMed
5. Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:42–50.Google Scholar
6. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.CrossRefGoogle ScholarPubMed
7. Kaatz, GW, Gitlin, SD, Schaberg, DR, et al. Acquisition of Clostridium difficile fiorn the hospital environment. Am J Epidemiol 1988;127:1289–1294.CrossRefGoogle ScholarPubMed
8. Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, Donskey, CJ. Clostridium difficile skin contamination in patients with C. difficile-associated disease. Clin Infect Dis 2008;46:447–450.Google Scholar
9. Guerrero, DM, Nerandzic, MM, Jury, LA, Jinno, S, Chang, S, Donskey, CJ. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control 2012;40:556–558.Google Scholar
10. Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.CrossRefGoogle ScholarPubMed
11. Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990;336:97–100.CrossRefGoogle ScholarPubMed
12. Fekety, R, Kim, KH, Brown, D, Batts, DH, Cudmore, M, Silva, J Jr. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906–908.Google Scholar
13. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf. Published 2007. Accessed November 1, 2012.Google Scholar
14. Haut Conseil de la Santé Publique. Avis Relatif à la Maîtrise de la Diffusion des Infections à Clostridium difficile dans les Établissements de Santé Français. http://nosobase.chu-lyon.fr/recommandations/hcsp/2008_clostridium_HCSP.pdf. Published 2008. Accessed November 1st, 2012.Google Scholar
15. Vonberg, RP, Kuijper, EJ, Wilcox, MH, et al. Infection control measures to limit the spread of Clostridium difficile . Clin Microbiol Infect 2008;14(suppl 5):2–20.CrossRefGoogle ScholarPubMed
16. Dubberke, ER, Gerding, DN, Classen, D, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S81–S92.CrossRefGoogle ScholarPubMed
17. Straelens, MJ, Maas, A, Nonhoff, C, et al. Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance. Am J Med 1991;91:138S–144S.Google Scholar
18. Rutala, WA, Gergen, MF, Weber, DJ. Inactivation of Clostridium difficile spores by disinfectants. Infect Control Hosp Epidemiol 1993;14:36–39.Google Scholar
19. Gerding, DN, Olson, MM, Peterson, LR, et al. Clostridium difficile-associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study. Arch Intern Med 1986;146:95–100.Google Scholar
20. Heard, SR, O'Farrell, S, Holland, D, Crook, S, Barnett, MJ, Ta-baqchali, S. The epidemiology of Clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis 1986; 153: 159–162.Google Scholar
21. Mutters, R, Nonnenmacher, C, Susin, C, Albrecht, U, Kropatsch, R, Schumacher, S. Quantitative detection of Clostridium difficile in hospital environmental samples by real-time polymerase chain reaction. J Hosp Infect 2009;71:43–48.Google Scholar
22. Manian, FA, Meyer, L, Jenne, J. Clostridium difficile contamination of blood pressure cuffs: a call for a closer look at gloving practices in the era of universal precautions. Infect Control Hosp Epidemiol 1996;17:180–182.Google Scholar
23. Johnson, S, Gerding, DN, Olson, MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.CrossRefGoogle ScholarPubMed
24. Rego, A, Roley, L. In-use barrier integrity of gloves: latex and nitrile superior to vinyl. Am J Infect Control 1999;27:405–410.Google Scholar
25. Dubberke, ER, Gerding, D. Rationale for Hand Hygiene Recommendations after Caring for a Patient with Clostridium difficile Infection: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, http://www.shea -online.org/Portals/0/CDI%20hand%20hygiene%20Update.pdf. Published 2011. Accessed August 24, 2013.Google Scholar

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