HealthDay News — About a quarter of healthcare workers who routinely cared for patients infected with Clostridium difficile, had C. difficile spores detected on their hands, study findings indicate.

“To our knowledge, this is the first study focusing on carriage of viable C. difficile spores on healthcare workers’ hands. Because of their resistance and persistence, bacterial spores could be the principal form of transmission,” Caroline Landelle, PharmD, PhD, from Geneva University Hospitals and Medical School, and colleagues reported in Infection Control and Hospital Epidemiology.

The number of U.S. hospitalizations due to primary C. difficile infection (CDI) more than tripled between 2000 and 2009, and in 2010 the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) issued guidelines for CDI prevention and treatment. These guidelines advocate the use of gloves and hand washing with soap and water to remove C. difficile spores rather than alcohol-based hand rubs.

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To determine the proportion of healthcare workers’ hands contaminated with C. difficile spores after caring for patients with CDI and to better understand risk factors associated with contamination, Landelle and colleagues performed a prospective study at a 950-bed French university hospital from June through August 2007.

They compared C. difficile contamination rates among healthcare workers caring for patients with CDI (exposed group, N=66) with rates among an unexposed group (N=44). Spores were recovered from the hands of healthcare workers after they rubbed their fingers and palms in rubbing alcohol shortly after patient care in order to kill vegetative forms of the bacteria.

C. difficile spores were detected on the hands of 24% of healthcare workers in the exposed group and 0% of the unexposed group. Risk factors independently associated with hand contamination among healthcare workers in the exposed group included high-risk contact, including exposure to fecal soiling (adjusted odds ratio [aOR] per one contact increment, 2.78; 95% CI: 1.42–5.45) and at least one contact without the use of gloves (aOR, 6.26; 95% CI: 1.27–30.78).

Despite glove use being the CDI prevention recommendation with the highest strength of recommendation and quality of evidence rating, 7 of 16 healthcare workers with contaminated hands (44%) and 9 of 50 without contaminated hands (18%) had at least one patient contact without gloves, the researchers found. 

“When caring for patients with CDI, healthcare workers should don gloves immediately upon entering the patient room according to our hospital protocol,” the researchers wrote. They added that “routine hand washing with soap and water after care of CDI patients should be recommended in all settings.”

In an accompanying editorial, Aurora Pop-Vicas, MD, MPH, and Rosa Baier, MPH, both of the Warren Alpert Medical School at Brown University in Rhode Island, praised the study, noting it “offers a vivid insight into why C. difficile might be so stubbornly persistent in our hospitals.”

“Much work remains to be done in implementing what is known about the prevention of C. difficile horizontal transmission, and further studies are needed to answer current knowledge gaps. Improvement in antimicrobial stewardship programs and effective environmental cleaning within healthcare institutions must also be achieved for effective CDI prevention,” Pop Vicas and Baier wrote.


  1. Landelle C et al. Infect Control Hosp Epidemiol. 2014; 35(1):10-15.
  2. Pop-Vicas A, Baier R. Infect Control Hosp Epidemiol. 2014; 35(1):16-17.