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Query on Clostridium Difficile
PA PSRS Patient Saf Advis 2007 Mar;4(1):2.   
 

PA-PSRS recently received a query from a reader about the article “Clostridium Difficile: A Sometimes Fatal Complication of Antibiotic Use” that appeared in the June 2005 PA-PSRS Patient Safety Advisory. The query involved the efficacy of alcohol-based hand rubs in preventing the transmission of C. difficile (C. diff). 

As stated in the article, according to the Centers for Disease Control and Prevention (CDC), gloves are worn when caring for patients with C. difficile (C. diff) diarrhea. After glove re-moval, hands can be washed with either of two methods: non-antimicrobial or antimicrobial soap and water, or disinfected with alcohol-based hand rub. Either handwashing approach is effective in reducing contamination by the vegetative state of C. diff. Because technique is important in the decontamination process, both handwashing techniques are presented in Figure 1 of the article.

Even during outbreaks of C. diff-related infections, the reason that CDC advises to wash with soap and water after removing gloves is that frequent use of alcohol-based hand rubs may dry the healthcare workers’ skin, making it vulnerable to breakdown. However, as also specified in the article, no agent used in antiseptic handwash or antiseptic hand rub preparations is reliably capable of killing the spore form of C. diff. Spores can be physically removed by washing hands vigorously with non-antimicrobial or antimicrobial soap and water. Healthcare workers, therefore, may prefer to use this handwashing method rather than alcohol-based handwashes or hand rubs when C. diff is suspected or diagnosed. 

The strategy referred to under the Cleaning/Disinfection section applies to environmental surfaces, rather than to provision of patient care. Environmental surfaces are inhospitable to micro-organisms. C. diff., therefore, is more likely to form spores in order to survive on environmental surfaces. Alcohol-based environmental disinfectant cleaning products do not kill these spores.

 
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Clostridium Difficile: A Sometimes Fatal Complication of Antibiotic Use

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THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS  
PSA LOGO The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .      
ECRI LOGO ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology.      

ISMP Logo The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.      
 
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