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Effectiveness of Liquid Soap vs. Chlorhexidine Gluconate for the Removal of Clostridium difficile from Bare Hands and Gloved Hands

Published online by Cambridge University Press:  02 January 2015

Kris Bettin ,
Connie Clabots ,
Pamela Mathie ,
Keith Willard  and
Dale N. Gerding
Kris Bettin
Affiliation:
Infectious Disease Section, Medical Service, Minneapolis VA Medical Center
Connie Clabots
Affiliation:
Microbiology Section, Laboratory Service, Minneapolis VA Medical Center
Pamela Mathie
Affiliation:
Infectious Disease Section, Medical Service, Minneapolis VA Medical Center
Keith Willard
Affiliation:
Microbiology Section, Laboratory Service, Minneapolis VA Medical Center
Dale N. Gerding*
Affiliation:
University of Minnesota Medical School, Minneapolis, Minnesota and Lakeside VA Medical Center and Northwestern University Medical School, Chicago, Illinois
*
Medical Service (111), Lakeside VA Medical Center, 333 E. Huron St., Chicago, IL 60611
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Abstract

Objective:

To compare liquid soap versus 4% chlorhexidine gluconate in 4% alcohol for the decontamination of bare or gloved hands inoculated with an epidemic strain of Clostridium difficile.

Design:

C difficile (6.7 log10 colony-forming units [CFU], 47% spores), was seeded onto bare or latex gloved hands of ten volunteers and allowed to dry. Half the volunteers initially washed with soap and half with chlorhexidine, followed by the other agent 1 week later. Cultures were done with Rodac plates at three sites on the hand: finger/thumbtips, the palmar surfaces of the fingers, and the palm. Statistical comparison was by paired Student’s t test.

Results:

On bare hands, soap and chlorhexidine did not differ in residual bacterial counts on the finger/thumbtips (log10 CFU, 2.0 and 2.1, P= NS) and fingers (log10 CFU, 2.4 and 2.5, P=NS). Counts were too high on bare palms to quantitate. On gloved hands, soap was more effective than chlorhexidine on fingers (log10 CFU 1.3 and 1.7, P<.01) and palms (log10 CFU 1.5 and 2.0, P<.01), but not finger/thumbtips (log10 CFU 1.6 with each, P=NS). Residual C difficile counts were lower on gloved hands than bare hands (P<0.01 to <0.0001).

Conclusions:

The two agents did not differ significantly in residual counts of C difficile on bare hands, but on gloved hands residual counts were lower following soap wash than following chlorhexidine wash. These observations support the use of either soap or chlorhexidine as a handwash for removal of C difficile, but efficacy in the prevention of C difficile transmission must be determined by prospective clinical trials.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 11 , November 1994 , pp. 697 - 702
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994 

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References

1. Mulligan, ME. Epidemiology of Clostridium difficile-induced intestinal disease. Rev Infect Dis 1984;6(suppl 1):S222–S228.10.1093/clinids/6.Supplement_1.S222CrossRefGoogle ScholarPubMed
2. Bartlett, JG, Chang, TW, Taylor, NS, Onderdonk, AB. Colitis induced by Clostridium dificile . Rev Infect Dis 1979;1:370–378.10.1093/clinids/1.2.370CrossRefGoogle Scholar
3. McFarland, LV, Surawicz, CM, Stamm, WE. Risk factors for Clostridium dificile carriage and C difficile-associated diarrhea in a cohort of hospitalized patients.] Infect Dis 1990;162:678–684.CrossRefGoogle Scholar
4. Gerding, DN. Disease associated with Clostridium dificile infection. Ann Intern Med 1989;110:255–257.10.7326/0003-4819-110-4-255CrossRefGoogle Scholar
5. McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed
6. Kaatz, GW, Gitlin, SD, Schaberg, DR, et al Acquisition of Clostridium dificile from the hospital environment. Am J Epidemiol 1988;127:1289–1294.10.1093/oxfordjournals.aje.a114921CrossRefGoogle Scholar
7. Delmee, M, Vandercam, B, Avesani, V, Michaux, JL. Epidemiology and prevention of Clostridium dificile infections in a leukemia unit. Eur J Clin Microbiol 1987;6:623–627.10.1007/BF02013056CrossRefGoogle Scholar
8. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium dificile by hospitalized patients: evidence for colonized new admissions as a source of infection.] Infect Dis 1992;166:561–567.CrossRefGoogle Scholar
9. Johnson, SJ, 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
10. Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Kemoval of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.10.7326/0003-4819-109-5-394CrossRefGoogle ScholarPubMed
11. Gobetti, JP, Cerminaro, M, Shipman, C Jr. Hand asepsis: the efficacy of different soaps in the removal of bacteria from sterile, gloved hands. J Am Dent Assoc 1986;113:291–292.CrossRefGoogle ScholarPubMed
12. Clabots, CR, Bettin, KM, Peterson, LR, Gerding, DN. Evaluation of cycloserinecefoxitin-fructose agar and cycloserine-cefoxitin-fructose broth for recovery of Clostridium difficile from environmental sites. J Clin Microbiol 1991;29:2633–2635.10.1128/jcm.29.11.2633-2635.1991CrossRefGoogle ScholarPubMed
13. Lilly, HA, Lowbury, EJL. Transient skin flora: their removal by cleansing or disinfection in relation to their mode of deposition. J Clin Pathol 1978;31:919–922.10.1136/jcp.31.10.919CrossRefGoogle ScholarPubMed
14. Ayliffe, GAJ, Babb, JR, Bridges, K, et al Comparison of two methods for assessing the removal of total organisms and pathogens from the skin. J Hyg Cambr 1975;75:259–274.10.1017/S002217240004729XCrossRefGoogle ScholarPubMed
15. Lowbury, EJL, Lilly, HA, Bull, JP. Disinfection of hands: removal of transient organisms. Br Med J 1964;2:230–233.10.1136/bmj.2.5403.230CrossRefGoogle ScholarPubMed
16. Newsom, SWB, Rowland, C. Application of hygienic hand disinfection test to the gloved hand. J Hosp Infect 1989;14:245–247.10.1016/0195-6701(89)90041-8CrossRefGoogle Scholar
17. Ojajarvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg Cambr 1980;85:193–203.CrossRefGoogle ScholarPubMed
18. Ayliffe, GAJ, Babb, JR, Davies, JG, Lilly, HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Infect 1988;11:226–243.10.1016/0195-6701(88)90101-6CrossRefGoogle ScholarPubMed
19. Ehrenkranz, NJ, Alfonso, BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Znfect Control Hosp Epidemiol 1991;12:654–662.10.1086/646261CrossRefGoogle ScholarPubMed
20. Eckert, DG, Ehrenkranz, NJ, Alfonso, BC. Indications for alcohol or bland soap in removal of aerobic gram-negative skin bacteria: assessment by a novel method. Znfect Control Hosp Epidemiol 1989;10:306–310.10.1086/646033CrossRefGoogle ScholarPubMed
21. Doebbeling, BN, Stanley, GL, Sheetz, CT et al Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.CrossRefGoogle ScholarPubMed
22. Larson, E. Handwashing and skin physiologic and bacteriologie aspects. Infect Control 1985;6:14–23.10.1017/S0195941700062445CrossRefGoogle Scholar