Changing the Incidence of Clostridium difficile Through Patient Hand Hygiene


C. difficile prevention is usually thought of in terms of environmental disinfection and health care worker hand hygiene; what about the patient's role?

Clostridium difficile (C. difficile) is a bacterium that causes inflammation of the colon (colitis) and severe illness for patients. The resulting diarrhea and stomach pains can be extremely painful and life-altering. During my time as an infection preventionist, C. difficile has been perhaps one of the greatest infection control challenges I’ve encountered. Several patients with C. difficile have said to me that it was so traumatic that they were afraid to leave their house. The infection profoundly altered their lives. Surprisingly, a new study has found that increasing the patient’s involvement in hand hygiene can positively impact whether they contract the infection.

Transmission of C. difficile usually occurs in a health care environment (hospital, long-term care facility, etc) and is spread through the fecal-oral route, which means that individuals ingest the bacterial spores usually after contaminating their hands. Antibiotic use (especially prolonged) and advanced age are risk factors for infection.

Perhaps the toughest part about C. difficile prevention is the pathogen is spore-forming, which makes it harder to kill through typical hand hygiene and disinfecting practices. For example: when practicing hand hygiene, individuals must wash their hands with soap and water because alcohol-based hand sanitizers are not effective against spores. Health care facilities also must use bleach product to properly kill the pathogen when cleaning and disinfecting rooms and other environments.

For these reasons, it’s not surprising that hand hygiene plays a vital role in stopping the spread of C. difficile. The problem is that hand hygiene in general, is sub-par in health care facilities. To this end, investigators in a new study attempted to combat the infection through an alternate route: patient involvement. More specifically, they looked to answer the question, “Can patient hand hygiene impact C. difficile infections within a hospital?”

In their study, investigators from the University of Pittsburgh Medical Center (UPMC) Mercy Hospital provided the staff and patients with education on hand hygiene and drew upon patients to provide opportunities for hand hygiene. They first gave patients a baseline survey and then provided staff with an educational presentation that involved data from the baseline survey. The presentation included information on the importance of hand hygiene, its role as a prevention tool for infections, and when hand hygiene should be performed (for example: prior to meals, after using the restroom, etc.)

Hospital staff were instructed to remind patients across 4 medical-surgical units about hand hygiene, and patients were provided with soap and water, and alcohol-based hand sanitizer. After these education interventions, staff monitored patients’ hand hygiene.

Following this new education initiative, the investigators found that patient hand hygiene opportunities significantly improved (P< .0001), and the standardized infection ratio for hospital-onset C. difficile infections dropped significantly (P ≤ .5) for 6 months.

The results of this study highlight the success that can be seen in reducing nosocomial cases of C. difficile through patient education and increased attention on staff and patient hand hygiene. The study also draws attention to the role of patients in C. difficile infections.

There are many factors that play into infection control: environmental disinfection, appropriate antibiotic usage, and hand hygiene among staff and patients. Although patient hand hygiene is not a singular method deterring C. difficile infections within health care facilities, it can aid in the reduction of disease transmission. Health care staff should encourage hand hygiene in all patients to halt the spread of disease throughout health care facilities.

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