An article in the American Journal of Infection Control evaluates the acquisition of Clostiridium difficile spores on the gloved hands of healthcare personnel (HCP) following contact with environmental surfaces and patients. The work was performed by Guerrero et al. in Curtis Donskey’s team at the Cleveland VA hospital. The prospective study included 30 patients with C. difficile infection. The hands of HCP were effectively used to sample surfaces on patients’ skin and from the inanimate environment. The key findings is that there was no significant difference between the rate of contamination of HCP hands when touching the patient as compared with touching environmental surfaces (50% for both). Although the concentration of spores acquired on the hands was lower for environmental surfaces than for patient sites, there was not a significant difference.
The study evaluated the proportion of various environmental and patient sites that transferred C. difficile spores to the gloved hands of HCP, which ranged from 20% to 50% for both patient and environmental contacts.
This study follows other that have examined the proportion of contacts with either patients or surfaces that result in HCP hand contamination. These studies have shown that the risk of acquiring hand contamination when touching a patient or a surface is approximately equal for MRSA and VRE.
These studies highlight the complex interplay between the hands of HCP, patients and their inanimate environment. It seems likely that a substantial proportion of transmission between patients occurs indirectly through contact with environmental surfaces. For example, a study published in 2000 evaluated the spread of a non-microbial marker (plant DNA) designed to model the spread of pathogens from hospitals surfaces. The marker was inoculated onto a single telephone handle in one of six 8-cot ‘pods’ in a neonatal intensive care unit. The spread of the marker was remarkable: within four hours it was identified from environmental surfaces and staff hands across the unit including all six pods. While the spread of plant DNA does not necessarily accurately represent the spread of a pathogenic micro-organism, it does present a picture of dynamic and rapid transmission involving both environmental surfaces and staff hands.
There has been much discussion around whether to focus on improving environmental cleaning and disinfection or compliance with hand hygiene. These studies demonstrate that there is a need to improve both environmental and hand hygiene in order to maximize patient safety.
Article citation: 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.