Contamination of Healthcare Workers' Hands with Clostridium difficile Spores after Caring for Patients with C. difficile Infection

OBJECTIVE: We determined the percentage of healthcare workers' (HCWs') hands contaminated with Clostridium difficile spores after caring for patients with C. difficile infection (CDI) and risk factors associated with contamination. DESIGN: Prospective study. SETTING: A French university hospital. METHODS: We compared the hand contamination rate among HCWs caring for patients with CDI (exposed group; n = 66) with that among an unexposed group (n = 44). Spores of C. difficile were recovered from the hands of HCWs after rubbing their fingers and palms in alcohol shortly after patient care. Associations between hand contamination and HCW category, type (patient or environment), and risk level (high or low risk) of HCW contacts and their respective duration as well as use of gloves were analyzed by bivariate and multivariate analysis. RESULTS: C. difficile spores were detected on 24% of HCWs' hands in the exposed group and on 0% in the unexposed group (P < .001). In the exposed group, logistic regression, which adjusted for high-risk contact (ie, exposure to fecal soiling), contact with the environment, and contact with or without use of gloves, revealed that high-risk contact (adjusted odds ratio aOR per 1 contact increment, 2.78; 95% confidence interval CI, 1.42-5.45; P = .003) and at least 1 contact without use of gloves (aOR, 6.26; 95% CI, 1.27-30.78; P = .02) were independently associated with HCW hand contamination by C. difficile spores. CONCLUSIONS: Nearly one-quarter of HCWs have hands contaminated with C. difficile spores after routine care of patients with CDI. Hand contamination is positively associated with exposure to fecal soiling and lack of glove use.