LOS ANGELES — The use of alcohol-based hand-cleaning gels has burgeoned in hospitals, where physicians, nurses, and other medical staff members have embraced them as a convenient alternative to soap and water hand washing.
But because such gels do not have activity against spores, reliance on their use faces further scrutiny in light of nationwide outbreaks of a new resistant strain of Clostridium difficile, according to John M. Boyce, M.D., chief of the infectious diseases section at the Hospital of St. Raphael in New Haven.
Dr. Boyce presented a study at the annual meeting of the Society for Healthcare Epidemiology of America that showed no increase in C. difficile-associated disease at his 500-bed community teaching hospital during the 3 years in which the use of alcohol-based hand rubs increased 10-fold.
Another study discussed at the meeting showed that rates of vancomycin-resistant Enterococcus (VRE) species and methicillin-resistant Staphylococcus aureus (MRSA) decreased in the 27 months following the introduction of alcohol-based hand gels and a hand-washing campaign at Loyola University Medical Center in Maywood, Ill. The reduction in VRE was statistically significant, but the drop in MRSA was not.
Rates of C. difficile were unchanged in the Loyola study, presented by Julie Leischner, M.D., of the department of infectious disease at the university.
Both investigators concluded that the use of alcohol-based hand cleaners did not influence rates of C. difficile infection.
But recent hand-hygiene guidelines written by the Centers for Disease Control and Prevention and a multisociety task force suggest “prudent” precautions during C. difficile outbreaks; the guidelines call for wearing gloves and washing hands with soap and water after removing gloves, because none of the antiseptic hand rubs are “reliably sporicidal” against Clostridium species (MMWR 2002;51(RR16):1–45).
The matter hit close to home for Dr. Boyce when a virulent C. difficile outbreak struck his hospital, months after completion of his study on alcohol-based hand rubs.
Two patients died and three underwent colectomies during a 2-week period—“something I haven't seen in 25 years and hadn't seen in [the] 31/2 years” of the study of alcohol-based hand rubs, he said during a scientific session at the meeting.
Cultures revealed isolates closely related to the highly toxic epidemic strains found in hospitals across the United States and Canada.
Despite his confidence that alcohol-based hand cleaners do not encourage C. difficile outbreaks, he said he believes that soap and water hand washing after diligent use of gloves should be the rule during outbreaks.
“I think it's fair to say a lot of health care workers have gotten used to alcohol-based hand rubs, and now it's hard to get them to go back to using soap and water,” he said.
Dr. Boyce disclosed that he has received funding from Gojo Industries Inc. and has served as a consultant to Mycrocept Corp. and Woodward Laboratories Inc., makers of hand sanitizers and soaps.