Keeping Patients Safe: Preventing the Spread of C. difficile

Nosocomial infections, also known as hospital-acquired infections, are a growing problem in health care facilities. Infections, such as Clostridium difficile, cause a cascade of problems, from delayed discharges, readmission to hospital, additional at-home care, increased costs for health care, and even death.

Although C. difficile can be contracted in the community, the highest risk of contamination is in a hospital or other health care facility. According to the Centers for Disease Control (CDC), one quarter of patients who first show symptoms of C. difficile infections are in an acute care hospital. The remaining three-quarters can trace their first symptoms back to when they were in a long-term care facility or to visits to doctors’ offices or clinics.

Cause for Concern

Each year C. difficile can be attributed to an estimated 14,000 deaths in the United States, a number equal to the total number of seats in the 1st Mariner Arena in Baltimore, Maryland.

Preventing the Spread

Patients with C. difficile must be identified as early as possible. Patients who are experiencing watery diarrhea (three or more episodes per day), fever, abdominal bloating, and cramping, should be isolated and tested for the bacteria as quickly as possible.

Contact isolation, which includes wearing gloves and gowns while in a patient’s room, can help reduce the infection spread to other patients. Single rooms are ideal but if sharing is necessary, patients with C. difficile should only share with another patient who also has the infection.


While studies have consistently shown that hand washing is the most effective tool in preventing the spread of infection, some health care workers are still not washing their hands either consistently or effectively.

A Morbidity and Mortality Weekly Report issued by the CDC in 2002 indicates that adherence to proper hand washing ranges from 5 percent to 81 percent. Reasons given for not adhering to guidelines include location of sinks not being convenient, lack of time, and the mistaken belief that wearing gloves makes hand washing not necessary.

The basic rules for hand washing starts with the most obvious: All personnel must wash their hands before and after touching a patient, after using the bathroom, and before handling food or feeding a patient. If gloves are worn, hands must be washed after removing the gloves. If using sterile gloves, hands must be washed before putting them on.

Hand washing is not necessarily performed with soap and water. Alcohol-based hand rubs that do not require rinsing are often preferable to soap and water. The general rule of thumb is if your hands are not visibly dirty, a hand rub should be used.

Other points to remember:

  • When washing hands, do not forget frequently overlooked areas, such as the thumbs, between the fingers, and bases of the finger nails, whether using soap and water or a hand sanitizer.
  • When using soap and water, be sure to pat dry (never rub) your hands thoroughly. If your skin is prone to dryness, apply lotion to prevent cracking. When using a sanitizer, it is essential to allow the rub to dry before touching anything.
  • Chipped nail polish and artificial nails can contribute to spreading bacteria. Rings are also dangerous for the spread of infection. According to the CDC report, certain types of bacteria can remain beneath a ring for several months.

Be Proactive

Encouraging good hand hygiene may require changes in the physical environment of the hospital unit or clinic. The ideal environment would have a sink by every patient’s and examination room door. In an older facility, this may not be practical, but when renovations or changes are being made, it should be suggested that convenient sinks be made a priority.

Hand sanitizer dispensers also should be available beside all patient and clinic doors, along with signs encouraging everyone – including visitors and patients – to clean their hands upon entering and leaving the room. Their presence can often trigger the thought that hand washing is necessary.

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