In the recent Medical Letter article on the treatment of Clostridium difficile–associated disease (CDAD) we wrote: “Healthcare workers caring for patients with C. difficile infection should follow contact isolation precautions, especially use of gloves and hand washing with soap and water after glove removal. Alcohol-based products such as hand sanitizers will not eradicate C. difficile spores.”1 One reader pointed out that alcoholbased products do eradicate some C. difficile spores and have been invaluable against other pathogens.
In an unpublished study available as an abstract, both alcohol-based hand gels and chlorhexidine washes reduced the number of C. difficile spores on contaminated hands, but chlorhexidine was more effective (8 spores/cm2 remaining vs. 30-44 spores/cm2 with 3 formulations of alcohol-based hand gels).2 A previous study showed that chlorhexidine was not different from soap in removal of spores.3 Alcohol itself should have no effect on spores (purified spores are frequently stored in alcohol), but the mechanical action of washing hands with alcohol-based products may be effective in removing them. The CDC has recommended that healthcare workers caring for patients with known or suspected CDAD use contact precautions and perform hand hygiene with either an alcohol-based hand rub or soap and water, except in an outbreak setting, where exclusive use of soap and water should be considered.4
2. J Leischner et al. Effect of alcohol hand gels and chlorhexidine hand wash in removing spores of Clostridium difficile (CD) from hands. Intersci Conf Antimicrob Agent Chemother (ICAAC), Washington, DC 2005, abstract LB-29-2005.