BMJ  2007;334:814 (21 April), doi:10.1136/bmj.39185.460243.3A

Letters

Clostridium difficile

Data on alcohol hand rubs are equivocal

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Data on alcohol hand rubs and Clostridium difficile are scant and controversial.¹ Bettin et al evaluated the efficacy of liquid soap v chlorhexidine gluconate in 4% alcohol to decontaminate bare or gloved hands inoculated with an epidemic strain of C difficile, and found that the two agents did not differ significantly in residual counts of C difficile on bare hands, but on gloved hands soap wash was more effective.² Studies on the impact of the introduction of alcohol hand rub policy on C difficile incidence are also controversial. Gopal Rao et al found a consistent, though not significant, reduction in methicillin resistant Staphylococcus aureus (MRSA) infection and C difficile associated diarrhoea.³ King found a reduced MRSA incidence and an increased C difficile incidence,⁴ and Boyce et al found essentially no change in the incidence of C difficile infection.⁵

Second Infectious Diseases Division, National Institute for Infectious Diseases, 00149 Rome, Italy

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Competing interests: None declared.

1. Starr J. Hospital acquired infection. BMJ 2007;334:708. (7 April.)[Free Full Text]
2. Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994;15:697-702.[ISI][Medline]
3. Gopal Rao G, Jeanes A, Osman M, Aylott C, Green J. Marketing hand hygiene in hospitals—a case study. J Hosp Infect 2002;50:42-7.[CrossRef][ISI][Medline]
4. King S. Provision of alcohol hand rub at the hospital bedside: a case study. J Hosp Infect 2004;56(suppl) 2:S10-2.
5. Boyce JM, Ligi C, Kohan C, Dumigan D, Havill NL. Lack of association between the increased incidence of Clostridium difficile- associated disease and the increasing use of alcohol-based hand rubs. Infect Control Hosp Epidemiol 2006;27:479-83.[CrossRef][Medline]

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Hospital acquired infection

John Starr
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