Clostridium difficile (C. difficile) is the most common cause of hospital-acquired diarrhea and is the bacterium responsible for several recent outbreaks of the sometimes-fatal illness. Surprisingly, researchers have found these bacteria on the hands of long-term care residents who are currently symptom-free at a greater rate than on the hands of symptomatic patients in the same facility.

In this study of male residents at one long-term care facility in the US, reported in the journal, Clinical Infectious Diseases1, researchers found C. difficile bacteria on the skin of 51% of residents without current infection (confirmed by stool cultures showing no bacteria). Moreover, an astounding 37% of these asymptomatic residents carried an epidemic strain of C. difficile on their skin. Researchers also detected these bacteria on beds, bed rails, and other furniture throughout the facility.

Many of the asymptomatic residents whose hands tested positive for these highly contagious bacteria had undergone a recent infection with C. difficile, which included antibiotic treatment.

These findings are significant because infected patients with symptoms are usually isolated, and the patient and all those in contact follow high-level protocols for hand washing and surface cleaning. However, as this new evidence suggests, others within the same facility might not be effectively cleaning surfaces or practicing appropriate hand washing, thereby allowing ongoing cross-transfer of these dangerous bacteria.

The researchers suggest that cleaning protocols need improvement for all residents and staff within the entire facility when C. difficile infected patients are identified, and not solely for the patients and their direct caregivers.

Alcohol-based products, including popular hand-cleaning gels, do not kill C. difficile spores yet many facilities routinely rely on this hand-cleaning method. Only sanitizing surfaces thoroughly with a 10% bleach solution and washing hands properly with soap and water will prevent transmission of these infectious bacteria.

All of us can work toward preventing the spread of disease by taking extra precautions when visiting sick family and friends in hospitals, long-term care facilities, and in their homes. Of course, proper hand-washing is a good idea all the time!

First published in the Inside Tract® newsletter issue 165 – January/February 2008
Riggs MM, et al. Asymptomatic carriers are a potential source for transmission of epidemic strain and nonepidemic Clostridium difficile strains among long-term care facility residents. Clinical Infectious Diseases. 2007;45:992-8.