EFFECTIVENESS OF LIQUID SOAP VS CHLORHEXIDINE GLUCONATE FOR THE REMOVAL OF CLOSTRIDIUM-DIFFICILE FROM BARE HANDS AND GLOVED HANDS

OBJECTIVE: To compare liquid soap versus 4% chlorhexidine gluconate in 4% alcohol for the decontamination of bare or gloved hands inoculated with an epidemic strain of Clostridium difficile. DESIGN: C difficile (6.7 log10 colony-forming units [CFU], 47% spores), was seeded onto b are or latex gloved hands of ten volunteers and allowed to dry. Half t he volunteers initially washed with soap and half with chlorhexidine, followed by the other agent 1 week later. Cultures were done with Roda c plates at three sites on the hand: finger/thumbtips, the palmar surf aces of the fingers, and the palm. Statistical comparison was by paire d Student's t test. RESULTS: On bare hands, soap and chlorhexidine did not differ in residual bacterial counts on the finger/thumbtips (log1 0 CFU, 2.0 and 2.1, P = NS) and fingers (log10 CFU, 2.4 and 2.5, P = N S). Counts were too high on bare palms to quantitate. On gloved hands, soap was more effective than chlorhexidine on fingers (log10 CFU 1.3 and 1.7, P<.01) and palms (log10 CFU 1.5 and 2.0, P<.01), but not fing er/thumbtips (log10 CFU 1.6 with each, P = NS). Residual C difficile c ounts were lower on gloved hands than bare hands (P<0.01 to <0.0001). CONCLUSIONS: The two agents did not differ significantly in residual c ounts of C difficile on bare hands, but on gloved hands residual count s were lower following soap wash than following chlorhexidine wash. Th ese observations support the use of either soap or chlorhexidine as a handwash for removal of C difficile, but efficacy in the prevention of C difficile transmission must be determined by prospective clinical t rials (Infect Control Hosp Epidemiol 1994;15:697-702).