Skip to main content
    • Aa
    • Aa

Effectiveness of Alcohol-Based Hand Rubs for Removal of Clostridium difficile Spores from Hands

  • Umair Jabbar (a1), Julie Leischner (a1), Douglas Kasper (a1), Robert Gerber (a1), Susan P. Sambol (a1), Jorge P. Parada (a1) (a2), Stuart Johnson (a1) (a2) and Dale N. Gerding (a1) (a2)...

Alcohol-based hand rubs (ABHRs) are an effective means of decreasing the transmission of bacterial pathogens. Alcohol is not effective against Clostridium difficile spores. We examined the retention of C. difficile spores on the hands of volunteers after ABHR use and the subsequent transfer of these spores through physical contact.


Nontoxigenic C. difficile spores were spread on the bare palms of 10 volunteers. Use of 3 ABHRs and chlorhexidine soap-and-water washing were compared with plain water rubbing alone for removal of C. difficile spores. Palmar cultures were performed before and after hand decontamination by means of a plate stamping method. Transferability of C. difficile after application of ABHR was tested by having each volunteer shake hands with an uninoculated volunteer.


Plain water rubbing reduced palmar culture counts by a mean (± standard deviation [SD]) of 1.57 ± 0.11 log10 colony-forming units (CFU) per cm2, and this value was set as the zero point for the other products. Compared with water washing, chlorhexidine soap washing reduced spore counts by a mean ( ± SD) of 0.89 ± 0.34 log10 CFU per cm2; among the ABHRs, Isagel accounted for a reduction of 0.11 ± 0.20 log10 CFU per cm2 (P = .005), Endure for a reduction of 0.37 ± 0.42 log10 CFU per cm2 (P = .010), and Purell for a reduction of 0.14 ± 0.33 log10 CFU per cm2 (P = .005). There were no statistically significant differences between the reductions achieved by the ABHRs; only Endure had a reduction statistically different from that for water control rubbing (P = .040). After ABHR use, handshaking transferred a mean of 30% of the residual C. difficile spores to the hands of recipients.


Hand washing with soap and water is significantly more effective at removing C. difficile spores from the hands of volunteers than are ABHRs. Residual spores are readily transferred by a handshake after use of ABHR.

Corresponding author
Research Service (151), Hines VA Hospital, 5000 S Fifth Ave, Bldg 1, Rm C344, Hines, IL 60141, (
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. JA O'Brien , BJ Lahue , JJ Caro , DM Davidson . The emerging infectious challenge of Clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect ControlHosp Epidemiol 2007;28:12191227.

2. B Razavi , A Apisarnthanarak , LM Mundy . Clostridium difficile: emergence of hypervirulence and fluoroquinolone resistance. Infection 2007;35(5): 300307.

4. DN Gerding , CA Muto , RC Owens Jr. Measures to control and prevent Clostridium diffidle infection. Clin Infect Dis 2008;46 (Suppl 1):S43S49.

5. JM Boyce , D Pittet ; Healthcare Infection Control Practices Advisory Committee; HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in healthcare settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30(8):S1S46.

6. DJ Weber , E Sickbert-Bennett , MF Gergen , WA Rutala . Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA 2003;289(10): 12741277.

7. AD Russell . Bacterial spores and chemical sporicidal agents. Clin Microbiol Rev 1990;3(2:99119.

8. CA Muto , M Pokrywka , K Shutt , et al.A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26(3:273280.

9. JM Boyce , C Ligi , C Kohan , D Dumigan , NL Havill . 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(5:479483.

10. FM Gordin , ME Schultz , RA Huber , JA Gill . Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based hand rub. Infect Control Hosp Epidemiol 2005;26(7:650653.

12. S King . Provision of alcohol hand rub at the hospital bedside: a case study. J Hosp Infect 2004;56(Suppl 2):S10S12.

13. K Bettin , C Clabots , P Mathie , K Willard , DN Gerding . Effectiveness of liquid soap versus Chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994;15:697702.

15. CP Kelly , JT LaMont . Clostridium difficile-more difficult than ever. NEJM 2008;359:19321940.

16. LV McFarland , HW Beneda , JE Clarridge , GJ Raugi . Implications of the changing face of Clostridium difficile disease for healthcare practitioners. Am J Infect Control 2007;35(4:237253.

17. R Durai . Epidemiology, pathogenesis, and management of Clostridium difficile infection. Dig Dis Sci 2007;52:29582962.

18. ME Rupp , T Fitzgerald , S Puumala , et al.Prospective, controlled, crossover trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29(1:815.

19. N Vernaz , H Sax , D Pittet , P Bonnabry , J Schrenzel , S Harbarth . Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. J Antimicrob Chemother 2008;62:601607.

20. MT Oughton , VG Loo , N Dendukuri , S Fenn , MD Libman . Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infect Control Hosp Epidemiol 2009;30: 939944.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 33 *
Loading metrics...

Abstract views

Total abstract views: 422 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd July 2017. This data will be updated every 24 hours.