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Lack of Association Between the Increased Incidence of Clostridium difficile–Associated Disease and the Increasing Use of Alcohol-Based Hand Rubs

Published online by Cambridge University Press:  21 June 2016

John M. Boyce ,
Cathy Ligi ,
Cindy Kohan ,
Diane Dumigan  and
Nancy L. Havill
John M. Boyce*
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut Yale University School of Medicine, New Haven, Connecticut
Cathy Ligi
Affiliation:
Mid-State Medical Center, Meriden, Connecticut
Cindy Kohan
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut
Diane Dumigan
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut
Nancy L. Havill
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut
*
Infectious Diseases Section, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511 (Jboyce@srhs.org)
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Abstract

Objective.

To determine whether there is an association between the increasing use of alcohol-based hand rubs (ABHRs) and the increased incidence of Clostridium difficile–associated disease (CDAD).

Setting.

A 500-bed university-affiliated community teaching hospital.

Methods.

Use of ABHRs during the period 2000-2003 was expressed as the number of liters of ABHR used per 1000 patient-days. The proportion of hand hygiene episodes performed by using an ABHR was determined by periodic observational surveys. CDAD was defined as a physician-ordered stool assay positive for C. difficile toxin A or A/B. The incidence of CDAD was expressed as the number of unique patients who had 1 or more positive CDAD test results per 1,000 patient-days.

Results.

During 2000-2003, the use of ABHR increased 10-fold, from 3 to greater than 30 L/1,000 patient-days (P< .001). The proportion of hand hygiene episodes performed using an ABHR increased from 10% to 85% (P< .001). The incidence of CDAD in 2000, 2001, 2002, and 2003 was 1.74, 2.33, 1.14, and 1.18 cases/1,000 patient-days, respectively.

Conclusion.

Despite a significant and progressive increase in the use of ABHRs in our facility during a 3-year period, there was no evidence that the incidence of CDAD increased. These findings suggest that factors other than the increased use of ABHRs are responsible for the increasing incidence of CDAD noted since 2000 in other facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 479 - 483
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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