Effectiveness of Liquid Soap vs. Chlorhexidine Gluconate for the Removal ofClostridium difficilefrom 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 ofClostridium difficile.Design:C difficile(6.7 log10colony-forming units [CFU], 47% spores), was seeded onto bare or latex gloved hands of ten volunteers and allowed to dry. Half the volunteers initially washed with soap and half with chlorhexidine, followed by the other agent 1 week later. Cultures were done with Rodac plates at three sites on the hand: finger/thumbtips, the palmar surfaces of the fingers, and the palm. Statistical comparison was by paired Student’sttest.Results:On bare hands, soap and chlorhexidine did not differ in residual bacterial counts on the finger/thumbtips (log10CFU, 2.0 and 2.1, P= NS) and fingers (log10CFU, 2.4 and 2.5,P=NS). Counts were too high on bare palms to quantitate. On gloved hands, soap was more effective than chlorhexidine on fingers (log10CFU 1.3 and 1.7, P<.01) and palms (log10CFU 1.5 and 2.0, P<.01), but not finger/thumbtips (log10CFU 1.6 with each, P=NS). ResidualC difficilecounts were lower on gloved hands than bare hands (P<0.01 to <0.0001).Conclusions:The two agents did not differ significantly in residual counts of Cdifficileon bare hands, but on gloved hands residual counts were lower following soap wash than following chlorhexidine wash. These observations support the use of either soap or chlorhexidine as a handwash for removal ofC difficile,but efficacy in the prevention ofC difficiletransmission must be determined by prospective clinical trials.