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In the hospital where I work, administrators have discontinued use of alcohol-based hand rubs. The reason, they say, is that alcohol-based products aren't effective againstClostridium difficile,one of the deadliest health care-associated pathogens. Is this true?-A.R., ILL.


Only partly. An anaerobic spore-forming organism, C. difficile isn't susceptible to alcohol when it's in its spore state. But most C. difficile organisms released in disease outbreaks are in the vegetative form, and these can be killed by alcohol.


The issue you raise is controversial. In general, the Centers for Disease Control and Prevention (CDC) recommends using hand rubs for routine hand hygiene when your hands aren't visibly soiled. On the subject of C. difficile, the CDC has no clear guidelines, but recommends "considering" not using them during C. difficile outbreaks. However, some experts worry that discouraging the use of hand rubs may contribute to the growth of drug-resistant organisms and lead to more cases of health care-associated infection.


Nurses need to know and follow their hospital's policies, which should be based on the latest evidence-based information from the CDC and other recognized authorities.

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Boyce JM, Pitter D, Guideline for hand hygiene in health-care settings, MMWR Recommendations and Reports, October 25, 2002; Sunenshine RH, McDonald LC, Clostridium difficile-associated disease: New challenges from an established pathogen, Cleveland Clinic Journal of Medicine, February 2006.