title: Clostridium difficile contamination of health care workers' hands and its potential contribution to the spread of infection: Review of the literature.
abstract: Clostridium difficile infection (CDI) can be transmitted from patient to patient by the hands of health care workers (HCWs); however, the relative importance of this route in the spread of C difficile in the hospital is currently unknown. Our aim was to review studies examining HCWs' hand carriage and its potential role in CDI transmission.
  
  
  
  First, English-speaking references addressing HCWs' hand sampling obtained from the PubMed database were reviewed. Second, C difficile outbreaks definitely or probably implicating HCWs were retrieved from the Outbreak Database Web site (www.outbreak-database.com). Finally, cases of C difficile occurring in HCWs after contact with an infected patient were retrieved from PubMed.
  
  
  
  A total of 11 studies dealing with HCWs' hand carriage were selected and reviewed. Between 0% and 59% of HCWs' hands were found contaminated with C difficile after caring for a patient with CDI. There were several differences between studies regarding site of hands sampling, timing after contact, and bacteriologic methods. Only 2 C difficile outbreaks implicating HCWs and 6 series of cases of transmission from patients to HCWs have been reported.
  
  
  
  This review shows that HCWs' hands could play an important role in the transmission of C difficile. Hand hygiene and reduction of environmental contamination are essential to control C difficile transmission.
authors.affiliation: Infection Control Unit, Centre Hospitalier Universitaire Grenoble Alpes, Université de Grenoble, Grenoble, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Jullian-Desayes
authors.affiliation: Infection Control Unit, Centre Hospitalier Universitaire Grenoble Alpes, Université de Grenoble, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France. Electronic address: caroline.landelle@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Landelle
authors.affiliation: Infection Control Unit, Centre Hospitalier Universitaire Grenoble Alpes, Université de Grenoble, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France.
authors.forename: Marie-Reine
authors.initials: MR
authors.lastname: Mallaret
authors.affiliation: Infection Control Unit, Centre Hospitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Paris, France; Medical Intensive Care Unit, Centre Hospitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: National Reference Laboratory for Clostridium difficile, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Groupe de recherche clinique EPIDIFF, Université Pierre et Marie Curie, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000635:transmission*; D003428:Cross Infection / Q000635:transmission*; D018562:Disease Transmission, Infectious; D006225:Hand / Q000382:microbiology*; D006282:Health Personnel; D006801:Humans
keywords: C difficile transmission; Clostridium difficile; Hands; Health care workers