Clostridium difficile contamination of health care workers' hands and its potential contribution to the spread of infection: Review of the literature

Am J Infect Control. 2017 Jan 1;45(1):51-58. doi: 10.1016/j.ajic.2016.08.017.


Background: 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.

Methods: 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 ( Finally, cases of C difficile occurring in HCWs after contact with an infected patient were retrieved from PubMed.

Results: 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.

Conclusions: 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.

Keywords: C difficile transmission; Clostridium difficile; Hands; Health care workers.

Publication types

  • Review

MeSH terms

  • Clostridioides difficile / isolation & purification*
  • Clostridium Infections / transmission*
  • Cross Infection / transmission*
  • Disease Transmission, Infectious*
  • Hand / microbiology*
  • Health Personnel*
  • Humans