Assessment of Routine Patient Bathing in the Reduction of Clostridium difficile Skin Contamination

Background: Patients with Clostridium difficile infection (CDI) frequently have contamination of multiple commonly-examined skin sites. Bathing with antimicrobial soaps has been shown to be effective in reducing the burden of pathogens such as vancomycin-resistant enterococci on skin; however, it is not known if current hospital bathing practices reduce levels of C. difficile spores on skin.

Objective: To determine the type of bathing performed by CDI patients and to test the hypothesis that showering is most effective in reducing the levels of spores on skin.

Methods: We performed a prospective cohort study of hospitalized patients with CDI at a Veterans Affairs Medical Center. Patients were interviewed to determine their bathing practices. To assess the effect of bathing on the burden of spores, handprint cultures were obtained from commonly examined sites (chest, abdomen, groin, hand and arm) before and after bathing for patients who had positive skin cultures.

Results: Of the 72 subjects, the mean age was 67 (range, 31 to 89), 30 (41%) were long-term care residents, and 7 (9%) were bed-bound. Six patients (8 %) reported showering daily, 4 (6 %) reported showering intermittently, and 30 (42%) received daily bed baths.

For the 20 patients who had cultures obtained before and after bathing, there was no significant reduction in the proportion of positive hand acquisition cultures before and after bed-bath (60% and 64%, P = 0.8) or shower (68% and 58%, P = 0.4). The mean number of spores acquired on hands was not reduced by bed-bath, but there was a trend toward a reduction in acquisition of spores by showering (Figure).

Conclusions: Although showering was more effective than performing a bed-bath, our findings suggest that current hospital bathing practices have limited efficacy in reducing the levels of spores on skin. Research is needed to develop new strategies to reduce the burden of spores on skin.