On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal

•Clostridium difficile may remain on a high proportion of patient hands after typical soap and water use.•New C difficile contamination can occur immediately after patient hand hygiene.•Prevalence of C difficile on patient hands may be low while on treatment. The prevalence of Clostridium difficile spores was assessed in 48 observations of infected inpatients. Participants were randomized to hand hygiene with either alcohol-based handrub or soap and water. C difficile was recovered in 14.6% of pre-hand hygiene observations. It was still present on 5 of these 7 participants after hand hygiene (3/3 using alcohol-based handrub; 2/4 using soap and water).