Although hand hygiene has been shown to prevent infection, hospitalized patients don't often have the opportunity to wash their hands because of factors such as reduced mobility, dexterity, and cognition. A study was conducted in a university-affiliated medical center to determine whether staff education and patient assistance could improve opportunities for patient handwashing and thus influence the occurrence of Clostridium difficile infection.

In phase 1 of the study, patient hand hygiene on four medical-surgical units was assessed using patient surveys. The staff on these units were then educated on the role of hand hygiene in preventing infection and instructed to provide education and assistance to patients. In phase 2, the initiative was implemented throughout the hospital. C. difficile infection events were defined as all hospital-onset, laboratory-confirmed, positive C. difficile stool tests. Patients' knowledge of hand hygiene and opportunities to perform hand hygiene increased significantly after staff were educated and in turn educated the patients. C. difficile infection rates initially decreased after the implementation of this initiative but later increased slightly.

Patient hand hygiene should be considered a potential C. difficile infection prevention measure in hospitalized patients. The authors conclude that the slight increase in infection rates that they noted after several months suggests continued staff support and education is necessary to sustain this prevention measure.

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