From Internal Medicine 2009, the annual meeting of the American College of Physicians in Philadelphia
Alcohol-based hand sanitizer gels have revolutionized our concept of cleanliness over the past decade or so.
Upscale public toilets sport gel dispensors on the wall. My daughter’s summer camp a couple of years ago placed a few huge pump bottles at the entrances to their dining hall. Mini vials of the stuff, sitting in large baskets, became a popular freebie in the exhibit hall at many medical meetings, the small plastic bottles often coming in a clip-on sleeve so health-care providers could dangle them from their white coats. Just in the past year or two I began noticing wall-mounted gel squirters in the hallways at my local hospital that seemed placed every 10 or 20 yards.
That same decade has seen a “precipitous” rise in the incidence of Clostridium difficle associated disease (CDAD), a potentially deadly, hospital acquired infection in the U.S. and many other countries, said Dr. Dennis G. Maki, an infectious diseases physician at the University of Wisconsin in Madison. Today, it’s estimated that more than 300,000 cases of CDAD occur in the U.S. annually, more than the number caused by methicillin-resistant Staphylococcus aureus, he said. Compounding the problem is a “super-virulent” strain of C. difficile that began to spread in the early 2000s, with a mortality rate of 10%-15% and resistance to metronidazole, one of the only two antibiotics that were effective against the bacterium (the other is vancomycin).
Hospital-acquired C. difficile and CDAD is “one of the most important emerging infectious diseases,” despite being first identified as a human disease only about 25 years ago, Dr. Maki said. Hospitals are “greenhouses” for it, with C. difficule spores covering all their surfaces.
What might explain the spike in CDAD in the 21st century? The super-virulent strains, more older patients (the most susceptible age group), and broader use of antibiotics that set the stage for C. difficule overgrowth probably have all played a role. But Dr. Maki hypothesized that heavy responsibility lies with another culprit: alcohol-based hand sanitizers.
A smear of hand sanitizer will not inactivate C. difficile spores (actually hardly anything will aside from bleach). Primarily for this reason, when Dr. Maki makes rounds in his hospital he cleans his hands between patients by scrubbing with some chlorhexidine and running water (he says plain soap also works). The physicial act of hand scrubbing under water will mechanically drop the number of spores carried on the hands. “I do not use alcohol-containing hand rubs,” he said.
Sanitizer gel seems so handy, so effective, and it does work at eliminating many hand-borne pathogens. But here’s another example where bacteria trump human ingenuity.
—Mitchel Zoler (on Twitter @mitchelzoler)