How to Use an Alcohol-Based Handrub
Hand hygiene is the single most important action that can help reduce the spread of infection in hospitals. However, some 2 million healthcare-associated infections (HAIs) occur each year accounting for nearly 90,000 deaths annually. Approximately one-third of these infections may be prevented by good hand hygiene on the part of healthcare workers. Other causes of HAIs may include housekeeping practices, more acutely ill patient populations, and antimicrobial resistance, etc. Current literature documents unacceptably low levels of hand hygiene among healthcare workers — approximately 40 percent to 50 percent.
Q: What are the most common reasons for healthcare workers’ lack of compliance with handwashing?
A: There are a number of reasons that impact healthcare workers compliance to handwashing:
- Lack of easy accessibility to sinks
- Handwashing causes dry, irritated hands
- HCWs are too busy
- Handwashing takes too much time
- Lack of knowledge on when hand hygiene should take place, including casual contact, before and after gloving, etc.
Q: How can hand sanitizers supplement proper hand hygiene?
A: Designed to promote new strategies for improving hand hygiene practices based on scientific data and evidence, the Centers for Disease Control and Prevention (CDC) issued a revised Guideline for Hand Hygiene in Healthcare Settings which authorizes the use of alcohol-based hand sanitizers as the preferred method of hand hygiene; that is, superior to soap-and-water washing when hands are not visibly soiled. The CDC legitimated alcohol-based hand sanitizers because it recognized that the efficacy of alcohol sanitizers was greater than soap and water, that the requirement of traditional soap-and-water handwashing was difficult during a busy hospital day, and that healthcare workers were more likely to use hand sanitizers which are accessible, fast, and more gentle on hands.
Alcohol can prevent the transfer of healthcare-associated pathogens, according to the CDC. In one study, gram-negative bacilli were transferred from a colonized patient’s skin to a piece of catheter material via the hands of nurses in only 17 percent of experiments after using an antiseptic handrub with an alcohol-based hand rinse. In contrast, transfer of the organisms occurred in 92 percent of experiments after handwashing with plain soap and water. This experimental model indicates that when the hands of healthcare workers are heavily contaminated, an antiseptic handrub using an alcohol-based rinse can prevent pathogen transmission more effectively than can handwashing with plain soap and water.
Alcohol-based products also are more effective for standard handwashing or hand antisepsis by healthcare workers than soap or antimicrobial soaps, according to the CDC. In all but two of the trials that compared alcohol-based solutions with antimicrobial soaps or detergents, alcohol reduced bacterial counts on hands more than washing hands with soaps or detergents containing hexachlorophene, povidone-iodine, 4 percent chlorhexidine, or triclosan.
In studies examining antimicrobial-resistant organisms, alcohol-based products reduced the number of multi-drug-resistant pathogens recovered from the hands of healthcare workers more effectively than did handwashing with soap and water.
Q: How do hand sanitizers fit into a busy healthcare worker’s handhygiene regimen?
A: Sanitizers are easily accessible — at the bed side, at the doorway, or as personal carriage. They are fast-acting, killing germs in as little as 15 seconds.
Q: What are the most pervasive misconceptions related to the CDC’s hand-hygiene guidelines related to alcohol handrubs and why?
A: HCWS think that since sanitizers are alcohol-based, they are drying to hands when in fact, the opposite is true. Alcohol-based hand sanitizers are less drying and irritating to hands than soap and water. Sanitizers contain emollients to moisturize hands, whereas soaps commonly remove the moisture from the skin. According to the CDC, in several recent prospective trials, alcohol-based rinses or gels containing emollients caused substantially less skin irritation and dryness than the soaps or antimicrobial detergents tested.
Q: How is an alcohol-based hand sanitizer best used?
A: When using an alcohol-based handrub, apply a dime-sized amount of product into the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. This usually takes 15 seconds or less.
Q: Why is an alcohol-based hand sanitizer a great way to boost residual kill rates/times?
A: According to data first published in Hospital Epidemiology and Infection Control, 2nd Edition (1999) and contained in the CDC’s hand-hygiene guidelines, alcohol-based handrubs are better than handwashing at killing bacteria. Numerous studies have documented the in vivo antimicrobial activity of alcohols, as they effectively reduce bacterial counts on the hands. Typically, log reductions of the release of test bacteria from artificially contaminated hands average 3.5 log10 after a 30-second application and 4.0 to 5.0 log10 after a one-minute application. In 1994, the FDA TFM classified ethanol 60 percent to 95 percent as a Category I agent (i.e., generally safe and effective for use in antiseptic handwash or healthcare worker handwash products). Alcohols are rapidly germicidal when applied to the skin, but they have no appreciable persistent (i.e., residual) activity. However, regrowth of bacteria on the skin occurs slowly after use of alcoholbased hand antiseptics, presumably because of the sub-lethal effect alcohols have on some of the skin bacteria, according to the CDC. Alcohols, when used in concentrations present in alcohol- based handrubs, also have in vivo activity against several nonenveloped viruses. For example, 70 percent isopropanol and 70 percent ethanol are more effective than medicated soap or non-medicated soap in reducing rotavirus titers on fingerpads.