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Improving Infection Prevention and Control: Alcohol-Based Hand Rubs

Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene, such as handwashing and the use of alcohol-based handrubs by healthcare workers before and after seeing patients, is considered the single most effective way of reducing healthcare-associated infection. However, compliance with hand hygiene guidelines among healthcare workers has been poor, generally below 50%.1

Studies assessing the effectiveness of strategies to improve adherence to recommended hand hygiene practices have generally lacked scientific rigour.2 Nevertheless, alcohol-based hand rubs are emerging as a promising solution in the fight against healthcare-associated infection.

Alcohol-based Handrubs: The Pros

Alcohol- based hand rubs have several advantages over traditional handwashing with soap and water:

  1. More effective in reducing the number of germs on hands. See Figure 1 below.
    Ability of Hand Hygiene Agents to Reduce Bacteria on Hands

    Figure 1. Ability of Hand Hygiene Agents to Reduce Bacteria on Hands. Courtesy Centers for Disease Control and Prevention

  2. Require less time to use. Application of a handrub takes about 20 seconds. On the other hand, to wash their hands, a healthcare worker has to leave the patient’s bedside, go to a sink, wash and dry their hands, and then perform the next task, all of which could take a few minutes. Over the course of a day’s work, if a healthcare worker washed their hands according to recommended guideline, the total amount of time spent on handwashing could be considerable, up to about an hour per eight-hour shift.
  3. Act faster in killing bacteria.
  4. Can be made accessible near points of patient care. This could improve adherence to hand hygiene. See Figure 2 (below).
    Hand Hygiene Compliance Trend

    Figure 2. Hand hygiene compliance: handwashing vs alcohol-based handrub. Source: Pittet D. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach. Emerging Infectious Diseases 2001; Vol. 7, No. 2.

  5. Less hand irritation and dryness with repeated use, provided emollients and/or skin moisturizers are added to the formula.

Alcohol-Based Handrubs: The Cons

  1. Alcohol is flammable. Therefore, alcohol-based handrubs should be stored, used and disposed safely.
  2. Require reliable dispensers that deliver the correct amount of product.
  3. Possible allergic contact dermatitis, contact urticaria syndrome or hypersensitivity to alcohol or additives present in alcohol-based hand rubs (rare).

Conclusion

Alcohol-based hand rubs represent a major advance in infection prevention and control. Compared with handwashing, their application requires less time, acts faster, irritates hands less often, and may improve hand hygiene compliance and healthcare-associated infection rates. Hospitals should consider installing alcohol-based hand rub dispensers near points of patient care as part of a multimodal, multidisciplinary strategy to improve hand hygiene behaviour.

References

  1. Pittet D. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach. Emerging Infectious Diseases 2001; Vol. 7, No. 2.
  2. Gould D, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005186. DOI: 10.1002/14651858.CD005186.pub2

Contact Teh & Associates to learn how we can help you optimise your infection control and prevention programme.

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