Improving Infection Prevention and Control: Alcohol-Based Hand Rubs

Alcohol-based hand rubs represent a major advance in infection prevention and control because, compared with traditional handwashing with soap and water, their application requires less time, acts faster, irritates hands less often, and may improve hand hygiene compliance and healthcare-associated infection rates.

Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene, such as handwashing and the use of alcohol-based hand rubs 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 rigor.2 Nevertheless, alcohol-based hand rubs are emerging as a promising solution in the fight against healthcare-associated infection.

Alcohol-based Hand Rubs: 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.

Alcohol-based hand rubs reduce the skin burden of bacteria on hands more effectively than plain soap and water or antimicrobial soap and water.

Efficacy of hand hygiene preparations in killing bacteria, in order of increasing efficacy: plain soap, antimicrobial soap, alcohol based handrub
Alcohol-based hand rubs have higher bactericidal efficacy than plain soap or antimicrobial soap. Courtesy: Centers for Disease Control and Prevention (USA).

Further, the bacterial burden on hands remain lower for a longer period with alcohol-based hand rub, compared with plain soap and water or antimicrobial soap and water.

Ability of plain soap, antimicrobial soap, and alcohol-based hand rubs to reduce bacteria on hands over 180 minutes
Comparison of bacterial burden on hands over time after use of plain soap, antimicrobial soap, and alcohol-based hand rub. Courtesy: Centers for Disease Control and Prevention (USA).

2. Require less time to use.

Application of a hand rub takes between 20 and 30 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.

Alcohol-based hand rubs are effective within 20 seconds of use. On the other hand, the entire procedure of handwashing, if the WHO guidelines are followed, requires between 40 and 60 seconds.

4. Can be made accessible near points of patient care.

Alcohol-based hand rubs dispensers can be placed at or near points of care without much trouble. Unlike dispensers, wash basins cannot be placed near all points of care.

5. Improve hand hygiene compliance.

The introduction of alcohol-based hand rub, in conjunction with other interventions, have been associated with improved hand hygiene compliance.

For example, Pittet et al. implemented a hospital-wide multidisciplinary, multimodal improvement program to promote hand hygiene at a teaching hospital in Geneva, Switzerland, with a focus on bedside, alcohol-based hand disinfection.3 A substantial and sustained improvement in hand hygiene compliance was achieved; much of this improvement was attributed to increased use of alcohol-based hand rub.

Impact of interventions on handwashing and hand disinfection with an alcohol-based hand rub
Hand hygiene compliance improved with increased use of alcohol-based hand rub.

6. Less hand irritation and dryness.

Compared with regular handwashing, alcohol-based hand rubs may cause less hand irritation and dryness with repeated use, provided emollients and/or skin moisturizers are added to the formula.

Alcohol-Based Hand Rubs: The Cons

1. Alcohol is flammable.

Because they are flammable, alcohol-based hand rubs should be stored, used, and disposed safely.

2. Require reliable dispensers.

Alcohol-based hand rub dispensers should be checked regularly to ensure they deliver the correct amount of product.

3. Possible allergic contact dermatitis, contact urticaria syndrome or hypersensitivity.

In rare instances, individuals may develop a skin reaction to alcohol or additives present in alcohol-based hand rubs.

Conclusion

Alcohol-based hand rubs are 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 and other healthcare provider organizations should consider installing alcohol-based hand rub dispensers near points of patient care as part of a multimodal, multidisciplinary strategy to improve hand hygiene behavior.

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

References

  1. Pittet D. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach [Internet]. Emerging Infectious Diseases. 2001;7(2):234–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631736

  2. Gould D, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care [Internet]. Cochrane Database of Systematic Reviews. 2007; Available from: http://dx.doi.org/10.1002/14651858.cd005186.pub2

  3. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet [Internet] 2000;356(9238):1307–12. Available from: http://www.sciencedirect.com/science/article/pii/S0140673600028142