Hand Hygiene Methods – which to use and when

Healthcare systems are created to provide safe and effective care for vulnerable patients. It can be unnerving, then, to think of hospitals as somewhere we can pick up infections. But the reality is that hundreds of millions of patients are affected by a healthcare-associated infection (HAI) every year.¹

HAIs are commonly caused by the spread of germs from healthcare workers’ contaminated hands or equipment. These infections can be fatal, especially in critically ill patients. Because of this, infection control should be a priority for all patients, all the time.

The good news is that most HAIs are preventable. Appropriate infection prevention and control practices can reduce the number of healthcare infections by 70%,² and healthcare hand hygiene (especially when performed during the WHO 5 key moments) is the single most important action to stop the spread of infection.^3,4

With seemingly endless options for anti-microbial soaps, sanitisers and wipes, what should you be using to protect your patients?

Hand hygiene methods: is there a clear winner?

Soap and water: Washing hands with soap and water for at least 60 seconds is the preferred method for hand hygiene when hands are visibly dirty or soiled, particularly with bodily fluids. It is also more effective than other methods for specific types of pathogens, such as influenza virus, norovirus, and Clostridium difficile—a common cause of HAI.^5–7 Learn more about effective handwashing practices here.

Alcohol-based hand sanitisers: Alcohol-based hand sanitisers have been the standard of care for hand hygiene since the 1990s and remain the most effective method available to reduce HAIs.^4,8 These products have become even more popular during COVID-19, offering an efficient means to reduce highly infectious pathogens. At concentrations between 60 and 80%, alcohol-based formulations are effective at killing most organisms and are not thought to contribute to microbial resistance.^4,8,9

Efficiency and effectiveness are critical factors in healthcare settings; by providing convenient alcohol-based sanitisers, HCPs are more likely to practice appropriate hand hygiene, which significantly reduces the incidence of HAIs and improves patient safety.¹⁰ The evidence is clear—alcohol-based hand sanitisers should be available at all points of care.

Alcohol-free hand sanitisers: Antimicrobial agents such as benzalkonium chloride—the main ingredient commonly used in alcohol-free hand sanitisers—may work just as well against some pathogens as alcohol-based products. When it comes to COVID-19, even small concentrations of benzalkonium chloride could quickly and effectively eliminate the SARS-CoV-2 virus.¹² In addition to being non-toxic and non-flammable, many alcohol-free formulations are less irritating to the skin. This makes them a good alternative to alcohol-based products, particularly for individuals who need to sanitise frequently (such as healthcare workers) and who often experience cracked or sensitive skin. With time, future studies will help unveil the effect of alcohol-free hand sanitisers on other types of pathogens.

So, which hand hygiene method should you choose?

In this case, it’s best to have options. Soap and water are necessary when hands are visibly soiled and are effective against many germs. But when it comes to practicality, hand sanitisers have earned a principal place in infection control. The most important thing is that the resources required for appropriate hand hygiene are available, especially in healthcare settings.

At Invios, we are dedicated to infection prevention so that we can help healthcare professionals deliver better healthcare, faster. It is important that we encourage wider access to a variety of hand hygiene and other decontamination methods in order to reduce the spread of infections and, ultimately, save lives.

Discover more infection prevention solutions at inivos.com.

References:

1. World Health Organization (2022). SAVE LIVES: Clean Your Hands. Available at: https://cdn.who.int/media/docs/default-source/save-lives—clean-your-hands/5may-advocacy-toolkit.pdf?sfvrsn=8301e563_2

2. Allegranzi B, et al (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. https://doi.org/10.1016/S0140-6736(10)61458-4

3. World Health Organization (2022). Global report on infection prevention and control. Available at: https://www.who.int/publications/i/item/9789240051164

4. Vermeil T, et al (2018). Hand hygiene in hospitals: anatomy of a revolution. https://doi.org/10.1016/j.jhin.2018.09.003

5. Blaney DD, et al (2022). Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007. https://pubmed.ncbi.nlm.nih.gov/21411187/

6. Oughton MT, et al (2009). Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. https://pubmed.ncbi.nlm.nih.gov/19715426/

7. Grayson ML, et al (2009). Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. https://pubmed.ncbi.nlm.nih.gov/19115974/

8. Lotfinejad N, et al (2021). Hand hygiene in health care: 20 years of ongoing advances and perspectives. https://doi.org/10.1016/S1473-3099(21)00383-2

9. Jing JLJ, et al (2020). Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations. https://pubmed.ncbi.nlm.nih.gov/32403261/

10. Tinajero CG, et al (2019). Vancomycin-resistant Enterococcus faecium sensitivity to isopropyl alcohol before and after implementing alcohol hand rubbing in a hospital. https://pubmed.ncbi.nlm.nih.gov/31036399/

11. Koff MD, et al (2019). Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. https://pubmed.ncbi.nlm.nih.gov/19352154/

12. Ogilvie BH, et al (2021). Alcohol-free hand sanitizer and other quaternary ammonium disinfectants quickly and effectively inactivate SARS-CoV-2. https://doi.org/10.1016/j.jhin.2020.11.023