Alcohol-based hand gels and hand hygiene in hospitals

Abstract

Axel Kramer and colleagues1Kramer A Rudolph P Kampf G Pittett D Limited efficacy of alcohol based hand gels.Lancet. 2002; 359: 1489-1490Summary Full Text Full Text PDF PubMed Scopus (140) Google Scholar report that 30 s exposure to the liquid preparations reduced contamination by around 99·99% compared with 99·9%, for gels, and conclude that gels should not be used. We disagree with this interpretation.Casewell and Phillips2Casewell M Phillips I Hands as a route of transmission for Klebsiella sp.BMJ. 1977; 2: 1315-1317Crossref PubMed Scopus (324) Google Scholar enumerated Klebsiella spp found on nurses' hands after normal contact with colonised patients. The typical recovery was around 100–1000 organisms; the highest was 7000. All except two of the ten alcohol gels that Kramer and colleagues tested would, therefore, have eliminated the typical numbers.What is important is that any preparation is used before and after close contact with any patient.3Cookson B Teare L May D et al.Draft hand hygiene standards.J Hosp Infect. 2001; 49: 153Summary Full Text PDF PubMed Scopus (2) Google Scholar We believe that anything that makes such preparations more acceptable to users is at least as important as a ten-fold difference in efficacy on a standard test. Kramer and colleagues note that the main reason for use of gel formulations is to reduce skin irritation and dryness. User acceptability is vital to the overall effectiveness of any product. Bischoff and colleagues4Bischoff WE Reynolds TM Sessler CN Edmond MB Wenzel RP Handwashing compliance by healthcare workers, the impact of introducing an accessible alcohol based hand antiseptic.Arch Intern Med. 2000; 160: 1017-1021Crossref PubMed Scopus (370) Google Scholar have shown introduction of easily accessible dispensers containing an alcohol gel can significantly improve hand decontamination rates among health-care workers.The standard used by Kramer and colleagues is an important method of testing hand rubs, but hand-rub use on wards will be more variable than under the test conditions. The investigators estimate that alcohol application times are more likely to be 8–15 s in daily practice, compared with the 30 s application of the standard test. Therefore, decontamination will be less from both types of preparation than in the study, with smaller differences between them. Axel Kramer and colleagues1Kramer A Rudolph P Kampf G Pittett D Limited efficacy of alcohol based hand gels.Lancet. 2002; 359: 1489-1490Summary Full Text Full Text PDF PubMed Scopus (140) Google Scholar report that 30 s exposure to the liquid preparations reduced contamination by around 99·99% compared with 99·9%, for gels, and conclude that gels should not be used. We disagree with this interpretation. Casewell and Phillips2Casewell M Phillips I Hands as a route of transmission for Klebsiella sp.BMJ. 1977; 2: 1315-1317Crossref PubMed Scopus (324) Google Scholar enumerated Klebsiella spp found on nurses' hands after normal contact with colonised patients. The typical recovery was around 100–1000 organisms; the highest was 7000. All except two of the ten alcohol gels that Kramer and colleagues tested would, therefore, have eliminated the typical numbers. What is important is that any preparation is used before and after close contact with any patient.3Cookson B Teare L May D et al.Draft hand hygiene standards.J Hosp Infect. 2001; 49: 153Summary Full Text PDF PubMed Scopus (2) Google Scholar We believe that anything that makes such preparations more acceptable to users is at least as important as a ten-fold difference in efficacy on a standard test. Kramer and colleagues note that the main reason for use of gel formulations is to reduce skin irritation and dryness. User acceptability is vital to the overall effectiveness of any product. Bischoff and colleagues4Bischoff WE Reynolds TM Sessler CN Edmond MB Wenzel RP Handwashing compliance by healthcare workers, the impact of introducing an accessible alcohol based hand antiseptic.Arch Intern Med. 2000; 160: 1017-1021Crossref PubMed Scopus (370) Google Scholar have shown introduction of easily accessible dispensers containing an alcohol gel can significantly improve hand decontamination rates among health-care workers. The standard used by Kramer and colleagues is an important method of testing hand rubs, but hand-rub use on wards will be more variable than under the test conditions. The investigators estimate that alcohol application times are more likely to be 8–15 s in daily practice, compared with the 30 s application of the standard test. Therefore, decontamination will be less from both types of preparation than in the study, with smaller differences between them. Alcohol-based hand gels and hand hygiene in hospitalsAuthors' reply Full-Text PDF