INFECTION PREVENTION & CONTROL
Alcohol gels: the end of an era?
Dr Andrew Kemp PhD (Bio), Dr Vanessa Hodgkinson MBBS, BSc, FRCA, FFPMRCA and Miss A Bugg MSc (Microbiology) take a retrospective and prospective view of the use of alcohol gels as hand sanitisers in healthcare.
In many national healthcare systems around the world there is significant pressure placed on clinical staff through the publication of guidance documents. Probably the best- known guidance document for hand hygiene is the WHO guide.14
basis of most local guidance documents. Most published guidance documents include recommendations for the use of alcohol hand gels, and in some cases (including in the USA), instead of washing hands.1,2
This document forms the
The most recent test results using
the Bacteria Specific Rapid Metabolic Assay (BSRMA) to detect bacterial counts on hands,3,4
suggest new guidance is needed. In order to discover the most effective method of hand decontamination, in both the short term and long terms, the hands of administrative staff were tested for bacterial bio burden following the use of antimicrobial soap, alcohol gel, alcohol liquid hand rub and a 5th generation Silane Quaternary Ammonium Compound (SiQAC). In a further series of tests, a combination of hand wash, followed by a single application of the 5th Generation SiQAC, and then either an alcohol gel, or alcohol liquid hand rub were used. The data shows that the most successful results from products used in isolation were achieved using the 5th generation SiQAC. However, in order to meet the WHO requirements for 5 moments in hand hygiene,14
the best combination was found to be hand wash, followed by application of a single daily dose of the 5th generation SiQAC, followed by regular use of liquid alcohol hand rub.
Traditional techniques
Since the days of Semmelweis, clinicians working in healthcare have understood the
fact that there is a link between Healthcare Acquired Infections (HAIs) including Surgical Site Infections (SSIs) and hand washing.5 Since those days, clinical staff have used soap and running water to decontaminate hands regularly throughout their work day. A little over 20 years ago there was a significant step change that saw a massive increase in use of alcohol gels in healthcare facilities. At around that time, there was a significant and growing amount of media attention, and pressure on the UK government to solve the problem of Methicillin Resistant Staphylococcus Aureus (MRSA) and other ‘superbugs’, a term adopted by the media. For those who remember that time of mass introduction of alcohol gels, fear and almost hysteria gripped
In its guidance the WHO admits that not enough evidence has yet been gathered linking hospital HAI or SSI rates to either hand sanitation or surface bio burden…
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the nation. Headlines of “Flesh eating bugs” helped to galvanise public opinion, with alcohol gels being portrayed to all as the answer to stopping the spread of these dangerous resistant bacterial species. In research terms, there was little efficacy data to work with, we have therefore been playing a game of “catch up” since, trying to prove the efficacy of alcohol hand gels already in widespread use in our healthcare facilities.2,3,4
In the face of increasing
numbers of bacteria that have resistance to antibiotics and to disinfectants, it is becoming even more important that we understand the true effects of our hand sanitation options.
Another matter of considerable concern to those who use these gels every day, is the damage that can be caused to skin at least in part by the drying effect of alcohol.9,10,11,12,13 Current World Health Organization (WHO) guidance does not actually recommend the use of alcohol gels over hand washing.14 However, the US Centres for Disease Control and prevention (CDC) does recommend the use of alcohol gels as preferred to hand washing. Their guidance states that “Alcohol-
JUNE 2018
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