In healthcare workers, what is the effectiveness of alcohol based hand sanitizers in hand hygiene compared to soap and water hand hygiene?

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November 11, 2016
Abstract: None Requested
The Effectiveness of Alcohol-based Hand Sanitizers in Hand Hygiene
Annotated Bibliography
Bloomfield, SF, Aiello, AE, Cookson, B, O’Boyle, C, Larson EL, (2007) The effectiveness of
Hand hygiene procedures in reducing the risks of infections in home and community settings, including handwashing and alcohol-based hand sanitizers. American Journal of Infection Control Volume 35, Issue 10, and S27-S64 Retrieved from
http://dx.doi.org/10.1016/j.ajic.2007.07.001
Bacterium circulates everywhere humans are. This bacterium is the main cause of ID (infectious disease. This makes the effectiveness of hand hygiene a crucial element in the expansion of ID. This article by Bloomfield et al, (2007) takes environmental, demographic, and healthcare trends into consideration that an Id posts a credible threat in upcoming years. They call two criteria, demographic changes of communities and the variety of pathogens that happen to mutate into ID. The authors claim that hand hygiene is the chief offender in the spread of ID. The study evaluates alcohol-based sanitization over hand washing. The article used both quantitative and qualitative risks. Their conclusions are the regular hand hygiene is critical to ID prevention. Removing bacterium from the hands is essential to reducing and prevention of ID and either method can work as long for the use of either method when properly accomplished. This properly accomplished hand hygiene is the first level of defense in the prevention of ID.

It is also critical to disinfect surfaces in all areas have the potential for contamination and where people work and live to also prevent ID and especially in healthcare facilities.
Jabber, U., Leischner, J. Kasper, D., Gerber, R., Sambol, SP., Johnson, S., Gerding, DN., (2010)
The effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hospital Epidemiology. (2010) Jun; 31(6):565-70. doi: 10.1086/652772. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/20429659
Jabber et al (2010) write that ABHRS (Alcohol-based hand rubs) are effective in decreasing pathogen transmission. They also state that alcohol is not effective against spores of Clostridium difficile. The test included a contaminating ten-test subject hand with this bacterium. The test subjects used three of the ABHRS and chlorhexidine soap-and-water cleaning and compared this to just water cleansing. Palm cultures by each test subject inoculated the agar cultures and commenced hand touching with other test subjects that are clear of the bacterium. Plain water washing slightly reduced palm culture counts 1.57 +/- 0.11 log10 colony-forming units (CFU), and this rate was set as the point zero for the other products. The chlorhexidine soap cleansing is by an average of 0.89 +/- 0.34 log10 CFU. The ABHRS proved a reduction of 0.11 +/- 0.20 log10 CFU per cm2 (P = .005). This proved a minimal change in reduction of spores at the lower level of 40% alcohol. The results state the hand hygiene was better when washing with chlorhexidine soap. This proved the chlorhexidine soap and water washing better than the ABHRS.
Larson, EL.; Cimiotti, J., Haas, JS; et al (2005) Effect of Antiseptic Handwashing vs Alcohol
Sanitizer on Health Care–Associated Infections in Neonatal Intensive Care Units Arch Pediatr Adolesc Med. 2005;159(4):377-383. doi:10.1001/archpedi.159.4.377 Arch Retrieved from
http://jamanetwork.com/journals/jamapediatrics/fullarticle/485991
The Larson et al (2005, write that the CDC recommends use ABHRS instead of old-style handwashing for patient care. There is little information representing the bearing of this recommendation on nosocomial-associated infections. The study objective is comparing the usefulness of two hand hygiene methods in the reduction of infection. The location is NCIUs. This study uses a crossover format in two NICUs in Manhattan N.Y. from 2001-2003, with 2932 NICU admissions and 119 nurses as test subjects. This study includes the use of ABHRS and the old-style hand washing. Both options tested in eleven-month periods within the NICUs. The authors adjusted for location, birth weight, surgeries and follow-ups, the results reported no major differences. The values were 0.77-1.25), 0.99 for bloodstream infections, for any infection, 1.61 for pneumonia, 1.78, for soft tissue and skin infections, and 1.26, respectively, for CNS infections. The skin complaint of contributing nurses was meaningfully better throughout the alcohol segment (P = .02 and P = .049) for spectator and self-assessments), but no noteworthy variances in mean bacteriological counts on hands. The rates of infection were almost equal using both methods of hand hygiene.
Oughton, MT, Loo, VG Dendukuri, N, Fenn, S., and MD Libman, (2015) Hand Hygiene with
Soap and Water are Superior to Alcohol Rub and Antiseptic Wipes for Removal of Clostridium difficile, doi.org/10.1086/6 Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/19715426/
The study also assesses alcohol formulated antimicrobial decontaminators nut uses Clostridium difficile as a bacterium. Oughton et al (2015) used random crossover assessments with ten test subjects by contaminating their hands with Clostridium difficile that is nontoxigenic. The authors tested with soap, antibacterial soap and water, at two temperatures (warm and cold) and antiseptic hand wipes and alcohol-based rubs and adding a control group, with no intervention. Analyzing each subject for CFUs (colony-forming units) with two contamination protocols identifies as “palm surface” and “whole hand” The method with the whole hand used the most reduction with plain soap warm water posted as 2.14 log10 CFU/mL, the cold water with plain soap posted at 1.74-2.54 log10, with antibacterial soap warm posted at 1.51log10 CFU/mL. The method of soap and water seemed more effective in eliminating Clostridium difficile. The author states hand washing should be the preferred method or alcohol-based sanitation in eradicating Clostridium difficile. This is sound results for this bacterium.
Pickering, AJ, Boehm, AB, Mwanjali, M. and Jennifer Davis, (2010) An Efficacy of Waterless
Hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania, (2010) doi: 10.4269/ajtmh.2010.09-0220Am J Trop Med Hyg February 2010 vol. 82 no. 2 270-278. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/20134005
Pickering et al (2010) purports that actively washing the hands with soap and water is one of the best ways to decontaminate when access to water is available. Infection from hand contamination is one of the foremost reasons of illness, whether in a health care or home environment. This study evaluated the use of alcohol formulated antimicrobial decontaminators ability to reduce contamination and subsequent infection. This study took place in environments in Dar es Salaam, Tanzania. The results proved the test product reduced the amount bacteria by 0.66 and 0.64 per hand. The bacteria test for was fecal streptococci and Escherichia coli. In the hand and water results, the levels were 0.50 and 0.25. The authors suggest it is definitely should be studied more. This seems credible when third world countries live in unsanitary conditions more often than not, and alcohol formulated antimicrobial decontaminators work better than the hand and soap method. All healthcare facilities have bathrooms.
Reynolds SA, Levy F, and Walker ES. (2006) Hand sanitizer alert. Emerging Infectious Diseases
EID Journal No 3 March 2006. dx.doi.org/10.3201/eid1203.050955 Retrieved from
http://wwwnc.cdc.gov/eid/article/12/3/05-0955_article
This article describes community epidemiologic research that is favorable for alcohol type, sanitation methods. The authors state the use of alcohol formulated antimicrobial decontaminators, are effective in the reduction of ID, and GI illnesses all locations where exposure is possible. It is critical for all health care facilities. They report that the FDA endorses a 60-95% concentration of alcohol for the best results. Products with less than the recommended amount of alcohol are not effective in the prevention of ID and GI or reducing the bacterium on the hands. They report one study on sanitizers with the Fad amount and one with only 40% alcohol. The later product failed at reducing the bacterium. The medium used is the standardized agar medium container with test subject palms, after applying the non-recommended bran. This proved that it was ineffective by the bacterium’s continued growth. The study moved on to a strict hand hygiene test where sanitizers sold in retail stores worked as advertised differentiated by the amount of alcohol listed on each brand. Five alcohol-formulated antimicrobial decontaminator brands each with 40 or 62%, respectively. The results for tap water and the 40 or 60% show no noteworthy results at reducing the bacterium. One-third of test subject displayed a greater than 50% reduction. The results were enlightening as buying these retail products are a waste of money.
Schmitz, K. Kempker, R., Tenna, T Stenehjem, E Abebe, E., Tadesse, E.,  KachaJirru E., and
Henry M Blumberg, (2013). The effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia Antimicrobial Resistance, and Infection Control20143:8. DOI: 10.1186/2047-2994-3-8 Retrieved from
http://aricjournal.biomedcentral.com/articles/10.1186/2047-2994-3-8
Schmitz et al write that hand hygiene must be the critical foundation of infection prevention and can reduce healthcare-associated infection rates. Citing that limited availability of data that gauges hand hygiene observance in Africa by WHO (World Health Organization). This study assesses the implications of a WHO campaign for hand hygiene in healthcare facilities the methodology includes a before and after study of HWC (HealthCare Workers) devotion to hand hygiene guidelines. This study was in three sections that started with a base evaluation if the test site. Next was the application in the usage of ABHRS. Finally, the study ends with a post analysis of HWC adherence to hand hygiene protocol. This includes HCW survey of the study. The results proved a noteworthy improvement from 2.1 % at baseline to 12.75% increase from baseline. The survey shows a 64% preference for ABHRS.
Vogel, L., (2011) Hand sanitizers may increase norovirus risk, CMAJ 2011 vol. 183 no. 12 doi:
10.1503/cmaj.109-3922 Retrieved from
http://www.cmaj.ca/content/183/12/E799.full
Vogel (20110 reports that ABHRS in health care facilities, may not be the solution for hand hygiene. The reports on research show that ABHRS might not be as effective as old-style handwashing, especially where norovirus is concerned. That in some situations may spread the virus. The experts cite the need for strenuous research studies is critical for prevention. The article also states that improper hand washing promotes the over prescribing of antibiotics add to the mutations into the super bugs. This link between ABHRS and resistance to bacteria begs more research. Also in this article are statistics that show that facilities use ABHRS more than old-style handwashing may have more outbreaks of norovirus in which the staff is 6 times expected in use ABHRS. In 45 facilities that report a preference for ABHRS, 53% had, an outbreak of norovirus and compares with 18% of 17 sites that used soap and water.