Evidenced Based Practice - HAND RUBBING WITH WATERLESS ALCOHOL vs. STANDARD HANDWASHING WITH ANTISEPTIC SOAP

HAND RUBBING WITH WATERLESS ALCOHOL BASED SOLUTION VS. STANDARD HAND WASHING WITH ANTISEPTIC SOAP IN REDUCTION OF HAND CONTAMINATION IN THE INTENSIVE CARE UNIT

Type of Study: Quantitative

Initial Question: Is water, alcohol-based solution an effective agent for hand washing?

Digging deeper: Although this question identifies a waterless, alcohol-based solution as the intervention of interest, it fails to provide additional necessary details. It does not include specific information about the population, the alternative intervention, or the outcome that we are interested in achieving.

Formulated question: For persons entering a health facility, is hand rubbing with a waterless, alcohol-based solution as effective as standard hand-washing with antiseptic soap for reducing hand contamination?

CHAPTER 1

Introduction 

Handwashing is emphasized as the single most important measure to prevent cross transmission of micro-organisms and thus to prevent nosocomial infections.1 However, under routine hospital practice compliance with this measure is still unacceptably low, less than 50% in most studies published in the past 20 years. This constant finding is worrying because recent studies have shown that this level of compliance will not reduce the risk of transmission of multi-resistant bacteria in hospital. Attempts to improve compliance have included increasing the number of accessible sinks and educating healthcare workers, but none of these interventions led to a marked and sustained improvement in compliance.

Handrubbing with an alcohol based, waterless hand antiseptic seems to be the best method of increasing compliance with hand hygiene. Recent studies have shown a significant improvement in compliance after the introduction of handrubbing as a substitute for handwashing with plain soap and water. However, introduction of this new method as a substitute to standard handwashing after decades of enforcement of the latter can be a real challenge for infection control teams. Despite showing healthcare workers that only half of the opportunities of handwashing are completed, mainly because of lack of time, and that compliance can be improved by handrubbing, staff may be reluctant to use it. We carried out a survey in a representative sample of 271 healthcare workers in our hospital. The main reason raised for not adhering to the recommendation to use handrubbing was the lack of confidence about its efficacy. It seems there is still reluctance to accept handrubbing as a substitute for handwashing, even among some infection control practitioners.

There is growing evidence from experimental studies on artificial contamination of volunteer's hands that handrubbing is at least as effective as handwashing with either unmedicated soap or antiseptic agent. To our knowledge only two clinical studies, one observational study and one randomised controlled trial, have evaluated handwashing with plain soap versus handrubbing in everyday practice, and both studies showed positive results in favor of handrubbing. One randomised clinical study compared handwashing with an antiseptic soap versus handrubbing with an alcohol based solution with the assessment of skin tolerance as the primary objective. Handrubbing was better tolerated than handwashing and achieved comparable reduction in bacterial contamination. We performed a randomised clinical trial to assess the efficacy of an alcohol based solution compared with standard handwashing with a medicated soap in reducing hand contamination during routine patient care.

Statement of the Problem

Is hand rubbing with waterless alcohol based solution as effective as standard hand washing with antiseptic soap for reducing hand contamination in an Intensive Care Unit?

Significance of the Study

To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units.

 CHAPTER 3

Synthesis of the Studies

            From the fourteen studies that we have encountered, it is concluded that hand rubbing with alcohol is far more effective than that of hand washing. More bacteria are eradicated with this method. Though it is greatly stressed that close monitoring must be done. Furthermore, the nurses cannot rely on handrubbing alone. It is recommended that the nurses use this method for only three times, then handwash. The cycle may be then repeated.