Yes! 5-10% of patients acquire health care-associated infections (HAIs) and in Canada that can lead to up to 220,000 HAIs per year and up to 8000 deaths. HAIs are the 4th leading cause of death in Canada and the vehicle identified most commonly in their spread are the hands of healthcare workers. It is estimated that a 20% increase in hand hygiene compliance can result in a 40% reduction in the rate of HAIs.

 

 

Alcohol (whether ethanol, isopropanol or a combination of the two) is the key ingredient in alcohol-based hand rub (ABHR) when it comes to killing the transient microorganisms that we pick up on our hands. Alcohols provide for rapid kill of most transient microorganisms due to their ability to denature proteins. The efficacy of ABHR depends on the quality of the product, the amount of product used, the time spent rubbing and the hand surfaces rubbed. For maximum efficacy, health care providers should perform hand hygiene at the appropriate moment of care which is why ABHR should be available as close to the point-of-care as possible.

 

3. When is the best time to use alcohol-based hand rub (ABHR)?

 

For maximum efficacy, health care providers should perform hand hygiene based on the "4 Moments” strategy developed by the Ministry of Health and Long Term Care which stresses the need for alcohol base hand rub (ABHR) to be available as close to the point-of-care as possible.

 

4. What concentration of alcohol should be used in an alcohol-based hand rub (ABHR)?

 

In health care settings, it is preferable that a minimum concentration of 70% alcohol be chosen as this level kills norovirus. Norovirus and other non-enveloped viruses (e.g. rotavirus, enterovirus) cause acute gastroenteritis in humans and are a frequent cause of outbreaks in health care facilities. As norovirus is a concern in all health care settings, this should be considered when choosing an Alcohol-based hand rub (ABHR) product. In non-health care settings, a concentration of 60-90% is acceptable. ABHR products being considered for purchase must have a Drug Identification Number (DIN) or Natural Product Number (NPN) from Health Canada.

 

 

The answer is found on page 25 of the ‘Best Practices for Hand Hygiene’ PIDAC document:

 "At the present time, there is no evidence for efficacy of non-alcoholic, waterless antiseptic agents in the health care environment. Non-alcohol-based waterless antiseptic agents are not recommended for hand hygiene in health care settings and should not be used.”

 

6. Is alcohol absorbed through the skin when using an alcohol-based hand rub (ABHR)?

 

Evidence indicates that alcohol is not absorbed through the skin and therefore does not pose a risk as far as increasing blood serum alcohol levels (blood alcohol levels).

 

 

Evidence indicates that alcohol is not absorbed through the skin and therefore does not pose a risk as far as increasing blood serum alcohol levels. Since there is no absorption, it is safe to use during pregnancy.

 

 

 A number of studies have looked at potential adverse events which could impact children through the use of alcohol-based hand rubs (ABHRs). Evidence indicates that alcohol is not absorbed through the skin and therefore does not pose a risk as far as increasing blood serum alcohol levels. There are some studies which indicate they can be effective in reducing absenteeism in schools and also reducing respiratory illness transmission in the home. ABHR is not to be ingested. There have been cases documented of toxicity from ABHR ingestion, so it is advisable to supervise children when the product is being used.

 

 

Alcohol-based hand rub (ABHR) is not to be ingested. There have been documented cases of toxicity from ABHR ingestion. ABHR is for topical use only.

 

10. How can I discourage the drinking of alcohol-based hand rub (ABHR)?

 

Alcohol-based hand rubs (ABHR) are available as rinses, gels and foams. There is limited data available regarding the relative efficacy of various formulations. The use of foams rather than gels or rinses may reduce the risk of ingestion of the product. If ingestion of ABHR is a concern, consider putting wall mounted, lockable units in visible locations. The use of an ABHR containing additives such as Bitrex assists by making the alcohol unpalatable.

 

 

Current alcohol-based hand rub (ABHR) products should not (if used correctly) irritate/dry the hands. Some health care providers may be familiar with the generation of alcohol-based hand rubs which didn’t contain skin softeners. Today’s generation of alcohol-based hand rubs all contain skin softeners which help prevent drying. Many published studies have found that nurses who routinely use alcohol-based hand rubs have less skin irritation and dryness than those using soap and water.

 

12. Can I use a hand hygiene product without a Drug Identification Number (DIN) or Natural Product Number (NPN)?

 

Alcohol-based hand rub (ABHR) products must have Drug Identification Number (DIN) or Natural Product Number (NPN) from Health Canada. The active concentration of alcohol can be found by searching on the DIN number in the Health Canada Drugs and Products Database and, for health care, the concentration is recommended to be 70-90% of ethyl and/or isopropyl alcohol. DIN and NPN product numbers can be found at: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php .  Also see PIDAC Best Practices for Hand Hygiene In All Health Care Settings

 

13. How would I go about starting up a hand hygiene program?

 

There are some great resources available to assist you in the planning and implementation of a hand hygiene program. The Just Clean Your Hands (JCYH) program was rolled out for acute care facilities in the spring of 2009 and will be rolled out for long term care settings in late 2009, early 2010. They both focus on the key moments when health care providers can perform hand hygiene and have the biggest impact on decreasing the transmission of microorganisms and reducing health care-associated infections. There are tools available on the JCYH website that walk you through step-by- step in planning, implementation and auditing.

You can also find more information in the PIDAC Best Practices for Hand Hygiene In All Health Care Settings document.

 

 

 

 

There is an excellent article that compares more than 20 hand hygiene programs. It was in Journal of Hospital Infection (2009) 72, 202-210 and called "Comparison of National and Subnational Guidelines for Hand Hygiene"

 

15. Can hand hygiene dispensers or bottles be "topped-up" or refilled?

Hand hygiene dispensers should never be refilled or topped up. While it may seem counter-intuitive, certain germs are actually able to live in just about any type of hand hygiene product. Several studies have shown that multi-use products can become contaminated with disease-causing germs over time – this includes liquid soap, antimicrobial soaps, and even alcohol-based hand rubs.
Plain liquid soap is only meant to help get germs off of the skin – there aren’t any products in it that actually kill germs. So, if dispensers are refilled or "topped-up” plain soaps can become contaminated quite easily. While antimicrobial soaps do have products in them that kill germs, there are increasing numbers of germs that are becoming resistant to the antimicrobial products that they contain. This may allow for contamination of these products by germs that are difficult to treat or kill.
Alcohol-based hand rubs contain between 60-90% alcohol (70-90% for healthcare facilities). In these concentrations, alcohol is considered an intermediate-level germicide, but it is not sporicidal. Spore-forming bacteria, such as Bacillus species and Clostridium species can survive in alcohol at these concentrations. There have been reports of outbreaks associated with contaminated alcohol products.
These findings highlight the importance of following expert recommendations to not refill or "top-up” hand hygiene product dispensers due to the potential risk of infection.  

 

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