To Help Stop Coronavirus, Wash Your Hands
Soap, water and hand sanitizer all play important roles in hand hygiene, which has been identified as a primary defense against the spread of the coronavirus. This Vitalacy blog article clarifies the facts about hand sanitizer and soap and their roles in proper hand hygiene.
Does hand sanitizer work? It’s one of the most commonly asked questions about hand hygiene—and it’s a question that has deep roots in history.
In 200 AD, Claudius Galen recommended alcohol as a treatment for topical wounds. In 1363, Guy de Chauliac used hot wine to treat wounds. And now, in 2020, alcohol is the main ingredient in antiseptic hand sanitizers.
While the antiseptic properties of alcohol have been known for quite some time, their role in health care hand hygiene wasn’t identified until 2002, when the Centers for Disease Control and Prevention (CDC) officially recommended the use of hand sanitizer in health care settings.
Over the past few decades, hand sanitizer has become increasingly popular, both in the world of health care and among the general public. But as its popularity has grown, so have some concerns.
Does hand sanitizer work? Is it healthy? Can germs become resistant to it?
Here are some of the most common myths – and facts refuting them – about the role of hand sanitizer in health care.
Myth: Health care workers should use hand sanitizer only when soap and water are not available.
Fact: For the general population, the CDC (Oct. 2019) recommends using hand sanitizer when soap and water are not available. Both the CDC (2017) and the World Health Organization (2009) have directed health care workers to use alcohol-based sanitizer to clean their hands. According to the WHO, hand sanitizers are quicker, more effective against certain germs, and are easier on the skin than soap and water.
However, soap and water are also important defenses against infection and should be incorporated into hand hygiene regimens (Gallese, 2020; Schreiber, 2018). According to the CDC (2020), health care workers should use soap and water when:
Hands are visibly dirty.
Hands are visibly soiled with blood or other bodily fluids.
They’ve potentially been exposed to Clostridium difficile (C. diff) when the facility is experiencing an outbreak or higher rates than usual.
They’ve potentially been exposed to patients with infectious diarrhea during an outbreak of norovirus.
They’ve potentially been exposed to Bacillus anthracis (anthrax).
They’ve recently used the bathroom.
They are preparing to eat
Myth: A quick pump of hand sanitizer is all you need.
Fact: It begins with a quick pump, but simply squirting some hand sanitizer onto your hands won’t cut it. As with soap and water, sanitizer won’t work unless it’s used at the proper duration and with the right amount and proper technique.
A Vitalacy customer found that hand hygiene duration performance with both soap and alcohol-based sanitizer was well below standard. With soap, 54 percent of their care providers hand washed for an average of under five seconds. With alcohol hand sanitizer, an even higher percentage of care providers – 63 percent – washed for less than five seconds.
With these performance data in hand, our customer’s care providers underwent thorough retraining on proper hand washing practices.
Vitalacy’s electronic hand hygiene monitoring system is the only one on the market that can track hand wash duration, as well as compliance. The Vitalacy system uses a SmartBand on the caregiver's wrist to capture duration data for each individual and unit and for the entire organization.
Research summarized in the American Journal of Infection Control (Kenters, et al., 2019) shows that workers often use less sanitizer than is required and that the sanitizer often dries before it can achieve maximum protection against germs.
"Some people with larger hands may need a bit more product, and this paper demonstrates that the amount being dispensed in many standard dispensers is not providing the ideal amount of product," said Elaine Larson, professor emerita at the Columbia University School of Nursing in New York City, in a Reuters Health story about the study (Rapaport, 2019).
Myth: Hand sanitizer is the best way to protect against all germs.
Fact: While it is recommended that health care workers use hand sanitizer, it cannot kill certain germs.
Hand sanitizers will not kill the germs that cause C. diffinfections, norovirus, and Cryptosporidium (the parasite that causes the diarrheal disease cryptosporidiosis).
In addition, non-alcohol-based sanitizers can contribute to certain germs becoming resistant to sanitizing agents, as well as to some antibiotics. The main antibacterial ingredient in non-alcohol based sanitizers is triclosan, which can contribute to bacteria becoming immune to many types of antibiotics.
Fortunately, triclosan use is declining. The FDA (2016) ruled that consumer antiseptic products containing triclosan could no longer be marketed. While the rule does not apply to products used in health care settings, it doesn’t necessarily make a difference—health care workers are supposed to use only alcohol-based products supplemented by soap and water.
While crediting alcohol-based hand sanitizer and disinfectants for their important contributions to controlling hospital infections worldwide, a recent study (Pidot, et al., 2018) shows that bacteria can develop resistance not only to antibiotic medicines per se, but to other substances, such as alcohol, as well.
The study presents data showing that infections caused by E. faecium are increasing due to this bacterium’s tolerance to alcohol used as a killing agent. E. faecium is a species of enterococcus, which causes 10 percent of the world’s hospital-acquired infections. In the United States, this bacterium is a leading cause of sepsis, a deadly blood infection. These findings provide more evidence of how bacterial adaptation is complicating hospital infection control.
Myth: Anyone working in a health care facility—not just nurses and physicians—should use hand sanitizer to clean their hands.
Fact: It’s important for everyone who could have contact with patients to keep their hands clean. But there are different recommendations for different types of workers in health care facilities. Cooks, cafeteria workers, and anyone else handling food should follow the hand hygiene recommendations for the food industry. US Food and Drug Administration (FDA) guidelines state that since sanitizers are not as effective when hands are wet—and since people handling food often have wet hands—soap and water should be used instead of sanitizer.
Myth: All hand sanitizers are the same.
Fact: There are many different options when it comes to hand sanitizers—and not all options are equal.
One of the most significant differences between hand sanitizers involves their alcohol content. Alcohol-free sanitizers can be appealing to consumers for a number of reasons: They don’t dry out the skin as much as alcohol-based ones, they’re not flammable, and they don’t smell like alcohol.
However, alcohol-free sanitizers have not been shown to be effective at warding off unwelcome germs. There even have been safety concerns—triclosan, a compound found in many alcohol-free sanitizers, may interfere with the endocrine system and contribute to antibiotic resistance.
Alcohol-based sanitizers, on the other hand, are both safe and effective when used correctly. The CDC (Sept. 2019)recommends using a hand sanitizer with an alcohol concentration of at least 60%.
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Centers for Disease Control and Prevention. Clean hands count for safe healthcare, May 5, 2017.
Centers for Disease Control and Prevention. Hand hygiene in healthcare settings, Jan. 31, 2020.
Centers for Disease Control and Prevention. Show me the science – how to wash your hands, July 12, 2019.
Centers for Disease Control and Prevention. Show me the science – when and how to use hand sanitizer in community settings, Sept. 17, 2019.
Centers for Disease Control and Prevention. When and how to wash your hands, Oct, 3, 2019.
Food and Drug Administration. FDA issues final rule on safety and effectiveness of antibacterial soaps, Sept. 2, 2016.
Gallese P. Why effective hand hygiene requires soap and water as well as hand sanitizer, Vitalacy Blog, Jan. 7, 2020.
Kenters N, et al. Produce dose considerations for real-world hand sanitizer efficacy. American Journal of Infection Control, Published online Jan. 13, 2020.
Pidot, et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Science Translational Medicine, August 1, 2018.
Rapaport L. Health workers may not use hand sanitizer properly. Reuters Health, Jan, 30, 2020.
Schreiber, M. Some bacteria are becoming ‘more tolerant’ of hand sanitizers, study finds.
National Public Radio, Aug. 2, 2018.
The Joint Commission. Acceptable practices of using alcohol-based hand rub. 2020.
World Health Organization. Hand hygiene: why, how & when? August 2009.