Hand Hygiene Best Practices: Study Finds Alcohol-Free Hand Sanitizers 2x more effective than alcohol in reducing risk of infection

Courtesy of Martha Bergen--extract from a fascinating study sponsored by the University of Michigan

Allison E. Aiello, PhD, MS, Assistant Professor of Epidemiology, University of Michigan School of Public Health, Center for Social Epidemiology and Population Health, Ann Arbor

Recorded at 9th annual Evidence Based Practice, sponsored by the University of Michigan Health System, Saint Joseph Mercy Health System, and Department of Veterans Affairs Health Center, and held March 16, 2007 in Ann Arbor, MI

Hand Hygiene in the Community

A variety of products are marketed for personal hygiene and preventing cross-contamination in the community setting (eg, households, restaurants, and daycare centers). These products include antiseptic hand washes (active ingredients include triclosan and triclocarban), antiseptic body washes (also with triclosan or triclocarban), and consumer hand sanitizers (alcohol or benzalkonium chloride).

What are the Benefits?

To assess the benefits of hand hygiene in the community setting, a large, comprehensive literature review was performed. It began with a PubMed search of journal articles published between 1980 and 2006. The interventions of interest were hand-hygiene education and the use of regular soap, antibacterial soap, or waterless hand sanitizers. A keyword search was conducted, using various keywords and combinations associated with hygiene, infection, soap, and hand washing in the community setting (241 search combinations were used).

To be included in the meta-analysis, studies had to include an outcome of gastrointestinal (GI) illness or upper respiratory infections (URIs).

Risk Reduction: GI Illnesses

The following are the relative reductions in risk associated with each intervention:

• Alcohol plus education: -23.6%
• Benzalkonium chloride: -42%
• Education alone: -30%
• Plain soap: -39%

Risk Reduction: URIs

Hand-hygiene interventions don't seem to be as effective against URIs as against GI infections. The following are the relative reductions in risk for each intervention:

• Alcohol plus education: -7%;
• Benzalkonium chloride: -39.9% (significant)
• Education alone: -14.5%
• Plain soap: (no published studies compared plain soap to no intervention)

this study found no association between the use of antibacterial products and bacterial resistance to antibiotics, but it did find reduced susceptibility to triclosan among a number of gram-negative bacteria and staphylococcal species.
Increasingly the most popular Benzalkonium Chloride-based product