New Study Raises Questions About Alcohol Foam Hand Sanitizers' Antimicrobial Efficacy in a Practical Clinical Setting

Excerpts below from March 30 news release published by one of the largest distributors of alcohol-based hand sanitizer products..

"...The way 62 percent ethanol foam hand sanitizers are used in a practical clinical setting most likely means they do not provide any more bacterial reduction than simply washing with the same quantity of water alone, says a new study presented at the Fifth Decennial International Conference on HAIs. The study results confirm preliminary data first presented by lead author Dr. Günter Kampf at Medline Industries, Inc.'s Prevention Above All conference late last year.

The study, "Efficacy of ethanol-based hand foams using clinically relevant amounts: a cross-over controlled study among healthy volunteers," was performed according to the EN1500 standards and found that the applied volume of 62 percent alcohol foam healthcare workers used so that their hands would dry in 30 seconds was small -- only 1.6 grams. Compared to published data, even a simple hand wash using 1.6 grams of water alone has similar or better antimicrobial efficacy than the same amount of 62 percent alcohol foam sanitizer. Furthermore, to reach desirable bactericidal levels would require approximately twice the practical amount of product, extending evaporation times upward of 90 to 120 seconds per application -- something that is not practical in a clinical setting given the patient care responsibilities healthcare workers face on a daily basis.

"The data suggests we have a false sense of security with regard to the level of bacterial reduction provided when using 62 percent foam hand sanitizers," said Kampf, who is a member of the German Association for Infection Control and a lecturer at the Ernst Moritz University in Germany.

"While 62 percent foam sanitizers are not entirely ineffective, it is incumbent upon us to educate regarding proper technique," commented Lessem. "If proper application technique is unattainable due to the practical considerations of the healthcare worker's daily job responsibilities, then other product options should be considered...."

The last excerpt in bold/italics was necessarily "striking." Dr. Kampf, a highly-published expert on the topic of hand hygiene, is otherwise pointing to facts that are widely-acknowledged--but are often overlooked by HCW's simply because most are at the mercy of administrators that are influenced not by facts, but by sales people representing alcohol-based hand sanitizer manufacturers, as well as one-sided "recommendations" provided by government agencies that are in turn, influenced by lobbyists representing the same manufacturers.

Equally interesting: the above-note study was distributed via a media release by Medline Industries--which is arguably one of the country's larger distributors of alcohol-based hand sanitizer products. Suggesting to some that their commitment to alcohol-based hand sanitizer is starting to wane.


Here are basic facts, supported by more than a handful of truly independent studies:


1. Repeated use of alcohol-based hand sanitizer products reduces alcohol's effectiveness with respect to killing germs/bacteria
On the other hand, numerous studies that have compared residual efficacy of alcohol-based products to quaternary ammonium-based products  have found that quats' efficacy increases with repeated application.

2. Repeated use of alcohol-based sanitizers increases the risk of exposure of pathogens, simply because alcohol causes the skin to become dry/irritated. Dry/irritated skin is akin to a cracked windshield; the pesky pathogens slip through the cracks as easily as tiny bugs can squeeze into the cracked windshield.

3. Quat-based hand sanitizer products have proven to be equally effective against a broad spectrum of pathogens (based on log rate), yet these products are safer to the skin, provided residual protection, and because they are water-based, these products break through any dirty on the hands, and delivery optimal antiseptic and antibacterial benefits. 

Unlike alcohol-based products, the quat-based, non-alcohol formulas (those that use benzalkonium chloride or benzethonium chloride) do not require rinsing before or after application, and they won't destroy anything other than the pathogens (alcohol-based products are notorious for destroying industrial floor wax, paint, and materials). 

Swine flu season not over, U.S. health officials warn

Courtesy of Reuters news service:

"The flu season is not over yet ... H1N1 has remained persistent in the southeast and now those states are experiencing more local and regional activity," U.S. Surgeon General Regina Benjamin told reporters in a conference call.
U.S. health officials said it was not clear why there were more swine flu cases in some regions and warned that many people were still vulnerable because they had not been immunized.
Alabama, South Carolina and Georgia have been reporting "regional disease" -- one step below "widespread disease," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said on the call. She said the situation in Georgia was unique.
"Recently, Georgia has seen more laboratory confirmed influenza hospitalizations each week than they've seen at any time since October," Schuchat said.

"Scientific Study":Hand Sanitizers Better than Washing When it Comes to Common Cold

Before you jump up and down at the headline, we didn't create it.  This was the headline to a story published today by the American Society of Microbiology.

First, the reader should be reminded that we're advocates of proper hand hygiene, and we believe the first line of defense is properly washing hands with appropriate soap (and water).

Ok..now lets examine the story itself--and carefully consider the first paragraph:

A new study suggests that hand sanitizers containing ethanol are much more effective at removing rhinovirus from hands than washing with soap and water. Sanitizers containing both ethanol and organic acids significantly reduced recovery of the virus from hands and rhinovirus infection up to 4 hours following application. The researchers from the University of Virginia School of Medicine, Charlottesville and Dial Corporation, Scottsdale, Arizona detail their findings in the March 2010 issue of the journal Antimicrobial Agents and Chemotherapy.

Without having to explain that rhinovirus is the scientific name for what is otherwise the common cold, suffice to suggest that the remaining prelude to the study was otherwise redundant in promoting the idea of rubbing alcohol on to the skin, even though most experts will acknowledge that alcohol actually breaks down protective skin cells, and increases the risk of exposure to pathogens.

The real troubling aspect of this "academic study" can be found right on its face: the research was underwritten by Dial Corporation, ironically one of the leading makers of hand soap, but not so ironically, they're also one of the leading makers of alcohol hand sanitizer.

Next paragraph to the 'coming soon trailer':

The experiments ranged from a control group who had no treatment, several groups who washed their hands for differing amounts of time (some with soap, some without), and several who used varying amounts of hand sanitizer. Results showed that the ethanol hand sanitizer removed approximately 80% of detectable rhinovirus from hands and was much more effective than no treatment, water alone, or soap and water. Soap and water removed rhinovirus from 31% of hands.

We know enough to acknowledge that many soaps aren't always so great for any number of reasons (check the actual ingredients), but the fact that these 'independent academics' and 'researchers' somehow failed to include non-alcohol sanitizers within their 'exhaustive clinical study' might be because Dial Soap doesn't manufacture non-alcohol hand sanitizer.

Lets open the debate, and invite comments from objective professionals (sic:those who have not been paid a salary and/or consulting fees within the last five years from any manufacturer or marketer of hand hygiene products). We're therefore looking for accredited experts that have actually researched and compared alcohol-hand sanitizers to quarternary ammonium-based products..

We've certainly interrogated all of the comparison studies that we could get our hands on, which explains why we keep this blog updated as frequently as possible.  Vote with your hands..or your feet..

Herbalife joins the Alcohol-Free Hand Sanitizer Sector

However late to the game, we tip our hats to Herbalife, the gurus of multi-level-marketing, for their 'breakthrough" launch of a non-alcohol hand sanitizer product.

While its always fun to take note of marketing strategies (and to notice how competitors within the space are emulating each other's "shout outs" and shouting down the dangers of alcohol-based products), some should be dismayed when having to peel back the Herbalife onion layers to discover that however effective when compared to the legacy alcohol-based products, their alcohol-free hand sanitizer is hardly unique, as its powered by the same active ingredient used by most of the other alcohol-free hand sanitizer products (the organic compound benzalkonium chloride a/k/a BAC); and that those existing products sell for 1/5 the price when compared to Herbalife's product.  

 A 1 oz spray bottle of Herbalife Hand Sanitizer has a suggested retail price of $5.50.

Established brands in the market place (whether Soapopular, Hy5, HandClens or others) have 1.7 oz- 3.4oz package sizes that sell for no more than $2.50-$3.50, and those respective makers have 7oz -8.5 oz packages that retail for under $5.00..

Lets see if we can do the math...a 1 oz bottle that sells for $5.50 vs. an 8.5 oz package that retails for under $5.00....OK..there's a premium that comes with a convenient, travel-size package.

But..The Hy5 1.7 oz, foam format, fragrance free product retails for $2.49. A similar-sized bottle of HandClens retails for just under $3.00.

Soapopular's 3.4 oz alcohol-free, dye-free, fragrance free product is available online for $2.85 ($16.99 for a six-pack) 

So, ounce for ounce, Herbalife is close to 5x more costly than competing products..

While we apologize to Herbalife for our transparency, and for providing our audience with like-product price comparisons, we truly applaud Herbalife for joining the fold, and for helping add to the credibility and raise the overall awareness re: dangers of Purell and similar alcohol products vs. the benefits/features of similar non-alcohol hand sanitizer products.

CDC: Hand Hygiene Reduces Absenteeism by 20%; Health Care Reformist Says US Schools Can Save Hundreds of Millions Per Year

We noticed several different blogs this weekend profiling a not-necessarily-new report that indicates proper hand hygiene practices can reduce absenteeism by as much as 20%. The frequently-cited report focused on school venues, and found

"..nearly 22 million school days are lost each year to the com­mon cold alone. That number goes down with proper hand hygiene — from an estimated 3.02 days missed per child to 2.42 days missed..."

 One need only extrapolate the above to calculate the cost issues associated with the findings. First and foremost, its easy to assume that teachers and school staff members are similarly exposed to the common cold within the school setting, and as a result, are compelled to miss work days. Those missed days require the school to bring in substitute teachers, at a cost that can equate to as much as $100 per day, if not more. 

According to the US Census Bureau (2006 study), of close to 7 million employed within the public and private school sectors, there are approximately 2.6 million school teachers servicing 100,000 elementary and secondary schools. One unrelated, and admittedly antiquated study (from 1982) found the average school teacher calls in sick 4 days per year.

Aside from lost productivity due to absenteeism, using the $100/day cost noted above, one can connect the dots on the back of an envelope and argue that school teacher absenteeism due to illness costs at least $1 billion each year (2.6 million teachers, $100 per day "substitute cost", 4 days per year) and that a 10% reduction in teacher absenteeism (as opposed to the potential 20% reduction suggested by the CDC) could produce $100 million in immediate savings, not to mention the additional tens of millions of annual savings i.e. health care costs associated with the common cold.

Since President Obama is purportedly a proponent of using hand sanitizer--we'd merely suggest that while the federal government is putting a bigger hand on controlling health care costs, and clapping hands for health care reform, that a few minutes of time and resources be dedicated to understanding the distinctions, and more importantly, the cost/benefits of alcohol-based hand sanitizers vs. alcohol-free alternatives.

We've made our own observations over the past few years, some objective, some subjective. But the math keeps adding up to the same results. Many alcohol-free hand sanitizers are not only equally effective and safer to the skin when compared to the legacy, flammable, and potentially toxic alcohol-based products, but the non-alcohol products are arguably 2x-3x more cost effective.

Wow.

citation: ROBERT WILLIAM COFFMAN, "TEACHER ABSENTEEISM: A STUDY OF SELECTED FACTORS IN SCHOOL DISTRICTS OF THE SOUTH PENN SCHOOL STUDY COUNCIL, GROUP D (PENNSYLVANIA)" (January 1, 1983). Dissertations available from ProQuest. Paper AAI8318154.

Tracy, CA School Bans Alcohol Sanitizer After 3rd Grader Lands in Hospital; School Will Now Only Allow "Soapopular Alcohol-Free" Sanitizers

Courtesy of the Tracy Press
March 17, 2010--
A Tracy, California private school has banned alcohol-based hand sanitizer after a third-grader ingested enough of the gel to land her in the hospital last week.

The West Valley Christian Academy student is fine now, but on March 9 suffered an “adverse reaction” after licking the gel off her hands, Principal Teresa Smith said.

The child was taken to the hospital from the school, at 1790 Sequoia Boulevard.

The school until last week had stocked in every classroom jugs of the germ-killing gel, which can contain up to 90 percent alcohol.

Roberto Alaniz, director of Disease Control and Prevention at the San Joaquin County public health department, said he recommends schools require children to wash their hands with soap or use non-alcoholic sanitizer to reduce risks.
 
As noted within this blog, there are several well-recognized 'brands' of non-alcohol sanitizers that are easily procured, thanks to update of this story since provided, the school in question procured and implemented "Soapopular" brand alcohol-free hand sanitizer

Obama's Health Care: Hand Hygiene in Hospitals: 1% rise in compliance = Massive Savings

Insightful study for those looking to raise their hands and lower health care costs!

Hand-Hygiene Compliance, it’s worth a HIT!

A recent in-depth study conducted by Cummings, Anderson and Kaye indicates a 1% rise in hand hygiene compliance (HHC) equals a $39K savings for the hospital. Models were set up to simulate several occurrences of hand-hygiene noncompliance by a single healthcare worker. According to the article, “Hand Hygiene Noncompliance and the Cost of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection”, Hand hygiene noncompliance events are associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings. The study used two different models:

1.       Events of noncompliance with patients of an unknown MRSA status (results: associated with 42 MRSA infections (Cost resulting in nearly $1,000,000 in cost to the hospital)

2.       Events with a known MRSA patient followed by events of an unknown MRSA patient (results: associated with 980 MRSA infections)(Cost resulting in nearly $22,000,000 in cost to the hospital)

The cost savings involved with an HHC solution are immense. With the data collected by Cummings, Anderson and Kaye and an analysis of their findings by a partner of DCC below are the conclusions that have been discovered:

·         1% increase in HHC = $200 savings per bed / year; 100% HHC = nearly $10k savings per bed / year

·         A conservative 25% increase in HHC should equate to $5k per bed / year or $1M total for a 200 bed hospital

·         Assume 500k CCM beds in the US times $10k per bed / year = $5B / year CMS problem.

o     The Hi-Tech act “hopes” that EMRs will save $1.7B per year over 10 years

o     A 25% HHC increase would result in $2.5B savings per year (forever)

o    $2.5B is a 50% GREATER savings than Hi-Tech and saves 50,000 lives per year forever

Study Finds Hand Sanitizer Program Helped Produce 20% Decrease in Hospital-Acquired Infections

A State of Tennessee Department of Health Study, which focused on statistics gathered for the year 2008 and published in January 2010, found a 20% decrease in projected hospital-acquired infections.

"....Dave Roberts, vice president and chief medical officer at Jackson General stated,
"Jackson General takes many steps to help prevent hospital-acquired infections. From the 1,500 hand sanitizer dispensers throughout the hospital to staff checklists, the goal is to get the number of infections down to zero.."