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Tuesday, March 30, 2010

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. G√ľnter 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). 

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