Group Members
Santana Suckra
Sashonie Taylor
Natasha-Lee Roache
Tressan Ritchie
Tameka Stewart
Althea Walker
Clinical question:
Is antiseptic hand washing as effective as alcohol
sanitizer in reducing the rates of hospital acquired
infections?
 Patient:
– Hospitalized patients
 Intervention:
– Hand washing
 Comparison:
– Alcohol sanitizer
 Outcome:
– Reducing the rates of hospital acquired infections.
Introduction
In a health-care setting certain procedures and
guidelines are essential and the implementation
of hand hygiene is one such requirement. Hand
hygiene involves general hand washing with the
use of soap and water and the use of antiseptic
agents such as antiseptic hand rubs or antiseptic
hand wash (Rosenthal, Guzman & Safdar,
2005).
Introduction Cont’d
According to the World Health Organization
(WHO) a hospital acquired infection is “An
infection acquired in hospital by a patient who was
admitted for a reason other than that infection.” or
“An infection occurring in a patient in a hospital or
other health care facility in whom the infection was
not present or incubating at the time of admission.
This includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility.”
Antiseptic hand washing versus the
alcohol hand sanitizer/rubs
It has been noted by that both antiseptic hand
washing and alcohol sanitizers contribute to a
reduction of nosocomial infections during
hospitalization. However, some studies
concluded that alcohol hand rubs are more
effective in reducing bacterial contamination
during patient care routine compared to
antiseptic hand washing (Girou et al., 2003).
Antiseptic hand washing versus the
alcohol hand sanitizer/rubs
Another study suggest that antiseptic hand
washing is more effective at removing the
Clostridium Difficile bacteria that result is a
nosocomial infection (Jabbar et al., 2010). There
are also studies saying that there is no difference
between the effectiveness of the antiseptic hand
washing versus the alcohol hand rubs (Larson et
al., 2005).
Study 1:
In a randomized qualitative study conducted by Girou
et al. in 2003, twenty-three (23) patients, permanent
and temporary nurses and nursing assistants
volunteered to participate. Twelve (12) health care
workers were allocated to hand rubbing with a
waterless alcohol based solution and eleven (11) were
allocated to hand washing with antiseptic soap. Patient
care activities were monitored during daily sessions of
2–3 hours until a predetermined number of eligible
activities had been performed. The conclusion was
that hand rubbing with an alcohol based solution
reduced bacterial contamination of healthcare
workers’ hands more than hand washing with
antiseptic soap during routine patient care activities.
Study 2:
Larson et al. (2005) conducted study using a crossover
design in two (2) neonatal intensive care units inclusive
2932 neonatal hospital admissions and 119 nurse
participants. Larson et al. compared the effects of two (2)
hand hygiene regimens in infection rates between the
traditional antiseptic hand wash and an alcohol hand
sanitizer. Each product was used for 11 consecutive months
in each neonatal intensive care unit in random order. The
study concluded that there was no difference seen on the
nurses’ hands during the hand washing and alcohol phase.
However, assessment of infection rates in a single
intervention was limited because of multiple contributory
factors such as patient risk, unit design, and staff behavior.
Other practices such as frequency and quality of hand
hygiene are likely to be as important as product in reducing
risk of cross-transmission.
Study 3:
This study was a comparison of alcohol based hand rubs
(ABHRs) as an effective means of decreasing the
transmission of bacterial pathogens. Even though alcohol is
not effective against the bacteria known as Clostridium
Difficile (C. Difficile) spores. The study was conducted by
Jabbar et al. in 2010 with ten (10) persons volunteering for
C. Difficile to be spread on their bare palms. The use of
three (3) ABRRs and hand washing with chlorhexidine
(antiseptic) soap were compared with plain water rubbing
alone for removal of C. Difficile. The result of the study
stated that there were no statistically significant differences
in the reductions achieved by the ABHRs. Therefore it was
concluded that hand washing with soap and water is
significantly more effective at removing C. Difficile spores
than ABHRs and after the use of ABHRs with a single
handshake the residual spores are readily transferred.
Appraisal
STUDY 1
This study was conducted with 23 participants in
three intensive care units in a University Hospital in
France. 12 participants were assigned to use a hand
rubbing agent with a waterless alcohol based
solution and 11 were assigned to hand washing with
antiseptic soap. The participants had already been
instructed on the use of alcohol based solution as
there was a policy that had been implemented 1 year
previously in the hospital. Each ICU had copies of
the policies.
The study zeroed in on the effectiveness of
antiseptic hand washing over hand rubbing with a
sanitizer. This article was helpful in formulating a
generalized conclusion.
The results of the study were formulated by testing
the participants hand after hand hygiene with any
products was done. Researchers did this by taking
an imprint of the fingertips and palm of participant’s
dominant hand 1 minute before and after the
procedure, to count the amount of bacteria present.
Limitations
Some participants were reported to have washed
hands under the recommended 30 second time limit,
which would have been inadequate time for
decontamination to be at an optimal level. Also,
there was no suggestion in the article how they
differentiated normal flora from infection-causing
bacteria.
STUDY 2
This study was centred in two (2) Neonatal
Intensive care units in Manhattan New York which
included 119 nurse participants. The participants
were oriented to the study products and procedures.
Also a comparison was done on two hand hygiene
products; they were antiseptic hand wash and an
alcohol hand sanitizer.
Both agents were used for 11 consecutive months,
where both were alternated following random order.
A six-point scale was used to examine the hand at
magnification x 3.
A special technique known as the glove-juice
technique used for sampling was done to
differentiate between normal flora and microbes.
The outcome variable in the model was the presence
or absence of any infection in each neonate.
The sample size was adequate for the type of
research being conducted as there is a greater
sample size fit for comparison.
Limitations
In the study, there was no indication that hand
washing procedures were performed within the 30
second time interval.
Infections that were not yet diagnosed (i.e.
infections arising after study was conducted) may
have gone undetected.
MEDIA
References
Girou ??? . (2003). Efficacy of handrubbing with alcohol based solution versus
standard handwashing with antiseptic soap: randomised clinical trial. ???
Retrieved from:
http://ebn.bmj.com/content/6/2/54.full.html
Jabbar, U., Leischner, J., Kasper, D., Gerber, R., Sambol, S. P., Parada, J. P., ... &
Gerding, D. N. (2010). Effectiveness of Alcohol‐Based Hand Rubs for Removal of
Clostridium difficile Spores from Hands. infection control and hospital
epidemiology, 31(6), 565-570. Retrieved from:
http://www.jstor.org/stable/10.1086/652772
Larson, E. L., Cimiotti, J., Haas, J., Parides, M., Nesin, M., Della-Latta, P., & Saiman,
L. (2005). Effect of antiseptic handwashing vs alcohol sanitizer on health careassociated infections in neonatal intensive care units. Archives of pediatrics &
adolescent medicine, 159(4), 377. Retrieved from:
http://archpedi.jamanetwork.com/article.aspx?articleid=485991
Moralejo, D., & Jull, A. (2003). Handrubbing with an alcohol based solution reduced
healthcare workers’ hand contamination more than handwashing with antiseptic
soap. Evidence Based Nursing, 6(2), 54-54. Retrieved from:
http://ebn.bmj.com/content/6/2/54.short
References Cont’d
Rocha, L. A., Nunes, M. J., & Gontijo Filho, P. P. (2012). Low Compliance to
Handwashing Program and High Nosocomial Infection in a Brazilian
Hospital.Interdisciplinary Perspectives on Infectious Diseases, 2012. Retrieved
from:
http://www.hindawi.com/journals/ipid/2012/579681/abs/
Rosenthal, V. D., Guzman, S., & Safdar, N. (2005). Reduction in nosocomial infection
with improved hand hygiene in intensive care units of a tertiary care hospital in
Argentina. American journal of infection control, 33(7), 392-397. Retrieved from:
http://www.nursingconsult.com/nursing/journals/0196-6553/fulltext/PDF/s019665530500430x.pdf?issn=01966553&full_text=pdf&pdfName=s019665530500430x.pdf&spid=15731325&article
_id=492627
World Health Organization. (2002). Prevention of hospital-acquired infections: A
Practical Guide 2nd edition. Retrieved from:
http://www.who.int/emc