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 Contd
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 23 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 crosstransmission.

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 participants 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 AlcoholBased 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 Contd
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/full-text/PDF/s019665
530500430x.pdf?issn=0196-6553&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