Wednesday, December 5, 2007

Controversy of Hand Washing vrs Alcohol Based Hand Rubs

I thought they were really singing me Happy Birthday.....
The Controversy of Hand Washing vrs Alcohol Based Hand Rubs
How did the hospital staff know that is was almost my birthday? Of course it was on my chart, but I thought they would be more interested in my medical history more than my personal history.
I heard that familiar song being sung over and over with each nurse that came into my room. It wasn't until I said thank you for the 20th time before the nurse told me it was because they use that old familiar tune for the timing of hand washing.
This made me think about my Mother asking me over and over again...”Did you wash your hands?” Who would have known that this training would help me in my future nursing career? There are many agencies with guidelines, the CDC may be the best known, on just how to wash you hands and why. My question was, “Is alcohol based hand rubs better or more efficient than soap and water?” We all know that washing has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms (ie...MRSA: methicillin resistant staphylococcus aureus) and reduce overall infection rates. Alcohol-based hand rubs take less time to use than traditional hand washing, but is one better than the other? Research (2*) shows that in an eight hour shift, an estimated one hour of time will be saved by using an alcohol-based hand rub.
Are hand rubs more effective than washing your hands with running water and soap? According to the Middlesex-London Health Care Unit (2*), the answer is “no”. Traditional hand washing with water and soap is just as effective if done properly.
While hot water may more effectively clean your hands, this is primarily due to its increased capability as a solvent, and not due to hot water actually killing germs. Hot water is more effective at removing dirt, oils and/or chemicals, but contrary to popular belief, it does not kill microorganisms. A temperature that is comfortable for hand washing is about 113 degrees F and it would take more than double that temperature, about 212 degree F, to effectively kill germs. The addition of antiseptic chemical to soap does have a killing action to a hand washing agent. (4*)
The proper washing of hands with water in a medical setting generally consists of use with generous amounts of the antiseptic soap, rubbing each part of ones hands systematically for 15-20 seconds...(3*)which happens to be that old familiar song talked about earlier. Hands should be rubbed together with digits interlocking. If there is debris under fingernails, a bristle brush is used. Finally, rinse well and wipe dry with a paper towel. Lastly turn off water with a dry paper towel. (2*)
Non water based hand hygiene agents, also known as alcohol based hand rubs, antiseptic hand rubs, or hand sanitizers, are based on isopropyl alcohol or ethanol formulated together with a humectant such as glycerin into a gel, liquid, or foam for ease of use and to decrease the drying effect of the alcohol. Their increasing use is based on their ease of use, rapid killing activity against microorganisms, and lower tendency to induce irritant contact dermatitis as compared to soap and water hand washing. Despite their effectiveness, the non water agents do not clean hands of organic material, they simply disinfect them. However, disinfection does prevent transmission of infectious microorganisms.(4*)
Hand sanitizers containing a minumum of 60-95% alcohol are very efficient germ killers. It kills bacteria, multi-drug resisitant bacteria (MRSA & VRE), tuberculosis, and viruses (including HIV<>
Allergic contact dermatitis due to alcohol hand rubs is very uncommon. However, with increasing use, it is reasonable to expect have occasional true allergic reactions to such products. (2*)
In conclusion, Alcohol rubs and combination hand sanitizers are effective at killing germs on your hands, but not effective at removing dirt. Conversely, soap and water are very effective at cleaning dirty or soiled hands, but are not good at killing germs (as discussed above).
References:
1* “Why Do I Really Need to Wash My Hands?”; Mary L. Gavin, MD from Children's Hospital, 13123 E. 16th Ave; Aurora, CO http://www.thechildrenshospital.org/wellness/info/kids/10624.aspx
2* “Hand Hygiene Fact Sheet”; United States Department of Health and Human Services: Center for Disease Control and Prevention Hospital URL:http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
3* “Alcohol Based Hand Rubs; Questions and Answers”; Local Public Health Program at the Middlesex-London Health Unit, 2007 http://healthunit.com/article.aspx?ID=12684
4* “Hand Washing” from Wikipedia.org; http://en.wikipedia.org/wiki/Hand_washing
A. Interventions #1 Truth about actually killing HIV virus with alcohol based hand rub
Disadvantage #1: There is not enough evidence in the articles researched to confirm this claim of alcohol being absolutely responsible to kill the AIDS virus through proper hand sanitizing techniques. The reference sited as its source: Hand Hygiene for Healthcare Workers. LearnWell Resources, Inc, a California nonprofit public benefit 501(c)(3) corporation. Retrieved on 2007-04-27,
Disadvantage #2 Even though microorganisms are killed on your hands after washing or alcohol base hand rub, there are still other areas in the room that can be picked up after gloving and transferred to patients wound sites or to their body. ( 1*)
B. Intervention #2 Hand washing must be done every time a nurse, Dr., other personnel staff or visitors enter the room.
Disadvantage #1: Due to the hurry staff or visitors are in, the assurance that hand washing or alcohol based hand rub is used every time is questionable and therefore puts the patient in greater risk for infections or contamination. (CDC.gov on their Fact Sheet on Hand Washing)
Disadvantage #2: Constant hand washing or use of alcohol based hand rub dries skin and may cause allergic reactions to occur on personnel while caring for patients. (Wikipedia web site under “Hand Washing”)

1 comment:

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