Alcohol gels: the end of an era?

Dr Andrew Kemp PhD (Bio), Dr Vanessa Hodgkinson MBBS, BSc, FRCA,FFPMRCA and Miss A Bugg MSc (Microbiology) take a retrospective and prospective view of the use of alcohol gels as hand sanitisers in healthcare.

In many national healthcare systems around the world there is significant pressure placed on clinical staff through the publication of guidance documents. Probably the best known guidance document for hand hygiene is the WHO guide.[14] This document forms the basis of most local guidance documents.

Most published guidance documents include recommendations for the use of alcohol hand gels, and in some cases (including in the USA), instead of washing hands.[1,2] The most recent test results using the Bacteria Specific Rapid Metabolic Assay (BSRMA) to detect bacterial counts on hands,[3,4] suggest new guidance is needed.

In order to discover the most effective method of hand decontamination, in both the short term and long terms, the hands of administrative staff were tested for bacterial bio burden following the use of antimicrobial soap, alcohol gel, alcohol liquid hand rub and a 5th generation Silane Quaternary Ammonium Compound (SiQAC). In a further series of tests, a combination of hand wash,followed by a single application of the 5th Generation SiQAC, and then either an alcohol gel, or alcohol liquid hand rub were used.

The data shows that the most successful results from products used in isolation were achieved using the 5th generation SiQAC. However, in order to meet the WHO requirements for 5 moments in hand hygiene,[14] the best combination was found to be hand wash, followed by application of a single daily dose of the 5th generation SiQAC, followed by regular use of liquid alcohol hand rub.

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