Alcohol-based hand sanitizers versus traditional soap for nosocomial infection prevention

¶ … hygiene techniques with traditional soaps may or may not be more effective than using alcohol-based solutions concerning reduction in nosocomial infection rates in acute hospitals. With recent usage of alcohol-based solutions, use of traditional antibacterial soaps may be outdated and take longer. Nosocomial infections present as a major issue for acute care hospitals and require research in identifying the most effective way to sterilize hands to avoid increasing infection rates. While traditional handwashing with antibacterial soaps have been done for years, water availability and time taken to perform handwashing may not promote efficiency among hospital staff. Alcohol-based solutions require no water and additional washing or scrubbing. This research paper will focus on recent articles and studies that highlight which method works best.

Integration and Synthesis of the Evidence

Many articles and studies the past and in recent years attest to the effectiveness and efficiency of alcohol-based solutions. One 2012 studied noted the efficacy of all sanitizers used in relation to soap. "All sanitizers sufficiently inactivated the test viruses in the suspension test whereas two soaps were active only against vaccinia virus and BVDV. In the modified fingerpad test a povidone-iodine-containing soap was superior to the sanitizers whereas two soaps showed no activity" (Steinmann et al., 2012, p. 277). The only soap that tested better than the sanitizers was the povidone-iodine-containing soap. The availability of sanitizers is much higher than the povidone-iodine-containing soap. Therefore, regardless of effectiveness of such soap over sanitizers, the ease and convenience, the availability of sanitizers, points to alcohol-based solutions as the potential better choice for hand sanitation and reduction of nosocomial rates.

Another study discussed dry-fast antisepsis, an alcohol-based solution as having a longer lasting effect than traditional handwashing. "The results showed that the use of dry-fast antisepsis has a better persistent effect (P = 0.001), more nurses chose dry-fast antisepsis than surgeons (P = 0.012)... The dry-fast technique has the advantage of being less irritating to the skin and less time consuming" (Chen et al., 2013, p. 179). Additionally, handwashing as noted by the authors, is time-consuming and leads to drier, more irritated skin. The article discusses availability of new alcohol-based solutions that are not as drying to the skin as traditional handwashing and dry faster than older alcohol-based solutions.

An article by Howard, Jowett, Faoagali, & Mckenzie (2014) shares the efficacy of alcohol solution to a conventional scrub and cites the same level of efficacy even after 30 minutes. "Several studies have shown that rubbing hands with an alcohol/chlorhexidine solution provides equivalent microbial decontamination to a conventional surgical scrub using aqueous chlorhexidine. An alcohol/chlorhexidine hand rub was found to be as efficacious as a traditional scrub after 30 min" (Howard, Jowett, Faoagali, & Mckenzie, 2014, p. 78). This means that while one technique (the surgical scrub) takes a long time to perform, the other technique (use of alcohol/chlorhexidine solution) does not and is just as effective. The article further supports the idea that alcohol-based solutions are the way to go to provide the level of hand hygiene needed to promote a decrease in nosocomial infections.

While some articles not the same level of efficacy for traditional handwashing and alcohol-based solutions, one study highlighted the overall superiority of alcohol-based antiseptic solutions. "Alcohol-based antiseptic solutions are superior in terms of reducing the incidence of colonization" (Siddiqui et al., 2016, p. 1). The authors explained the alcohol-based solution was easier and faster to use and promoted reduced bacterial colonization even after a certain amount of time passed (30 minutes to 1 hour). While the study could have included a greater variety of antibacterial soaps, the study further supports the use of alcohol-based solutions over traditional handwashing (with antibacterial soaps).

Alcohol-based solutions offer superior guard against bacteria even when compared to ozone handwashing. "Post-wash bacterial counts were determined from one hand (immediate effect), and from the other hand that had been gloved for 3h (delayed effect). The investigation indicated that ozone is inferior to propan-1-ol 60% hand rub for hand asepsis" (Appelgrein, Hosgood, Dunn, & Schaaf, 2016, p. 340). The level of convenience and ease of use are also factors in being able to maintain a reduced rate of bacterial growth on hands thanks to faster and easier reapplication. Because handwashing takes time and is shown to not be as effective or is as effective, the literature points to the best option being alcohol-based solutions.

The final article notes the use of unfiltered water as a potential factor in less efficacy concerning handwashing. "Bacterial counts were markedly reduced after hand hygiene with ABHR (1.4 log10; P < .0001) and 4% chlorhexidine gluconate with filtered water (0.8 log10; P < .0001). Use of unfiltered water was associated with minimal nonsignificant bacterial reduction" (Salmon, Truong, Nguyen, Pittet, & Mclaws, 2014, p. 178). If filtered water plays a role in how much bacteria remains on the hands post handwashing, this proves that alcohol-based solutions are far superior than traditional handwashing. This article revealed a potential factor in the decreased efficacy of handwashing. Many hospitals do not have filtered water for handwashing. The easiest solution for reduction of nosocomial infections would be to use alcohol-based solutions.

The themes across the articles demonstrate clearly that handwashing is inconvenient, takes too long, and is as or not as effective as alcohol-based solutions. The articles also demonstrate alcohol-based solutions keep working over a marked period. Furthermore, handwashing appears to require certain factors to maintain effectiveness concerning bacterial growth on hands. For example, hands must be washed for a certain time to decrease bacterial presence on skin.

Summary

In conclusion, evidence from recent literature points to the efficacy of alcohol-based solutions over traditional handwashing when using antibacterial soaps for the reduction of nosocomial infections. The reasons why are several. The first is convenience. Alcohol-based solutions are provided through dispensers and located through acute-care hospitals.

The second is alcohol-based solutions are fast. It takes just a few seconds to apply hand sanitizer. However, when washing hands, it may take several minutes. Literature also points to a potential factor that may decrease efficacy of handwashing through using unfiltered water. Why spend several minutes washing hands when the same level of efficacy in hand hygiene can be achieved through using alcohol-based solutions?

The third reason is, alcohol-based solutions are easy. There is no worry for having to look for a sink to wash hands nor is there a need to spend too much time cleaning hands. The ease of use, conveniences, and fast nature of alcohol-based solutions makes it more likely hospital staff will keep their hands clean, therefore keeping nosocomial infections through exposure at a decreased rate. There may be some barriers such as lack of dispensers or available alcohol-based products. There may also be reluctant staff. However, research shows handwashing is not the best way to keep hands clean. Use of alcohol-based solutions is the best way.

Implications for practice/research are to show just how effective alcohol-based solutions are compared to handwashing and the potential damage using antibacterial soap can be on humans. Some studies point to the use of antibacterial soap as potentially hazardous to the health of humans. This would be an interesting area to research to further support the use of alcohol-based solutions for reduction of nosocomial infections. Nosocomial infections are a burden for hospitals and patients and must be reduced.