Handwashing versus hand gel in reducing hospital-acquired infections

¶ … robust and effective ways of reducing infection within a hospital-based setting is to ensure that routine and effective hand-washing practices occur. Medical professionals continue to search for ways to eliminate contamination, particularly in reducing nosocomial infections. This is particularly relevant in the Third World, where in combination with a lack of resources, the problem of infections is often rampant. Numerous compounds have been suggested as alternatives for traditional surgical scrub procedures, including alcohol-based hand rubs. Using two evidence-based research articles, we then ask: Is hand washing more effective than alcohol-based hand gels in reducing hospital acquired infections?

In two separate studies, one conducted in the Division of General Surgery, King Khalid University Hospital in Riyadh, Saudi Arabia; the other in Bind Dan Hospital, Ho Chi Mind City, Vietnam, researchers compared patient infection levels with medical personnel using previous hand washing techniques (in Vietnam), and then in using 3-5-minute scrubs with Betadine or Hibiscrub (Saudi Arabia), finally with an alcohol-based hand-rubs (Vietnam and Saudi Arabia). Proper research control procedures were followed in both cases; with statistics prior to implementing the test in Vietnam as the control in that study (Al-Naami, M., et al., 2009; Nguyen, K., et al., 2008).

The assumptions and methodological considerations between the studies varied slightly. In the Saudi study, the null hypothesis was that there would be no difference between traditional hand-washing methods (Betadine or equivalent), while in the Vietnamese study the hypothesis was that using alcohol-based hand-washing techniques rigorously would have a positive effect on the reduction of infections. In fact, prior to implementation of the new protocol, 13.1% of the patients in Vietnam were diagnosed with infection, while after implementing the new protocol, an average of 2.1%, or a reduction of 84% of the NI rate was shown, irrespective of gender, age, or other demographic factors (Nguyen, 1298). This clearly shows that alcohol-based hand-washing, when used regularly and vigorously (e.g. prior to any healthcare procedure by any level of personnel), infection will be reduced.

The Saudi study was a bit more detailed, with protocols varying depending on severity of procedure (surgery, etc.) and the administering of prophylactic antibiotics as part of the regular treatment procedure. Statistical analysis of the samples showed no significant differences between the Betadine Group and the Alcohol-Based Gel Group. However, the total number of infections within both groups were quite small, 20 out of 600 subjects in the trial. This suggests that the conditions at the Saudi hospital were already more sterile, with less than 5% (3.33%) even developing infections; compared to 13.1% in Vietnam. In both cases, demographic differences between patients were not statistically significant in the protocol.