Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial

doi:10.1136/bmj.325.7360.362

BMJ 2002;325:362 ( 17 August )

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Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial

Emmanuelle Girou, hospital epidemiologist, ^a Sabrina Loyeau, infection control technician, ^a Patrick Legrand, microbiologist, ^b Françoise Oppein, infection control nurse, ^a Christian Brun-Buisson, infection control unit director. ^c

^a Infection Control Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France, ^b Microbiology Laboratory, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, ^c Medical Intensive Care Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris

Correspondence to: E Girou emmanuelle.girou{at}hmn.ap-hop-paris.fr

Objective: To compare the efficacy of handrubbing withan alcohol based solution versus conventional handwashing withantiseptic soap in reducing hand contamination during routinepatientcare.
Design: Randomised controlled trial during daily nursingsessions of 2 to 3hours.
Setting: Three intensive care units in a French universityhospital.
Participants: 23 healthcareworkers.
Interventions: Handrubbing with alcohol based solution (n=12)or handwashing with antiseptic soap (n=11) when hand hygiene wasindicated before and after patient care. Imprints taken of fingertipsand palm of dominant hand before and after hand hygiene procedure.Bacterial counts quantifiedblindly.
Main outcome measures: Bacterial reduction of handcontamination.
Results: With handrubbing the median percentage reductionin bacterial contamination was significantly higher than withhandwashing (83% v 58%, P=0.012), with a median difference inthe percentage reduction of 26% (95% confidence interval 8% to44%). The median duration of hand hygiene was 30 seconds in eachgroup.
Conclusions: During routine patient care handrubbing withan alcohol based solution is significantly more efficient in reducinghand contamination than handwashing with antisepticsoap.

What is already known on this topic
To improve compliance with hand hygiene during patient care, handrubbing with an alcohol based solution has been proposed as a substitute for handwashing because of its rapid action and accessibility

Experimental studies show that handrubbing is at least as effective as medicated soap in reducing artificial contamination of hands

Many healthcare workers still have reservations regarding its efficacy and are reluctant to use this technique

What this study adds
When used in routine practice, handrubbing with an alcohol based solution after contact with patients achieved a greater reduction in bacterial contamination of hands than conventional handwashing with medicated soap

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