March 6, 2000 (Atlanta) -- A faster, milder way for doctors and nurses to disinfect their hands promises to make hospitals healthier places. But data presented Monday at a CDC conference on health care-associated infections show that doctors still lag behind all other health care workers in doing the single most important thing to prevent hospital infections: washing their hands.
Current hospital guidelines call for scrubbing each surface of the hands for at least 10 seconds with soap, alcohol-based rinses, or gels to be used only for additional protection when there is no water nearby. Experts speaking at Monday's conference argued that these guidelines should be changed to permit the use of alcohol gels, which take only a few seconds to apply.
"Even in the presence of blood, alcohol works great," presenter Elaine Larson, RN, PhD, tells WebMD. "The only problem is aesthetic -- it leaves a residue on the hands. You also need to have soap available [to remove the residue]."
"I'm thinking that the best thing to do is have both products around the intensive care unit," says John M. Boyce, MD. The Hospital of Saint Raphael, New Haven, Conn., researcher conducted a study showing that each shift of workers at his institution would spend 16 hours at the sink if they completely followed handwashing guidelines, while they would spend only four hours if they used alcohol gels. Nurses originally thought that the alcohol would dry out their hands, but the study showed that there was significantly less dryness with the gels than with soap and water. "After the study, most of them -- about 90% -- agreed they would use the gel routinely," he says. "They continued to ask for the gel after the study was over."
Larson, a researcher at Columbia University School of Nursing in New York and editor in chief of the Journal of Infection Control, knew nurses' hands got sore from frequent handwashing. When she and coworkers studied the problem, however, they were surprised at the extent of the problem: one out of four nurses has skin damage.
When it comes to use of hand lotions to counteract such damage, Larson quips, "Just because it feels good doesn't mean it's bad." She notes that use of hand lotions decreased bacterial shedding. She warned, however, that some lotions counteract the main ingredient of antimicrobial soaps and thus should not be used in the hospital.
In another conference presentation, Didier Pittet, MD, was even more emphatic than Larson and Boyce about the need to switch to alcohol gels. "We have to change the system," he says. "We have to change the way handwashing is done. There is no bacterial resistance to alcohol, and it is much quicker to use."
In earlier studies, Pittet, the director of infection control at University of Geneva hospitals, showed that health care workers washed their hands only half as often as they should. Nurses had a slightly better average --they washed a little more than half the time -- but they were far better than doctors, who washed less than a third of the time.
A new study explored the effect of making alcohol gel easily available in a hospital, attempting to encourage handwashing, particularly for doctors. The results were partially encouraging -- overall, hospital workers complied with the new guidelines more than 70% of the time. "Most of the impact was explained by the use of [alcohol] hand disinfectant," Pittet says. "Yet we did not improve doctors. They did change their behavior -- they used the hand disinfectant. But they still missed most opportunities to use it."
These changes had a major impact on patients: Hospital-acquired infections dropped by half during the study period. "Of course it cost more money, but I assure you there were cost savings," Pittet says.
Boyce notes that the cost of alcohol gels ranges from twice that of non-medicated liquid soap to about the same price. But he agrees with Pittet that the money spent is money saved. "The entire annual budget for hand products would be equal to the cost to hospitals of just one bad blood-borne infection," Boyce says. "One message we need to get to hospital administrators is that the cost of hand care is tiny compared to the cost of [hospital] infections. If they don't get this they are missing the boat."
- Researchers are calling for changes in handwashing standards among hospital staff.
- Recent studies show handwashing with alcohol gels is effective, is more time efficient than soap and water, and does not lead to discomfort such as dryness.
- The largest concern, however, is getting hospital staff to wash their hands in the first place, as doctors, nurses, and others do it only a fraction of the times they should, experts say.