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Authors of a research letter in this week's issue of THE LANCET suggest that recently introduced disinfectant gels for hand hygiene are significantly less effective than rinses and could contribute to an increase in hospital-based infection.
Hand hygiene among health-care workers is a major priority to prevent the spread of infection in hospitals. Soap and water (used in the USA) and alcohol-based hand rub (commonly used in Europe) are the main methods for hand hygiene; hand rub is thought to be more effective as it causes less skin irritation, is quicker to administer, and can be used at the bedside. Gel formulations of alcohol-based hand rub have recently been introduced to counteract the drying effect of alcohol rinses in order to increase hand-hygiene compliance.
Didier Pittet from the University of Geneva, Switzerland, and colleagues from Germany investigated the antimicrobial efficacy of ten alcohol-based gels and four alcohol-based hand rinses in comparison to a reference disinfectant (2-propanol 60%); the reference disinfectant meets European requirements for antiseptic efficacy (known as EN 1500 requirements. None of the gel formulations, most of which were ethanol-based, were as effective as the reference disinfectant within 30 seconds of application; all of the hand rinses showed no significant difference in efficacy from the reference disinfectant.
Didier Pittet comments: "In hospitals where most health-care workers use alcohol-based solutions that already meet the EN 1500 requirements, the introduction of any of the tested gels would be a backward step and unnecessarily lower the hygiene standard. An increased risk of cross-transmission would certainly result because the application time in daily practice averages 8-15 seconds and is unlikely to exceed 30 seconds."
Contact: Professor Didier Pittet, Infection Control Programme, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland.
