Hand hygiene.pdf

isopropyl alcohol) were applied to HCWs’ hands every 10 minutes over a 4-hour period. A
blood sample was taken 5 minutes after the final application of handrub and blood isopropyl
alcohol levels were measured. In 9 out of 10 participants, a rise in the blood isopropyl
alcohol level was noted at very low levels (the highest observed level was 0.18 mg/dl),
much less than the levels achieved with mild intoxication (50 mg/dl). In addition, reliable
investigations demonstrate that the amount of alcohol absorbed is negligible on the toxic
level for human beings (A. Kramer, personal communication 2005). Studies to measure both
alcohol and acetone levels in subjects chronically exposed to topical alcohols are required
to investigate further this issue.
10. A WHO ALCOHOL-BASED FORMULATION
10.1 GENERAL REMARKS
The design of a product to be used worldwide has to take logistic, economic and cultural
(including religious) factors into consideration (see also Part I, Section 14).
At present, alcohol-based handrubs are the only products to reduce or inhibit the growth
of microorganisms with maximum efficacy 156,256,262,350,359-361 .
WHO recommends an alcohol-based formulation for the following reasons:
• to benefit from its evidence-based intrinsic advantages: fast acting and broad-spectrum
activity, excellent microbicidal characteristics, lack of potential emergence
of resistance;
• to overcome the lack of accessibility to sinks or other facilities (including clean
running water or towels in some poor and remote areas) to perform hand cleansing
actions that require the use of water (handwashing and hand antisepsis using
a formulation different from a waterless agent);
• to improve compliance with hand hygiene by reducing the time required to perform
it and the convenience of the method;
• to reduce costs: the annual cost of hand hygiene promotion including recourse
to an alcohol-based handrub may not exceed 1% of HCAI costs (see also Part III,
Section 3) 362-364 .
To achieve a maximum effect and optimal compliance of HCWs with hand hygiene,
products should be easily available, either through dispensers placed close to the point of
care or in small individual bottles for pocket carriage 263,359 .
Health-care settings currently using commercially-available handrubs, liquid soaps and
skin care products sold in disposable containers should continue this practice, provided that
the handrubs meet recognised standards for microbiological efficacy (ASTM or EN standards)
and are well accepted by the HCWs. In health-care settings where these products are
not available or too costly, production of the WHO handrub according to the formulation/s
and methodology suggested below is an alternative.