Hand hygiene.pdf

Handrubs are available as gels, solutions or foams. Dermal tolerance and efficacy are not
affected by consistency 140,479 . Although more expensive than solutions, gels have recently
become the most popular type of alcohol-based handrub preparation in many countries.
Gels have a better consistency than solutions and some may produce a feeling of humectant
“build-up” with repeated use or may feel slippery or oily. This difference in consistency has
not been associated with better objective tolerance or higher compliance with hand cleansing
in a controlled study. First generations of gel formulation have reduced antimicrobial
efficacy compared with solutions 141,153 .
Solutions have a consistency similar to water; a few are more viscous. They often dry
more quickly than gels or foams (a potential advantage) and may be less likely to produce
a feeling of humectant “build-up”. They are more likely to drip from the hands onto to the
floor during use and these drips have created spots on the floor under the dispensers in
some hospitals. Solutions often have a stronger smell of alcohol than gels, but dermal tolerance
is similar for both 478,479 .
Foams are used less frequently and are more expensive. They are less likely to drip from
the hands onto the floor during application, but may produce stronger “build-up” feeling
with repeated use. The manufacturer’s instructions for use for some of the foam products
recommend a fairly large amount of product, and HCWs should be reminded to follow the
manufacturer’s recommendation.
13.2.3 PRACTICAL CONSIDERATIONS
Several studies suggest that the frequency of hand cleansing is determined by the accessibility
of hand hygiene facilities 263,360,476,480-484 . A reliable supplier (industrial or local, at
the health-care facility) is essential to ensure a continuous supply of products. If industrial
products are not available or are too expensive, products may be produced within the local
setting (see also Part I, Section 10). It is, however, difficult to regulate the quality control of
locally made products, and methods to monitor quality are needed.
For handrubbing, dispensers should be available near to the point of care. The time
required for an HCW to leave a patient’s bedside, go to a sink, and wash and dry his/her
hands before attending to the next patient is a deterrent to frequent hand cleansing 461,485 .
In contrast to sinks used for handwashing, dispensers for alcohol-based handrubs do not
require plumbing. They can be available next to each patient’s bed and at many other
points of patient care, such as in the hall between patients’ rooms, at nurses’ stations or
near the medication preparation area. To avoid any confusion between soap and alcohol-based
handrubs, alcohol dispensers should preferably not be placed adjacent to sinks.
Alcohol-based handrub solutions carried in the pocket, together with bedside dispensers,
have been associated with significant improvement in HCWs’ adherence to hand cleansing
protocols 262,263,486 . For handwashing, the soap dispenser should be placed next to the sink.
Soap dispensers may become contaminated 487 , and their design should allow easy decontamination.
In some health-care facilities, only one sink is available in rooms housing several
patients, or sinks are located far away from the entrance to the room or from the patient’s
bedside, and this situation may discourage hand cleansing by HCWs leaving the room 488 . In
ICUs, access to sinks may be blocked by bedside equipment such as ventilators, intravenous
infusion pumps, or other medical devices that take up space.