Hand hygiene.pdf

eluctant to accept scientific recommendations in place of what they believe are superseding
spiritual decrees.
Considering the issues discussed above, possible solutions and areas for further research
may be identified.
At the beginning of a process promoting a new HCAI prevention tool, such as alcoholbased
handrubs, on a large scale, WHO intends to denominate these products prudently
as antiseptic or disinfectant handrubs, avoiding the use of the term alcohol, especially in
settings where the observance of related religious norms is very strict.
While preparing guidelines, international and local religious authorities should be consulted
and their advice clearly reported. For instance, it would be worthwhile referring to the
recent statement of the Muslim Scholar Board of the World Muslim League, which declared:
“It is allowed to use medicines that contain alcohol in any percentage that may be necessary
for manufacturing, if it cannot be substituted. Alcohol may be used as an external wound
cleanser, to kill germs and in external creams and ointments”.
Within hand hygiene promotion campaigns in health-care settings where Muslims or other
religious affiliations refusing the use of alcohol are strongly represented, education strategies
should include focus groups on this topic to facilitate HCWs to raise their concerns openly
regarding the use of alcohol-based handrubs, to understand the scientific evidence underlying
this recommendation and to identify possible solutions to overcome the related religious
and cultural obstacles. The results of this discussion may subsequently be summarized as
“issues and solutions” in information leaflets to be produced and distributed locally.
Alcohol skin absorption and its smell are additional perceptive barriers to the use of alcohol-based
handrubs. Serious concerns have been expressed about the potential systemic
diffusion of alcohol or its metabolites following dermal absorption or airborne inhalation
related to the use of alcohol-based handrub formulations. Currently available scientific data
are unfortunately limited, even though some published 355 and unpublished but reliable (A.
Kramer, personal communication, 2005) investigations clearly demonstrate that the quantity
of alcohol absorbed in these situations is minimal and well below toxic levels for human
beings. More consistent information is required on this topic and further research should be
undertaken to eliminate the alcohol smell from handrub preparations. Both WHO solutions
may provide much needed reassurance to HCWs who may be reluctant to ‘trade’ scientific
recommendations for their beliefs in overriding spiritual decrees.
Finally, the opportunity to involve patients in a multimodal strategy to promote hand
hygiene in health care should be carefully evaluated. Despite its potential value, this intervention
may be premature in settings where religious norms are taken literally; rather, it
could be a subsequent step, following the achievement of awareness and compliance
among HCWs.