Alcohol-Based Solution vs Standard Handwashing - Essay Example

Running Head: ALCOHOL BASED SOLUTION VS STANDARD HANDWASHING Effectiveness of Hand-rubbing with Alcohol-Based Solution Versus Standard Handwashingwith Antiseptic Soap Vivek Lahoti Academia Research 09 April 2009 Abstract The objective of this research is to compare between the effectiveness of hand-rubbing using an alcohol-based solution and hand-washing with an antiseptic soap. For this, we take reference from three different researches done already and analyze their data. The individual researches are described as below: 1. From the research conducted by Parienti, et al. at six surgical services from teaching and non-teaching hospitals in France, the two methods of achieving hand-hygiene were compared in regard to surgical site infection risk factors. It concluded that hand-rubbing with liquid aqueous alcoholic solution could be safely used as an alternative to traditional hand-scrubbing in surgical practices. 2. The research done by Girou, et al. at 3 intensive care units in a university hospital in France, 12 healthcare workers were allocated to hand-rubbing with a waterless alcohol based solution and 11 were allocated to hand-washing with antiseptic soap. It concluded that the median percentage reduction in bacterial contamination with hand-rubbing was significantly higher than with hand-washing. 3. Research conducted by Karabay, et al. 35 nurses were randomly selected from a nursing staff of 141 and divided into 2 groups: hand rubbing and hand washing. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap. Compliance was also better in the hand rubbing group than in the hand washing group. Effectiveness of Hand-rubbing with Alcohol-Based Solution Versus Standard Handwashing with Antiseptic Soap Purpose of Research: To prove that alcohol-based solution leads to improved compliance with hand hygiene and better skin condition than liquid soap solution. Step 1: Identifying the Hypotheses While framing our hypothesis we should consider the objective of our research. The purpose of this research is to compare hand-hygiene and skin condition after hand-rubbing with an alcohol based solution or washing our hands with an antiseptic soap. So, the primary object of our comparison would be 'hand-hygiene'. To measure hand-hygiene, we make a natural assumption that "Hands with lesser bacterial contamination are more hygienic". Therefore we frame the following hypothesis as our 'Null Hypothesis'. H0: The median percentage reduction in bacterial contamination using Alcohol Based Solution (ABS) is greater than that with hand-washing with liquid soap solution (LSS). i.e. H0: MeABS > MeLSS Our 'Null Hypothesis', in simpler words states that by using Alcohol Based Solutions we kill more bacteria on our hands and achieve disinfection better than liquid soap solutions. Our 'Null Hypothesis' thus assumes the objective of our research to be true. So, in a similar manner we can also state our 'Alternative Hypothesis' as: Ha: The median percentage reduction in bacterial contamination using Alcohol Based Solution is less than or equal to that with hand-washing. i.e. Ha: MeABS MeLSS Step 2: To Formulate an Analysis Plan For our analysis, we would be using the data obtained from three separate research projects carried out on similar topic. 1. Research conducted by Parienti, et al. at six surgical services from teaching and non-teaching hospitals in France, conducted between January 1, 2000 and May 1, 2001. In their research, "surgical services used two hand cleaning methods alternatively every month: a hand-rubbing protocol with 75% aqueous alcoholic solution and a hand-scrubbing protocol with antiseptic preparation." (Parienti et al, 2002) Thirty-day surgical site infection rates were the primary factor being monitored. 2. In the research done by Girou, et al. at 3 intensive care units in a university hospital in France in 2002, 23 nurses and nursing assistants had volunteered to participate. "12 healthcare workers were allocated to hand-rubbing with a waterless alcohol based solution and 11 were allocated to hand-washing with antiseptic soap." (Girou et al, 2003, BMJ) Patient care activities were monitored during daily sessions of 2-3 hours until a predetermined number of eligible activities (i.e. direct contact with a patient's skin before invasive care, after interruption of care, and after contact with any part of a patient that was colonized with multi-resistant bacteria) had been performed. Participants in the hand-rubbing group were excluded if their hands became visibly soiled; they then had to wash their hands with standard antiseptic soap, and the session was stopped. 3. In the research conducted by Karabay, et al. through Baysal University, Bolu, Turkey, done from February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into 2 groups: hand rubbing and hand washing. "They were observed on days 1, 7 and 14 of the study to check their compliance and efficiency of the hand-hygiene program." (Karabay et al, 2005) Step 3: Analyze Sample Data 1. In the research conducted by Parienti, et al. the 2 protocols were compared in regard to surgical site infection risk factors. "Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%)." (Parienti et al, 2002) Also, the recommended duration of use was better complied in the hand-rubbing protocol as compared with the hand-scrubbing protocol (44% vs 28%, respectively; P =.008). 2. In the research done by Girou, et al, "the median percentage reduction in bacterial contamination with hand-rubbing, was significantly higher than with hand-washing (83% v 58%, P=0.012)". (Girou et al, 2003, EBN) 3. During the research conducted by Karabay, et al, a total of 368 routine patient care activities were observed. "Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap (54% and 27%, respectively; p < 0.01). Compliance was also better in the hand rubbing group than in the hand washing group (72.5 and 15.4%, respectively; p < 0.001)." (Karabay et al, 2005) Step 4: Interpret the Result. 1. In the research conducted by Parienti, et al, it can be concluded that hand-rubbing with liquid aqueous alcoholic solution could be safely used as an alternative to traditional hand-scrubbing. 2. From the research done by Girou, et al, we can conclude that during routine patient care hand-rubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than hand-washing with antiseptic soap. 3. Research conducted by Karabay, et al indicated that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Comments: Hand hygiene is the simplest, most effective measure for preventing nosocomial infections. Many studies have documented that compliance of healthcare workers with recommended practices is quite low. Promotion of hand hygiene is a major challenge for infection control experts. Some barriers for the lack of adherence with hand hygiene guidelines have been identified. Some of the most frequently reported reasons associated with poor compliance are inconveniently located or insufficient numbers of sinks, low risk for acquiring infection from patients, belief that glove use obviates need for hand hygiene and ignorance of or disagreement with guidelines and protocols. Skin irritation by hand hygiene agents is also an important barrier. The superficial skin layers contain water to keep the skin soft and pliable. Hand cleansing can increase skin pH, and increase trans-epidermal water loss, and even increase microbial shedding. Since most soaps are not pH balanced, they can be damaging when applied to skin on a regular basis. Alcohol based formulations for hand disinfection are less irritating than antiseptic or non-antiseptic detergents. Alcohols with added emollients are better tolerated and efficacious as compared to detergents. Emollients are recommended and may protect against cross-infection. Hand lotions help protect skin and may reduce microbial shedding. References Parienti, JJ., Thibon, P., Heller, R., Le Roux, Y., von Theobald, P., Bensadoun, H., et al. (2002) Hand-rubbing with an aqueous alcoholic solution vs. traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. Departments of Infectious Diseases and Intensive Care Unit, Cte de Nacre University Hospital, France. Retrieved April 08, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/12169076 Girou, E., Loyeau, S., Legrand, P., Oppein, F., Brun-Buisson, C. (2003) (BMJ) Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ Publishing Group. Retrieved April 08, 2009 from http://ebn.bmj.com/cgi/content/full/6/2/54 Girou, E., Loyeau, S., Legrand, P., Oppein, F., Brun-Buisson, C. (2003) (EBN) Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. EvidenceBased.Net Retrieved April 08, 2009 from http://icu-10.med.usyd.edu.au/ebdm/journal/therapy35.shtml Karabay, O., Sencan, I., Sahin, I., Alpteker, H., Ozcan, A., Oksuz, S. (2005) Compliance and Efficacy of Hand Rubbing during In-Hospital Practice. International Journal of the Kuwait University Health Sciences Centre. Retrieved April 08, 2009 from http://content.karger.com/produktedb/produkte.asptyp=fulltext&file=MPP2005014005313 Read More