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Alcohol Sanitizer.


Gold NA1, Avva U2.


StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020-.
2020 Feb 6.

Author information

Hackensack University Medical Center
Joseph M. Sanzari Children's Hospital


Compliance with hand hygiene recommendations is critical to reducing colonization and infection of the hands of all people, and specifically the hands of health-care workers (HCW). This will decrease the transmission of microorganisms to patients, ultimately reducing morbidity, mortality, and costs associated with healthcare-associated infections (HCAI). The global burden of HCAI is enormous. Data suggests that more than 1.4 million patients in developed and developing countries worldwide are affected at any time. There is ample evidence that hand antisepsis reduces the transmission of healthcare-associated pathogens and the incidence of HCAI. Even after so much emphasis on the importance of hand hygiene, recent studies show poor hand hygiene compliance in the medical setting. In a 2017 study of healthcare professionals in an emergency department, the compliance rate was only 54%. In a survey of EMS providers regarding hand hygiene practices, compliance was even lower. According to the Center for Disease Control (CDC) hand hygiene encompasses the cleansing of your hands by using hand washing with soap and water, antiseptic hand washes, antiseptic hand rubs such as alcohol-based hand sanitizers (ABHS), foams or gels, or surgical hand antisepsis. For many reasons, alcohol hand sanitizers are increasingly being used as disinfectants over hand washing with soap and water.  Their ease of availability, no need for water or plumbing, and their proven effectiveness in reducing microbial load are just a few. In one study, a hospital-wide, hand hygiene campaign with special emphasis on a bedside, alcohol-based hand disinfection resulted sustained improvement in hand-hygiene compliance, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of the bedside, antiseptic, hand rubs largely contributed to the increase in compliance. Many other studies have demonstrated that having bedside alcohol-based solutions available increased compliance with hand hygiene among HCWs. However, it is important to keep in mind that alcohol hand sanitizer efficacy is dependent upon which and how much product is used, proper technique, and consistency of use. There are also situations where these products are not ideal, for example, in preventing the spread of certain infections or when the hands are significantly soiled and the bacterial load is too high.[1][2][3] Non-Alcohol-Based Hand Sanitizers Benzalkonium Chloride, a quaternary ammonium, is the active ingredient contained in most alcohol-free hand sanitizer products available today. It is non-flammable, and the low concentrations of Benzalkonium make it relatively non-toxic. Typically, these solutions, often water-based foams, are much easier on the hands and continue to provide protection well after the solution has dried. They pose much less of a threat in cases of accidental ingestion or as a potential fire hazard and are non-damaging to surfaces. However, alcohol-free products have yet to gain a foothold in the health market. Alcohol-based gels are favored by most health organizations and are therefore perceived as being more credible. Definition Alcohol-based (hand) rub According to the World Health Organization (WHO), "an alcohol-containing preparation (liquid, gel or foam) designed for application to the hands to inactivate microorganisms and/or temporarily suppress their growth. Such preparations may contain one or more types of alcohol, other active ingredients with excipients, and humectants." Ingredients Most alcohol-based hand antiseptics contain isopropanol, ethanol, n-propanol, or a combination of 2 of these products. The antimicrobial activity of alcohols can be attributed to their ability to denature and coagulate proteins. The microorganism’s cells are then lysed, and their cellular metabolism is disrupted. Alcohol solutions containing 60% to 95% alcohol are most effective. Notably, higher concentrations are less potent because proteins are not denatured easily in the absence of water. Alcohol concentrations in antiseptic hand rubs are often expressed as percent by volume, but sometimes as percent by weight. Alcohols such as ethanol are well-known antimicrobial agents and were first recommended for the treatment of hands in 1888. The highest antimicrobial efficacy can be achieved with ethanol (60% to 85%), isopropanol (60% to 80%), and n-propanol (60% to 80%). The activity is broad and immediate. Ethanol, the most common alcohol ingredient, appears to be the most effective against viruses; whereas, the propanols have a better bactericidal activity than ethanol. None of the alcohols has shown a potential for acquired bacterial resistance. The combination of alcohols may have a synergistic effect. The concentration of alcohol does change the efficacy with one study showing a hand rub with 85% ethanol being significantly better at reducing bacterial populations compared to concentrations of 60% to 62%. ABHS also often contain humectants, like glycerin, which help prevent skin dryness, and emollients or moisturizers, like aloe vera, which help replace some of the water that is stripped by the alcohol.[4][5]

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