Efficacy of Alcohol-based hand-rub in comparison to hand washing in prevention of nosocomial infections Melinda Hawley BSN, RN-BC Purpose Analyze the efficacy of alcohol based hand-rub (ABHR) in comparison to traditional hand washing in the prevention and reduction in non-spore forming nosocomial infections. Results Minimal literature available with RCT utilizing different hand hygiene preparations-may be due to broad nature of the study of efficacy In 2011 approx 722,000 HAI & ~75,000 deaths from HAI (majority outside of ICU’s) 1:25 hospitalized patients with HAI on any given day and costing healthcare industry billions of dollars every year in non-reimbursed medical costs. Hand hygiene compliance among HCW low (estimated <40%) Multiple Barriers ABHR most effective 55-70% alcohol concentration Alcohol denatures proteins = reduced risk of infection ABH against most Gram + and Gram - bacteria Reduced risk of nosocomial infections caused by: MRSA, VRE, Staphylococcus aureus and E-coli infections Amount of ABHR used and dry time can affect efficacy ABHR efficacy in comparison to: Plain soap: % vs % effective (Zarpellon et al., 2008) ABHR more effective than antimicrobial hand soap 99.99% vs % effective, (Paulson et al., 1999) Effectiveness reduced to 99.98% after 3 rd use (Paulson et al., 1999) ABHR not effective against Clostridium difficile bacteria VS. Healthcare Associated Infections as Reported to the National Healthcare Safety Network WHO: 5 moments for Hand hygiene Significance to Nursing Lack of Medicare reimbursement for nosocomial infection costs $ billion dollar annual cost (estimated) (Scott, 2009) Need for education re: compliance rates, rates of infections, and efficacy of ABH Encourage healthcare professionals to increase compliance with use of 5 moments Suggestions for practice: Include ABH at bedside for patient use Encourage hand washing with soap and water after third use of ABH Implement a hand hygiene initiative within patient care facilities Conclusion Many people die each year due to preventable hospital acquired infections. Greater hand hygiene efforts are needed among HCW Use of ABHR in conjunction with 5 moments for hand hygiene will help decrease rate of NI ABH considered Gold Standard Considered 99.99% effective against many non-sporeforming bacteria Better microbial efficacy, less wash time, better skin tolerance compared to traditional hand washing. Can reduce and prevent incidence of NI caused by: MRSA, VRE, staphylococcus aureus and e-coli. Hand washing recommended after 3 rd use of ABHR 55-70% alcohol concentration is best Hand washing is required to remove spore-forming bacteria from surface of hands Barriers to hand washing need to be overcome Work loads Time it takes to wash with soap and water Inherent/ elective sense to need to wash hands Lack of knowledge in hand hygiene Suggestions for future research: Hand hygiene by hospitalized patients Use of hand sanitizer by patients if available at bedside Methodology A PICOT question was used to guide literature search Literature: only those articles dated after 1990 included 27 articles reviewed- only 15 relevant nursing and non-nursing research Rapid critical appraisal used to evaluate relevancy Online Websites CDC, WHO, Google Scholar Online Databases CINAHL, PubMed Keyword Search Hand washing Hand hygiene, hand hygiene compliance Alcohol based hand-rub, hand sanitizer Nosocomial infections (NI), hospital acquired infections (HAI) Limitations Limited research available to support efficacy of one preparation over another in preventing nosocomial infections. Data presented by the CDC is 3-4 years behind in reporting Data tables published by the NHSN are available, the data is difficult to accurately interpret due to various ways of reporting.