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Title |
Soap and Water Vs Alcohol-Based Hand Hygiene Products |
Clinical Question |
Does the use of alcohol-based hand hygiene products decrease the incidence of healthcare-associated infection compared to traditional hand washing with soap? |
Clinical Bottom Line |
It seems the biggest factor in increasing hand washing compliance and reducing healthcare-associated infections is the emphasis placed on it. The CDC recommends washing with soap and water when hands are visibly soiled or contaminated with infectious material, and the use of alcohol-based products otherwise. (See Comments on the CAT below) |
Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
#1) 17655977 | Stout/2007 | 26 studies were included | Systematic Review | Key results | Four studies looked specifically at hand washing compliance: 3 found compliance improved with alcohol-based products (introduced independent of awareness and educational activities) and the other found better compliance with traditional hand washing. Most all of the studies found increased compliance and many studies found decreased nosocomial infection rates when hand hygiene education and awareness programs were initiated. This was observed regardless of the incorporation or absence of alcohol-based products. | #2) 14959873 | Kohn/2004 | Panel of experts | Expert Opinion | Key results | These guidelines published by the Center for Disease Control provides expert recommendations for infection control. Regarding hand hygiene in dental settings, they recommend washing with soap and water if hands are visibly soiled or contaminated with blood or other potentially infectious material. Otherwise, an alcohol-based rub is sufficient. For surgical procedures, both washing with soap and water and use of an alcohol-based product should be performed. | |
Evidence Search |
PubMed was searched for the following terms: "Handwashing"[Mesh] AND "Infection"[Mesh] AND alcohol-based[All Fields]. A second PubMed search was performed using the following terms: "Handwashing"[Mesh] AND "dentistry"[Mesh]. |
Comments on
The Evidence |
Stout et al. noted that it is difficult to isolate the effect of alcohol-based products because they are usually incorporated along with education programs and other incentives. Their study is a systematic review but it is based on relatively weak evidence, as no randomized controlled trials were included. It also excluded studies done in dental surgeries. The CDC report is more specifically directed toward dental settings, but is considered lower level evidence. PubMed lists the study as a systematic review, but it is in fact a statement of recommendations from a panel of experts. |
Applicability |
This evidence applies to health care professionals working with patients in most professions. Unfortunately, the studies included here do not specifically address the use of alcohol-based products alone versus conventional hand washing. The counsel from the Center for Disease Control is applicable for all dental procedures, surgical and non-surgical. |
Specialty/Discipline |
(Public Health) (General Dentistry) (Dental Hygiene) |
Keywords |
healthcare-associated infections; hospital-acquired infections; handwashing; alcohol-based cleansers; hand hygiene
|
ID# |
450 |
Date of submission: |
12/07/2009 |
E-mail |
FrancisJ@uthscsa.edu |
Author |
Sara E. McLin |
Co-author(s) |
J. Christian Francis |
Co-author(s) e-mail |
|
Faculty mentor/Co-author |
Gregory Spackman, DDS, MBA |
Faculty mentor/Co-author e-mail |
SPACKMAN@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
by Xingkun Liu (San Antonio, TX) on 04/02/2012 A PubMed search on this topic was completed in April 2014. A more recent publication, PMID 19720430, suggested the use of alcohol based hand rubs is a practical solution to overcome time and structure constraints, especially in developing countries and in the situation of inadequate access to soap and water. This study further strength the conclusions of this CAT. | |
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