ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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) 17655977Stout/200726 studies were includedSystematic Review
Key resultsFour 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) 14959873Kohn/2004Panel of expertsExpert Opinion
Key resultsThese 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)
Keywords healthcare-associated infections; hospital-acquired infections; handwashing; alcohol-based cleansers; hand hygiene
ID# 450
Date of submission: 12/07/2009spacer
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 on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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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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