Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial
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Posted By: Sharon McKinley
Posted Date: 6 January, 2003
Title: Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial
Authors: Girou E, Loyeau S, Legrand P, Oppein F, Brun-Buisson C.
Reference: Girou E. BMJ 2002 175: 362
Link: Click here for a direct link to the paper. A password may be required for access to fulltext.
Abstract: Objective: To compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care.
Design: Randomised controlled trial during daily nursing sessions of 2 to 3 hours.
Setting: Three intensive care units in a French university hospital.
Participants: 23 healthcare workers.
Interventions: Handrubbing with alcohol based solution (n=12) or handwashing with antiseptic soap (n=11) when hand hygiene was indicated before and after patient care. Imprints taken of fingertips and palm of dominant hand before and after hand hygiene procedure. Bacterial counts quantified blindly.
Main outcome measures: Bacterial reduction of hand contamination.
Results: With handrubbing the median percentage reduction in bacterial contamination was significantly higher than with handwashing (83% v 58%, P=0.012), with a median difference in the percentage reduction of 26% (95% confidence interval 8% to 44%). The median duration of hand hygiene was 30 seconds in each group.
Conclusions: During routine patient care handrubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than handwashing with antiseptic soap.
Are the Results Valid?
1. Was the assignment of patients to treatments randomized? ( Was allocation concealment maintained?)
Yes, 23 staff were randomised at the start of their shift to handwashing or handrubbing for defined patient care activities throughout the shift. Five activities per person were studied and the average percentage reduction per person was calculated.
2. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
2a. Was followup complete?
One participant was omitted from the handrubbing group because soiling of hands necessitated handwashing.
2b. Were patients analyzed in the groups to which they were randomized?
3. Were patients, health workers, and study personnel blind to treatment?
No but the microbiologist examining the cultures was unaware of the hand hygiene method used.
4. Were the groups similar at the start of the trial?
The groups had similar characteristics and performed similar activities.
5. Aside from the experimental intervention, were the groups treated equally?
Yes, it appears so.
What are the Results?
1. How large was the treatment effect?
Reduction of bacterial contamination was 83% for the handrubbing group vs 58% for the handrubbing group, i.e. a 25% greater reduction.
2. How precise was the estimate of the treatment effect?
The interquartile range for the handrubbing group was narrow, but for the handwashing group was wide, indicating that handwashing results in more variable decontamination of hands and some ineffective decontamination. The 95 % confidence interval for the difference in the percentage reduction in contamination was 8-44%, indicating that the benefit of handrubbing is fairly certain.
Will the Results Help Me In Caring For My Patients?
1. Can the results be applied to my patient care?
The study was conducted in three ICUs in a large tertiary referral hospital in France. The patients therefore were likely to be similar to those in ICUs in similar hospitals in Australia. Considerations such as the educational preparation of the staff, staffing levels and skillmix are more pertinent considerations and little is known about them. However it seems that these factors are unlikely to be more optimal in France than in Australia and therefore that similar benefits from routine handrubbing rather that handwashing should be seen here.
2. Were all clinically important outcomes considered?
Neither actual nor surrogate clinically meaningful outcomes were considered, but in the introduction the authors link hand hygiene and nosocomial infection rates.
3. Are the likely treatment benefits worth the potential harms and costs?
There are no apparent potential harms. The benefits of potentially reducing nosocomial infection in ICU patients would justify additional costs of handrubbing lotions over handwashing. The rates of compliance with handwashing are dismal despite many interventions to improve compliance, and the failure to wash the hands long enough to achieve decontamination. In this study, 65% of handwashing procedures lasted less than 30 seconds.

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