In the battle against the spread of infection, new federal healthcare guidelines and new consumer research are changing the way people wash their hands. The guidelines say doctors and nurses should wash their hands with hot soapy water less, while the research says household members probably should use plain soap more often.
Last month, the Centers for Disease Control and Prevention issued new hand hygiene guidelines for health care workers that have revolutionized infection control for workers in direct contact with patients. The recommendations say doctors and nurses should use alcohol-based hand antiseptics to decontaminate their hands between seeing patients to prevent the spread of infections rather than soaping up. In the home, new research suggests antibacterial cleaners, which may increase the likelihood of creating antimicrobial-resistant bacteria, are no better at removing germs than good old-fashioned soap and water.
Dr. Elaine Larson, professor of pharmaceutical and therapeutic research in the Columbia University School of Nursing and professor of epidemiology in the Mailman School of Public Health, had a "hand" in both the development of the guidelines and the research findings for the public.
CDC estimates hospital-acquired infections cost $4.5 billion a year and 80 percent are transmitted by direct touch. Adhering to old guidelines that recommend washing with soap before and after direct contact with a patient can reduce a hospital's rate of infection, but perfect adherence often takes more time than most healthcare workers can spare.
"If nurses washed their hands like they were supposed to, the washing time would amount to 16 hours of each day in a 20-bed intensive care unit," Dr. Larson says. "In reality, healthcare workers followed the washing guidelines about 50 percent of the time."
The new CDC guidelines should reduce the time spent to decontaminate hands. The recommended alcohol-based products can be carried with the healthcare worker or installed in several convenient places near patient rooms. The alcohol in the lotion kills bacteria, but added emollients keep hands soft. The product dries on the hands so towels are unnecessary.
In September, before the new guidelines were officially released, Peggy Fracaro, the manager of hospital epidemiology at the Columbia Presbyterian Medical Center campus of New York-Presbyterian Hospital, switched the hospital to alcohol-based antiseptics. "With soap, there was always a problem with not enough sinks, running out of paper towels, or soap that was too caustic," she says. "This is easy, one dab and you're done."
Besides saving time, the new alcohol products may be more effective than soap at reducing infections. Research by Dr. Larson in the neonatal ICU and operating rooms of New York-Presbyterian showed alcohol-based products either worked as well or better than hospital-strength antimicrobial soap at reducing hand bacteria and left hands softer.
But whether alcohol-based products can actually reduce hospital-acquired infections remains unknown. The only study of alcohol vs. soap, published in the Journal of the American Medical Association in August, showed no difference in surgical site infections during the 30 days of the study. Dr. Larson is conducting a study in Children's Hospital of New York and NewYork-Presbyterian Hospital at Cornell to compare hospital-acquired infections in babies exposed to the two cleaners. "Even if alcohol products are not any better than soap, they're much faster than soap and that's a huge savings in time and money," Dr. Larson says.
Outside the hospital, though, good hand hygiene doesn't need any special treatment beyond standard soap and water, according to Dr. Larson's research.
With antibacterial soaps commanding 75 percent of the cleaning product market and growing concern about the possibility that such soaps might lead to the development of microorganisms resistant to antimicrobial agents, Dr. Larson recently decided to perform her first household study and the first ever on household antibacterial soaps. She hoped her findings might help consumers decide which cleanser was better to use.
She provided 220 Manhattan households antimicrobial or standard cleaners and recorded hand bacteria counts before and after the one-year study. She found antimicrobial products work no better than soap in removing bacteria from the hands. Participants in both groups had an average 1 million bacteria per hand at the beginning of the study, but only 300,000 per hand by the end. Dr. Larson reported her data in October at the Infectious Diseases Society of America meeting.
"People in the study probably washed more often and longer than usual," Dr. Larson says, "but the research shows if you wash your hands with plain soap, it helps."
The study also found no difference between the soaps in the type of normal skin bacteria found on the participant's hands.
Dr. Larson continues to analyze data to see how well each cleanser affected the number of infections in the households. "Personally, I'd recommend just washing your hands with soap at home," she says. "If you have a sick child and want to disinfect your hands, use an alcohol-based product."
The research was supported by a grant from the National Institutes of Health.