Alcohol hand rubs cause less irritation than washing

Ambulatory sites should continue to use method

As alcohol-based hand rub dispensers become ubiquitous at hospitals and are growing in popularity at outpatient facilities, health care professionals will be happy to learn that they're not as harsh on the skin as feared.

A new study in the British Journal of Dermatology concludes that alcohol-based hand rubs cause less skin irritation than hand washing and may even decrease skin irritation after a hand wash.1

The findings bode well for infection control professionals who want to improve hand hygiene compliance in outpatient settings.

Health care workers sometimes have low compliance with hand hygiene because of the assumption it will lead to skin irritation and hand eczema.1

"I am convinced that with a widespread use of alcohol hand rubs, the problem of skin irritation of health care employees will decrease, and the compliance will increase," says Harold Löffler, MD, PhD, head of the department of dermatology at SLK-Kliniken GmbH in Heilbronn, Germany. Löffler is the lead author of the study, "How irritant is alcohol?"

"The problem of alcohol hand rubs is that when the skin of the health care workers are still damaged, due to extensive hand washing, the application of an alcohol hand rub will lead to a burning sensation," Löffler explains. "This is due to the fact that the alcohol can penetrate more into the skin and excite sensible nerve ends."

But this sensation does not mean there is skin irritation, he adds.

"It is not dangerous for the skin, it is just an unpleasant sensation," Löffler advises. "This burning should hence not lead to a reduction of alcohol hand rub use."

What the burning signifies is that the skin has been disturbed by other irritants, such as hand washing, he says.

So if health care workers reduce the amount of times they wash their hands with soap and water and increase their use of alcohol hand rubs, then the skin will regenerate faster, Löffler says.

"People have been very worried about using alcohol gels because they think the gels will hurt their skin, but it looks like it has the opposite effect," says John English, MBBS, FRCP, a doctor in the department of dermatology at Queen's Medical Center, Nottingham University Hospitals in Nottingham, United Kingdom.

English co-authored an editorial in the British Journal of Dermatology that discussed the alcohol hand rub as a good substitute for soap-and-water hand hygiene.2

"If you wash your hands in soap and then use a gel, it seems to have an effect that diminishes the bad effects of the soap," English says.

Both the gels and soap and water are irritants, but the alcohol gel doesn't appear to be as bad as many people feared, even if it's used 20 times a day, English adds.

Another benefit of alcohol gels is that it's nonallergenic, so it's safe for most people from that perspective, he adds.

Here's how alcohol hand rubs provide a protective effect after skin washing: "After hand washing, some parts of the detergent may remain on the skin," Löffler says.

"These detergents are irritants and are able to decrease skin hydration or disturb the skin barrier," he explains. "Alcohol hand rubs are often used in a manner in which the amount of applied alcohol is more than what can remain on the skin."

This means the alcohol may rinse off the detergents and protect the skin.

Löffler says he was strongly surprised by the study's finding that alcohol hand rubs did not enhance the irritation caused by hand washing with a detergent. But now that the study proves its safety, there are no barriers to having health care workers use alcohol hand rubs between every patient contact.

"Alcohol hand rubs irritated the skin in a far less amount than any washing procedure — even with water alone," Löffler adds.


  1. Löffler H, Kampf G, Schmermund D, et al. How irritant is alcohol? Br J Dermat 2007; 157(1):74-81.
  2. Johnston GA, English JSC. The alcohol hand rub: A good soap substitute? Br J Dermat 2007; 157(1):1-3.