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The presence of alcohol hand gel for the entire period of a recently published study was “strongly and independently associated with decreased risk of hospital-associated gastrointestinal infections among patients undergoing elective surgical procedures,” the lead study author reports.

Study links alcohol gel to fewer infections

Study links alcohol gel to fewer infections

But rubs should not be used in some outbreaks

The presence of alcohol hand gel for the entire period of a recently published study was "strongly and independently associated with decreased risk of hospital-associated gastrointestinal infections among patients undergoing elective surgical procedures," the lead study author reports.

"The idea is that the hospitals that had it the whole time were using it and likely had a higher frequency of hand hygiene [compliance] overall because of it," says Danielle M. Zerr, MD, MPH, infection control director at Children’s Hospital in Seattle.

The study adds to "a growing body of evidence" showing the effectiveness of alcohol hand gels, she tells Hospital Infection Control.

The cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding children’s hospitals.1 A survey of the hospitals yielded additional information on infection control policies and practices. Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48,278 patients met the study’s inclusion criteria; 2.3% of these patients had respiratory infections, and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied among the hospitals and ranged from less than 1% to 6%.

Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections. The authors could not state with certainty why alcohol hand gel use was associated inversely with gastrointestinal infections and not with respiratory infections.

"There is some evidence that the gel may be more specifically effective against rotavirus than soap-and-water washing," Zerr explains. "That is one possible explanation for why we are seeing an effect with gastroenteritis, because rotavirus is one of the most common causes of nosocomial gastroenteritis. That may be what we are seeing playing out there. I don’t think that our paper proves that there would be no effect on respiratory infections. It may just be that it is a weaker effect that we were not able to detect."

The one variable the study found to be protective against infections was the availability of alcohol hand gel, which supports the importance of hand hygiene in preventing hospital-associated infections.

"Commonly cited barriers to health care worker hand hygiene include lack of time and the skin damage that accompanies frequent washing with soap and water," the authors note. "Alcohol-based hand gels address these barriers, because they require a fraction of the time for effective hand hygiene and they are less damaging to skin than soap and water. In addition, alcohol hand gels appear to be more effective in killing many microorganisms. However, because of poor activity against bacterial spores, protozoan oocysts, and certain nonenveloped (nonlipophilic) viruses, such as hepatitis A, it is recognized that alcohol hand gel should not be used in outbreak situations involving these organisms."

Reference

  1. Zerr DM, Garrison MM, Allpress AL. Infection control policies and hospital-associated infections among surgical patients: Variability and associations in a multicenter pediatric setting. Pediatrics2005; 115:387-392.