Efficacy of Alcohol-gel as a Substitute for Soap and Water Hand in a Clinical Setting

This essay analyses the efficacy of Alcohol-gel as a substitute for soap and water hand in a clinical setting. It highlights the efficacy of the alcohol-based hand rubs (ABHRs) and water and soap based hand sanitization towards the prevention of the spread of the bacterial and viral infection through the touch of hands.

Running head: NURSING
Efficacy of Alcohol-gel as a substitute for soap and water hand in a clinical setting
Name of the Student
Name of the University
Author Note

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Introduction
According to the World Health Organisation (WHO) (2018), the most efficacious and
well-tolerated yet well-researched product, which can be placed safely and ergonomically for
the prevention of the touch based contamination of the patient care under the healthcare
settings is alcohol-based handrub. The research conducted by Ellingson et al. (2014)
highlighted that during routine patient care, the use of alcohol based hand rub or alcohol gel
is significantly more effective in reducing the chances of the spread of the hospital acquired
infections among the patients in comparison to the hand washing done with the help of the
antiseptic soap. Moreover, the use of the alcohol based hand rub is effective in reducing the
chances of the spread of infection through Clostridium difficile, a spore forming bacteria and
Norovirus. The following essay aims to analyse efficacy of Alcohol-gel as a substitute for
soap and water hand in a clinical setting (World Health Organisation, 2018). The essay will
mainly aim to highlight the efficacy of the alcohol based hand rubs (ABHRs) and water and
soap based hand sanitization towards the prevention of the spread of the bacterial and viral
infection through the touch of hands. The essay will also highlights the ease of usage of the
both the disinfectants and based on which, the overall usage efficacy will be determined.
Hospital Acquired Infections (HAIs)
According to Graveto et al. (2018), HAIs occurs during healthcare delivery under
hospital settings and was not present during the time of the hospital admission. HAIs are a
barrier towards the proper treatment that cause increase in the level of mortality and
morbidity along with increase in the cost of care and length of stay at the hospital. The hands
of the healthcare professionals are the common mode of transmission of the infectious agent
and thus causing HAIs, although the mode of transmission is complex and multifactorial
(Graveto, 2018). Thus proper practice of the clinical skill of HH both during and after the

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care of the patients is an important aspect of the nursing care. WHO (2018) 5 moments of
HH, recommends the healthcare workers to clean their hands under five different instances.
First instance is before touching the patient, second is before aseptic/clean procedures, third
is after exposure to body fluid, fourth is after touching the patient and fifth is after tough any
part of component present in the patient’s surroundings.
Figure: WHO’s Five Moment of Hand Hygiene
(Source: WHO, 2017)
According to the National Institute for Health and Care Excellence (2016), the proper
practice of the hand hygiene helps in the prevention of the HAIs, surgical site infection and
other antimicrobial stewardship. Under the primary and community care settings, the
prevention of the HAIs can be done by the use of the proper personal protective equipments
(PPEs) and use of the proper HH protocol. Use of the proper HH protocol and PPEs help in
the prevention of the infection among the people who has long-term urinary catheter, person

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who have enteral feeding and person is fitted with a vascular access devise. In the prevention
of the HAIs in wound management, proper use of the HH protocol must be undertaken both
before and after cleansing and dressing of wound (Nursing and Midwifery Council, 2018).
Comparison between alcohol-gel and soap and water hand in a clinical setting
Protection against the bacterial infection
According to Shinde and Mohite (2014), hand hygiene done with the help of non-
medicated liquid soap and warm water will help in the removal of the transient micro-
organisms. Transient micro-organisms are mainly found on the surface of the skin like
methicillin-resistant Staphylococcus aureus (MRSA) which are mostly acquired during the
healthcare delivery (Mohite, 2014).
Alcohol-based hand rubs (ABHRs) are an effective means of reducing the
transmission of the bacterial pathogens. However, ABHRs are not effective against the
removal of the Clostridium difficile spores. The study conducted by Kundrapu et al. (2014)
highlighted that hand rubbing in plain water helps in the reduction of the palmar spores
culture significantly with a man value o the 1.57 ± 0.11 log10 colony-forming units (CFU)
per cm2 ( the initial value was set to zero). Chlorhexidine soap washing help in the reduction
of spore count with a standard deviation of .89 ± 0.34 log10 CFU per cm2. However, no
significant reduction in the colony forming unit of the Clostridium difficile spores was found
in case of the ABHRs. Thus, it can be concluded that washing of hands with soap and water
is significantly more effective in reducing the Clostridium difficile spores from the hands of
the healthcare professionals. In case of ABHRs, the residual spores is transferred by the
means of hand shake (Jabbar, et al., 2010). The effectiveness of the soap and water can be
improved by washing the hands with soap and water followedby soaking in a sporicidal
electrochemically generated hypochlorous acid solution. This procedure is significantly more

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effective in decreasing the levels of copy-number of C. difficile spores on hands of the
healthcare professionals than was hand washing alone (Kundrapu, Sunkesula, Jury,
Deshpande, & Donskey, 2014).
In relation to the efficacy of the ABHRs in the prevention of the HAIs transmitted
through bacteria, it can be said that sporadial activity of alcohol can be induced by making an
alteration in the physical and the chemical condition of the alcohol which increases the
efficiency of alcohol in degrading the sporaidal structure through penetration inside the
spores coats. The change in the physical and chemical condition of the alcohol can be done
with the help of the acidification, heating and alkalinisation of the ethanol which helps to
induce the sporicidal activity of ethanol against C.difficile and to lesser extent to Bacillus
thuringiensis and Bacillus subtilis. Acidification is chosen as the preferred approach for the
improvement of the sporadicidal activity of ethanol. Acidification of ethanol increases the
sporadicial activity of ethanol by increasing the ionic strength of the alcohol along with
increase internal temperature (Nerandzic, Sunkesula, Setlow, & Donskey, 2015).
In the domain of effectively of the HH towards the reduction of the HAIs, it can be
said that C. difficile spores are difficult to remove with the hand washing in comparison to the
spores of the surrogate species. Peracetic acid and surfactant formulation is found to promote
highest log reduction by providing a combination of spore removal and subsequent
inactivation. However, the log reduction of prototype is found to be less in comparison to the
ABHRs and antimicrobial hand washes against the vegetative bacteria. Only sodium
tetraborate dehydrate powder and ink and stain remover. However, these products have been
found to contain harsh ingredients which are harmful for the skin (Edmonds, et al., 2013).

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Protection against viral contamination
In order to test the effectiveness of the alcohol-based hand disinfectant in the domain
of prevention of the transmission of the viral infection, Tuladhar (2015) conducted an
experiment. The authors mainly tested the efficacy of the alcohol hand disinfectant against
the human enteric and respiratory viruses and compared the results with the efficacy o of the
soap and water against the norovirus. The authors mainly tested the efficacies of a propanol,
an alcohol based disinfectant against the human enteric and respiratory viruses and compared
the efficacy of the alcohol based hand rub and water-soap over the efficacy of the killing the
infection of norovirus of different strains (GI.4, GII.4 and MNV1). The analysis of the results
highlighted that alcohol-based hand disinfectant helped in the reduction of the infectivity of
the rotavirus and influenza virus in a comprehensive manner within 30 seconds. On the other
hand, the infectivity of the polio-virus (Sabin 1) and adeno-virus type 5 and parecho-virus 1
and MNV1 was reduced within 3 minutes. Whereas washing hands with soap and water for
30 seconds helped in the removal of the genomic copies of the MNV1, norovirus completely
from the finger tips. Washing hands with the help of propanol-based hand disinfectant
highlighted little or no significant reduction in the mean genomic copy number reduction in
the norovirus family and MNV1. Washing hands with the help of the soap and water is much
more effective in comparison to the alcohol-based disinfectants for the removal of the
norovirus contamination from hands (Tuladhar, 2015).
Drawbacks of water-soap hand wash
However, the majority of the areas of hand are missed while practice of the hand
hygiene. Moreover, the use of water-soap in hand washing also requires towels for drying of
hand and contamination might also come from towel (World Health Organisation, 2017).

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Moreover, the use of water and soap in HH used the use of elbow for the closing of
the tap and touching the head of the taps might cause cross contamination. The use of the
alcohol hand rub on the other hand, does not require the availability of the other resources of
hand hygiene like tap water (for washing) and hand towel (for drying the hands). The alcohol
gel hand rub evaporates easily due to its effervescence characteristics and thus giving and
thus giving ease of access to the nursing professional (La Fleur & Jones, 2017). Moreover,
the health care professionals who have skin infection like allergic contact dermatitis have
allergy to certain types of anti-bacterial soaps and alcohol based rubs. The symptoms of the
allergic contact dermatitis range from mild to localize to severe and generalized. The spread
of the infection through allergic contact dermatitis lead to the generation of respiratory
distress and other complications of the anaphylaxis. Thus it is recommended to use personal
protective equipments (PPE) in such cases. The use of PPEs like hand gloves will not only
help to prevent the spread of the contact infection but will also prevent spread of the allergic
reaction in hands (La Fleur & Jones, 2017).
Why hand hygiene
According to the Nursing and the Midwifery Council of the United Kingdom (2018),
it is the duty of the nursing professionals for preserve the patient safety while working within

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the limits of the nursing competence. Moreover, it is also the duty of the nursing
professionals to raise their concern whenever, the patient’s safety comes at stake. Thus in
order to ensure patient’s safety, as an important professional skill of the nursing and the
midwifery practice, a nurse must adherence to and must excel in the skill of using alcohol
based hand rub for the prevention of HAIs (Nursing and Midwifery Council, 2018).
Conclusion
Thus from the above discussion in the essay, it can be concluded that, use of water
and soap is far more effective than the use of the ABHRs towards the prevention of the HAIs.
The use of the water and soap helps to prevent the spread of the bacterial infection while
giving protection against the spore forming bacteria. The water and soap based hand washing
protocol is also effective in preventing the spread of the viral infection through touch
contamination under the hospital settings. However, the use of the water and soap for HH
might ignore few major portion of the palm and at the same time might not suitable for the
professionals who have sensitive skin or skin allergy. But use of hand hygiene and PPE is
crucial for the prevention of the HAIs and this will help in improving the quality of care.
Recommendation
Lack of proper knowledge about the importance of the HH in the protection of the
HAIs increases the compliance of the HH among the nursing professionals leading to lack of
proper development of the clinical skill (Ellingson, et al., 2014). National Institute for Health
and Care Excellence (2016) further highlighted that proper training of the healthcare
professionals is also important in order to increase their efficiency in using this clinical skill
(use of the HH protocol for the prevention of the HAIs) (National Institute for Health and
Care Excellence , 2016). Towards the practice of the clinical skill, lack of proper availability
of the resources at the bed side of the patients or increase in the work pressure due to nurse to

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patient ration leads to decrease in the compliance of the clinical skill of hand hygiene
(Ellingson, et al., 2014). NICE recommends that active partnership with the Health Protection
Agency (HPA) will help in the establishment of the excellence in the measure of the infection
control and management at the organisational level.

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