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

Running head: NURSING
Efficacy of Alcohol-gel as a substitute for soap and water hand in a clinical setting
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NURSING
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