| FAQ - Hand Hygiene - 2014
Do you have any articles or studies that would address effectiveness of regular hand soap vs antimicrobial hand soap.
I am getting concerns from employees regarding the long term use of antimicrobial soaps and hand sanitizers.
Is regular hand soap acceptable ? If you can help me on this I would greatly appreciate it.
From an infection prevention standpoint, Ask OSAP would like to reference the 2003 CDC guidelines for infection control in dentistry:
The preferred method for hand hygiene depends on the type of procedure, the degree of contamination, and the desired persistence of antimicrobial action on the skin (Table 2). For routine dental examinations and nonsurgical procedures, handwashing and hand antisepsis is achieved by using either a plain or antimicrobial soap and water. If the hands are not visibly soiled, an alcohol-based hand rub is adequate.
The purpose of surgical hand antisepsis is to eliminate transient flora and reduce resident flora for the duration of a procedure to prevent introduction of organisms in the operative wound, if gloves become punctured or torn. Skin bacteria can rapidly multiply under surgical gloves if hands are washed with soap that is not antimicrobial (127,128). Thus, an antimicrobial soap or alcohol hand rub with persistent activity should be used before surgical procedures (129–131).
Agents used for surgical hand antisepsis should substantially reduce microorganisms on intact skin, contain a nonirritating antimicrobial preparation, have a broad spectrum of activity, be fast-acting, and have a persistent effect (121,132–135). Persistence (i.e., extended antimicrobial activity that prevents or inhibits survival of microorganisms after the product is applied) is critical because microorganisms can colonize on hands in the moist environment underneath gloves (122). Alcohol hand rubs are rapidly germicidal when applied to the skin but should include such antiseptics as chlorhexidine, quaternary ammonium compounds, octenidine, or triclosan to achieve persistent activity (130). Factors that can influence the effectiveness of the surgical hand antisepsis in addition to the choice of antiseptic agent include duration and technique of scrubbing, as well as condition of the hands, and techniques used for drying and gloving. CDC’s 2002 guideline on hand hygiene in health-care settings provides more complete information (123). 1
Selection of Antiseptic Agents Selecting the most appropriate antiseptic agent for hand hygiene requires consideration of multiple factors. Essential performance characteristics of a product (e.g., the spectrum and persistence of activity and whether or not the agent is fast acting) should be determined before selecting a product. Delivery system, cost per use, reliable vendor support and supply are also considerations. Because HCP acceptance is a major factor regarding compliance with recommended hand hygiene protocols (122,123,147,148), considering DHCP needs is critical and should include possible chemical allergies, skin integrity after repeated use, compatibility with lotions used, and offensive agent ingredients (e.g., scent). Discussing specific preparations or ingredients used for hand antisepsis is beyond the scope of this report. DHCP should choose from commercially available HCP handwashes when selecting agents for hand antisepsis or surgical hand antisepsis. 1
This publication can be accessed in its entirety at this link:
CDC’s Guideline for Hand Hygiene in Health-Care Settings can be accessed at this link:
This publication states:
Proposed Methods for Reducing Adverse Effects of Agents
Potential strategies for minimizing hand-hygiene–related irritant contact dermatitis among HCWs include reducing the frequency of exposure to irritating agents (particularly anionic detergents), replacing products with high irritation potential with preparations that cause less damage to the skin, educating personnel regarding the risks of irritant contact dermatitis, and providing caregivers with moisturizing skin-care products or barrier creams (96,98,251,271–273). Reducing the frequency of exposure of HCWs to hand-hygiene products would prove difficult and is not desirable because of the low levels of adherence to hand-hygiene policies in the majority of institutions. Although hospitals have provided personnel with non-antimicrobial soaps in hopes of minimizing dermatitis, frequent use of such products may cause greater skin damage, dryness, and irritation than antiseptic preparations (92,96,98). One strategy for reducing the exposure of personnel to irritating soaps and detergents is to promote the use of alcohol-based hand rubs containing various emollients. Several recent prospective, randomized trials have demonstrated that alcohol-based hand rubs containing emollients were better tolerated by HCWs than washing hands with nonantimicrobial soaps or antimicrobial soaps (96,98,166). Routinely washing hands with soap and water immediately after using an alcohol hand rub may lead to dermatitis. Therefore, personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol hand rub.
Hand lotions and creams often contain humectants and various fats and oils that can increase skin hydration and replace altered or depleted skin lipids that contribute to the barrier function of normal skin (251,271). Several controlled trials have demonstrated that regular use (e.g., twice a day) of such products can help prevent and treat irritant contact dermatitis caused by hand-hygiene products (272,273). In one study, frequent and scheduled use of an oil-containing lotion improved skin condition, and thus led to a 50% increase in handwashing frequency among HCWs (273). Reports from these studies emphasize the need to educate personnel regarding the value of regular, frequent use of hand-care products.
Recently, barrier creams have been marketed for the prevention of hand-hygiene–related irritant contact dermatitis. Such products are absorbed to the superficial layers of the epidermis and are designed to form a protective layer that is not removed by standard handwashing. Two recent randomized, controlled trials that evaluated the skin condition of caregivers demonstrated that barrier creams did not yield better results than did the control lotion or vehicle used (272,273). As a result, whether barrier creams are effective in preventing irritant contact dermatitis among HCWs remains unknown.
In addition to evaluating the efficacy and acceptability of hand-care products, product-selection committees should inquire about the potential deleterious effects that oil containing products may have on the integrity of rubber gloves and on the efficacy of antiseptic agents used in the facility (8,236). 2
Additionally, Infection Control and Management of Hazardous Materials for the Dental Team states as follows:
If hands are visibly soiled or contaminated with blood or other potentially infectious material, they are to be washed with a non-antimicrobial or an antimicrobial soap and water. If the hands are not visibly soiled, they can be washed with a non-antimicrobial or an antimicrobial soap and water or can be decontaminated with an alcohol-based hand rub. For oral surgical procedures, before putting on sterile gloves, the hands can be washed with an antimicrobial soap and water and dried with sterile towels, or they can be washed with a non-antimicrobial soap and water, dried, and decontaminated with an alcohol-based hand rub. 3
The CDC also maintains this webpage which you may find to be a helpful resource:
Hand Hygiene in Healthcare Settings
It should be noted that Ask OSAP makes no claims in the event that an occupationally related health condition is in question. OSAP provides no medical advice. That should be evaluated and addressed by an occupational healthcare provider expert such as a physician.
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on April 25, 2014.
2) Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR- 16):1-56. http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf Accessed on April 25, 2014
3) Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Page 85.
4) Centers for Disease Control and Prevention. Hand Hygiene in Healthcare Settings http://www.cdc.gov/handhygiene/ Accessed on April 26, 2014.