Wednesday, 15 February 2012

The Use of Alcohol Based Hand Rubs and the Outbreaks of Norovirus.

Every year the outbreaks in our hospitals just here in the UK of Norovirus (Winter Vomiting Bug) has a major impact on patients health outcomes, smooth operation of wards impacted by closures, the cost of related to these patient health, ward closures, deep cleaning, staff sickness and so on.

It is a well known fact that Alcohol Based Hand Rubs have very little if at all any impact on the control of Norovirus and the key vehicle for spreading the virus is our hands.

Infection: prevention and control of healthcare-associated infections in primary and community care.

Commissioned by the National Institute for Health and Clinical Excellence

Highlights of recommendations proposed for primary and community care:
Decontaminate hands preferably with a hand rub (conforming to current British Standards),
except in the following circumstances, when liquid soap and water must be used: 

When hands are visibly soiled or potentially contaminated with body fluids or in clinical situations where there is potential for the spread of alcohol-resistant organisms (such as norovirus, Clostridium difficile, or organisms that cause diarrhoeal illness).

For many years the use of ABHR's has been pushed as a method of hand hygiene and now is seen as a replacement for hand washing by healthcare workers, patients and visitors. With the visibility of so many dispensers there is a false "security" of the use of ABHR's surrounding Norovirus. People believe they are doing the right thing.

With the outbreak of Norovirus in the hospital and care environment staff, patients and visitors are rightly so encouraged to be diligent about hand hygiene, but how many of those using the ABHR dispensers know that really and truly they are having no impact on the spread of Norovirus by hand transmission.

The use of ABHR's has become a routine practice particularly surrounding the five moments of hand hygiene issued by the WHO. This without doubt has had a major impact on Healthcare Acquired Infections, but it is not the "be all and end all". For the same reasons ABHR's came to the fore hand washing with soap and water itself throws up a number of issues.

So it is time to continue to educate everyone about hand hygiene it's importance and viable products to use to enable high compliance of use and a true broad spectrum efficacy.

There should be questions being asked about current practice and products used as the outbreaks of Norovirus continue to interrupt healthcare systems in many countries.

Why are the CDC continuing to recommend solely the use of ABHR's when the following statement has been made by a key member:

A survey of 161 long-term care facilities in the United States presented at an American College of Preventative Medicine meeting in February revealed an association between the preferential use of alcohol-based hand sanitizers for routine hand hygiene with an increased risk for outbreaks of norovirus, the highly infectious virus that causes most cases of acute gastroenteritis

Of the 45 facilities that reported preferential use of alcohol-based hand sanitizers in a recent survey, 53% experienced a confirmed outbreak of norovirus, compared with 18% of the 17 facilities that used hand sanitizers less often than soap and water.

"...these findings indicate that alcohol-based hand sanitizers might be “suboptimal in controlling the spread of noroviruses,” said Dr. David Blaney of the Epidemic Intelligence Service at the US Centers for Disease Control and Prevention (CDC).
What is an alternative, Natural Esense from Ebiox Ltd UK.

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