It is of key interest that decision makers look to what is an old recommendation from bodies such as CDC and WHO on the use of Alcohol Based Hand Rubs (ABHR’s), when in so many other aspects they are looking for the latest product and advice.
The recommendations, and I stress recommendation not legal requirement was made some 13 years ago and in that time frame issues have arisen with the use of ABHR’s and the development of non alcohol based hand rubs which have gone through rigorous efficacy testing.
The focus of any Healthcare Facility should be compliance with the hand hygiene protocols laid out for Healthcare Workers (HCW’s) it is totally irrelevant what product is used and recommended by the CDC and WHO, if HCW’s do not comply with the use of ABHR’s for which there are a number of reasons.
A forward looking Healthcare Facility will look to meet the need for increasing their compliance rate by at least a minimum offering a choice of hand rubs, not just ABHR’s.
Questions that need to be asked by a key person within the facility are:
Do we know what is the components and strength of the ABHR we use, as these are key to the efficacy of the product?
If the facility uses a hand gel, do our HCW’s wash their hands after 8-10 uses as recommended by the authorities and manufacturers? This is due to efficacy decreasing with the build up of the gel component on the hands.
So are there enough hand washing facilities?
Do the HCW’s keep their hands wet for 30 seconds using ABHR’s and therefore re-apply if they are not, as recommended by the authorities and manufacturers.
Do the HCW’s conduct a full Ayliff technique or does the ABHR dry too quickly?
Are HCW’s avoiding the use of ABHR’s, this can be for a number of reasons, so are the required compliance levels being met or improving?
If the answer to any of the questions is no then the facility will not be meeting required compliance levels and therefore failing in it’s duty of care.
Is the ABHR being stored correctly, meeting fire regulations?
How much is known about the developing resistance to ABHR’s?
There are viable alternatives in non ABHR’s, giving choice to the end user and improving hand hygiene compliance rates.
As to why the CDC and WHO have not reviewed in any depth, only they can answer.