Hand rubs and the skin

Hand rubs

Hand rubs are gels or liquids containing antimicrobial agents that decrease the number of microorganisms present on hands. The antimicrobial agents in most hand rubs are alcohols (ethanol, isopropanol, and n-propanol), available in varying concentrations. Because hand rubs do not remove organic material, they cannot be used if hands are visibly soiled. They are sometimes called sanitisers.

Ethanol, at a concentration of 60% or greater, is effective against:

• Most bacteria – including multidrug-resistant bacteria such as MRSA
• Fungi
• Some viruses, such as influenza virus, herpes simplex virus, rotavirus, and HIV. Hepatitis viruses and enteroviruses may require a higher concentration of alcohol to be reliably inactivated.

Alcohol-based hand rubs have limited effectiveness against bacterial spores (e.g. Clostridium difficile), protozoan oocysts, and certain viruses.

Hand rubs

Regular household soap

Social handwashing with non-antiseptic household soap removes bacteria and viruses by physical/mechanical means. Household soaps act as a detergent to help remove loosely adherent bacteria and viruses; microorganisms are not actually killed by these products. Downsides to washing hands using this method include:

• Contact with contaminated taps, towels, or the sink edge after washing hands
• Bacteria stick more readily to wet hands, increasing the risk of contamination

Healthcare settings

Healthcare settings traditionally use chemical hand-wash products, such as chlorhexidine in addition to alcohol. These products have antimicrobial/antiseptic properties and are effective against many bacteria, fungi, and viruses.

Most studies comparing the effectiveness of hand rubs against regular hand-washing have been performed in healthcare settings. These data show that hand rubs are at least as effective as traditional hand-washing with chemical hand-wash products in reducing bacterial counts on skin and in reducing hospital-acquired infections. Furthermore, hand rubs are less irritating to the skin than traditional chemical hand-wash products.

Side effects of hand rubs

It is uncommon to experience side effects from using hand rubs. Evidence shows that hand rubs are less damaging to the skin than soap and water. However potential skin reactions from hand rubs include:

• Irritant contact dermatitis
• A brief stinging sensation if skin is dry or cracked
• Allergic contact dermatitis, usually to a preservative
• Contact urticaria to the ethanol or other ingredient

These reactions are more likely in those with existing dermatitis or sensitive skin.

When to use hand rubs

• In the home, regular household soaps will likely be sufficient to prevent transmission of infectious diseases
• Hand rubs can be used when there is no access to sinks and clean running water
• Hand rubs should not be used when the skin is visibly soiled or contaminated with blood or other body fluids
• Hand rubs are increasingly recommended in healthcare settings.

How to use hand rubs

• Hand rubs should be applied to dry hands
• Apply at least 3 mL, or enough to completely wet hands
• Rub hands together covering all surfaces for at least 10 to 30 seconds until hands are dry