Hand gel 'not enough to curb hospital infections'

Alcohol-based hand gels alone cannot kill all bacteria on the hands of hospital staff or curb the spread of infection, a US study found.

In a Nebraska hospital, medical workers nearly doubled their use of the alcohol-based gel, but their generally cleaner hands had no bearing on the rate of infections among patients.

The doctor who studied the problem pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that were not sanitised.

“Hand hygiene is still important, but it’s not a panacea,” said Dr Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Centre.

The results of his study appear to contradict hospital guidelines which say better hand hygiene, through frequent washing or use of hand gels, has been shown to cut the spread of infections.

The spread of infection-causing germs in US hospitals is a huge health problem, accounting for an estimated 1.7 million infections and 99,000 deaths each year. These include drug-resistant staph, urinary tract infections and ventilator-associated pneumonia, among others.

“There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem,” Dr Rupp said.

His study appears in the January issue of Infection Control and Hospital Epidemiology.

Research has shown alcohol-based hand gels are more effective, faster and easier to use than soap and water.

The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.

More gel dispensers were put in the units, and usage rose from 37% to 68% in one unit and from 38% to 69% in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40%, according to experts, although some hospitals do better.

Every two months, bacteria samples were taken from health workers’ hands, which were found to be cleaner when using the alcohol gel.

The infection rates in both ICUs were “relatively low,” the study said. And researchers found “no significant relationship” between rates of hand gel use and infections among patients. In fact, in one unit the infection rate rose when the hand gel was widely available and its use promoted.

Dr Rupp found the results surprising. However, he said hospital-borne infections cannot be stopped by better hand hygiene alone because infections were not limited to person-to-person contact.

He suggested hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and doctors prescribing antibiotics only when necessary so more drug-resistant bacteria do not pop up.

He also said hospital workers should not wear rings and should trim their fingernails even shorter than the recommended 0.25in.

Dr Rupp said bacteria showed up when nails extended just beyond the fingertip.