Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness

Background: The effectiveness of an alcoholic solution compared with the st andard hygienic handwashing procedure during regular work in clinical wards and intensive care units of a large public university hospital in Barcelon a was assessed. Methods: A prospective, randomized clinical trial with crossover design, pa ired data, and blind evaluation was done. Eligible health care workers (HCW s) included permanent and temporary HCWs of wards and intensive care units. From each category, a random sample of persons was selected. HCWs were ran domly assigned to regular handwashing (liquid soap and water) or handwashin g with the alcoholic solution by using a crossover design. The number of co lony-forming units on agar plates from hands printing in 3 different sample s was counted. Results: A total of 47 HCWs were included. The average reduction in the num ber of colony-forming units from samples before handwashing to samples afte r handwashing was 49.6% for soap and water and 88.2% for the alcoholic solu tion. When both methods were compared, the average number of colony-forming units recovered after the procedure showed a statistically significant dif ference in favor of the alcoholic solution (P <.001). The alcoholic solutio n was well tolerated by HCWs. Overall acceptance rate was classified as "go od" by 72% of HCWs after 2 weeks use. Of all HCWs included, 9.3% stated tha t the use of the alcoholic solution worsened minor pre-existing skin condit ions. Conclusions: Although the regular use of hygienic soap and water handwashin g procedures is the gold standard, the use of alcoholic solutions is effect ive and safe and deserves more attention, especially in situations in which the handwashing compliance rate is hampered by architectural problems (lac k of sinks) or nursing work overload.