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Hand washing or sanitising - which is best?25th of November 2011
Hand sanitisers are becoming increasingly widely used as the public’s fear of becoming ill grows higher with each new health scare. However, a recent study has linked the use of hand sanitisers to an increased risk of Norovirus. So are sanitisers a good substitute for soap and water, or aren’t they?
Suddenly, hand sanitisers are being offered everywhere as a quick and easy substitute for soap and water. Following the recent swine flu and E.coli scares, the presence of hand sanitisers in hospitals, shopping centres and offices serves to remind us all of the need for good hand hygiene. This is obviously a positive step, but there is a risk that people might begin to regard them as a 'quick fix' and an alternative to hand washing. But would this be such a bad thing?
Global advice on the use of hand sanitisers versus hand washing can be somewhat vague. The UK’s Health Protection Agency claims that sanitising gels may be of benefit when used after a hand wash, but adds they should not be regarded as a substitute for soap and water since they may fail to remove all contamination from the hands.
The Center for Disease Control in the US also claims clean, running water plus soap should be used where available, but that a hand sanitiser containing an alcohol content of at least 60 per cent may be used instead where there is no convenient water supply.
However, a recent study in the US indicated that alcohol-based hand sanitisers may actually increase the risk of Norovirus in healthcare settings. Staff in long-term care facilities where Norovirus has been reported were found to be six times more likely to use hand sanitisers either to the same degree or more frequently than they would use soap and water.
Some more effective
According to Hagleitner’s washroom hygiene product manager Nicole Wolfbeisz, the reason for these findings could lie in the fact that some hand sanitisers are more effective than others. “Untrained personnel may not be aware of which hand sanitisers are effective against noroviruses and which aren’t,” she said. “If only partially-virucidal products are used, staff might think they are safe from contamination - but may then go on to spread the virus.”
Hagleitner offers sept LIQUID PLUS, an alcoholic solution claimed to be effective against MRSA and Noroviruses, plus a range of soaps including septFOAMSOAP which is aimed at hygiene-sensitive areas such as kindergartens and kitchens.
According to Wolfbeisz, sanitisers have become increasingly important following recent health scares – and she believes they can help to prevent mass infection. “A recent study carried out at the Ernst Moritz Arndt university in Germany found that administrative employees who sanitised their hands several times a day reported fewer common illnesses than their colleagues who did not use the sanitisers.”
She adds that hand sanitisers provide an effective, convenient and simple alternative to hand washing –while also offering economic advantages. “Hand sanitisers avoid the need for a sink, mountings, water supply, disposable towels, soap and waste paper,” she said, “They only need a dispenser which means that the everyday costs of hand disinfection are lower.”
Wolfbeisz concedes that soap and water are necessary for cleaning visible dirt from the hands. “But if hands are already clean it is better to sanitise than wash since frequent hand washing can lead to dry hands, especially in the nursing sector,” she said.
However despite all the benefits offered by hand sanitisers, Wolfbeisz admits that they cannot take the place of old-fashioned soap and water. “The Food and Drug Administration says hand sanitisers may be used as a supplement - but not as a substitute for hand washing,” she says.
SCA’s product manager hand hygiene and care Peter Bergman feels that washing the hands with water and a mild soap and then drying them with a paper towel is the best choice from a hygiene point of view. “Washing is the best policy since this will remove soiling as well as many bacteria and viruses,” he said. “However, an alcohol-based sanitiser can be a very good substitute provided your hands are not actually dirty.“
He agrees hand sanitisers offer a number of advantages: for instance, they can be gentler on the hands than soap and water in professions where frequent washing is necessary. They also provide a rapid and convenient hand hygiene solution – and one that can be carried around in the pocket.
Difficult to kill
“Hand sanitisers can also be very effective against many bacteria,” he said. “However, there are some types of viruses – such as the Norovirus - that are difficult to kill with a sanitiser so for most situations hand washing is preferred.“
SCA’s new Tork Antimicrobial Foam Cleanser is a two-in-one soap and hand sanitiser claimed to destroy bacteria, viruses and fungi. The company also offers a Tork Premium alcohol gel hand sanitiser said to leave the hands 99.9 per cent bacteria free.
Senior segment marketing manager at Kimberly-Clark Professional Richard Millard claims that both hand sanitisers and hand washing have a valid place in a good daily hand hygiene routine.
“There are occasions where hand washing followed by sanitising is needed, especially in hygiene-critical areas,” he said. “We believe that good hand washing with hygienic soap followed by good hand drying with single use towels is the most effective method of removing both visible and invisible contamination from the hands. However it is not always the most practical method, depending on the frequency with which hand hygiene practices are required and the availability of soap, water and towels.”
He says hand sanitisers offer a suitable alternative for hand washing in certain circumstances. “Wider knowledge and understanding by the public is required to ensure that sanitisers are seen as a complementary solution to keeping hands clean,” he said. “I feel sometimes people believe sanitisers to be the new replacement for washing and drying. They are more convenient - however they cannot replace hand washing completely.”
He says sanitisers are a good option in crowded environments such as on public transport, in busy offices and airports. “Here there is huge potential for hand-to-hand and surface-to-hand germ transmission and it is more about what is practical to use,” he said.
Of the recent Norovirus study he said: “The actual study highlighted in a number of cases, outbreaks of norovirus occurred more often at healthcare locations where more emphasis had been placed on hand sanitising and less often at locations where hand washing had the greater emphasis.
“As the CDC states in its comments regarding the study, far more work would be needed to prove whether there was an actual link between the outbreaks and heavier reliance on sanitisers. It also comments on the efficacy levels of the sanitisers as there are a variety of different types with different effects on the Norovirus.“
Kimberly-Clark Professional has recently launched an Alcohol Gel Hand Sanitiser under the KLEENEX brand claimed to be effective against the Norovirus.
Vectair’s marketing manager Matthew Wonnacott claims that both hand washing and hand sanitisers have their place in a good hand hygiene regime. “If you are walking around in an open environment and touch something dirty - such as a park bench - it would be seen as hygienic to sanitise your hands with a small dose of hand sanitiser,” he said. “However, the individual would still be advised to wash their hands with soap and water at the first opportunity, especially if their hands were visibly dirty.”
Vectair offers hand sanitisers and soaps including the Sanitex Instant Hand Sanitizer which is claimed to be quick-drying and soft on the skin.
According to Wonnacott, hand washing offers several advantages over sanitising. “Washing hands with soap after using the toilet and before handling food can reduce rates of diarrhoea by nearly 50 per cent and rates of respiratory infection by about 25 per cent,” he said. “Using soap breaks down the grease and dirt that carry most germs by facilitating the rubbing and friction that dislodges them.
“Hand washing with soap, however, does take a considerable amount more time than sanitising with gel products, which is why hand sanitisers are preferred in certain areas such as outside a hospital ward where people need a quick ‘fix’.“
Level of protection
Metsä Tissue sales director UK and Ireland Mark Dewick agrees that sanitisers provide a good level of protection where access to soap, water and hand towels are limited. “In healthcare environments where hygiene is a minute-by-minute necessity and there is constant exposure to new hand contamination it is simply not practical to wash and dry your hands every few minutes,” he said.
“However, a slovenly use of sanitisers can give a false sense of comfort. Proper methodologies to reach every part of the hand still need to be followed – a quick drop in the palm and a token rubbing of the hands is not good hand hygiene since the sanitiser will not work if it does not touch all areas.”
He adds that washing the hands according to proven methodologies and drying them with a paper towel is still recognised as the most effective way to reduce bacteria spread.
“Studies prove it time and time again,” he said. “While sanitisers have a role to play, going back to basics is still the best solution wherever possible.”