Hand Washing vs Hand Sanitizer

By Rebecca Israel, MS, Charles Li, MD

April 13, 2020

  • Researchers compared the number of norovirus outbreaks in New English long-term care facilities and hand hygiene practices.

  • Staff who preferred the use of alcohol-based hand sanitizers over handwashing were 3 times as likely to have a norovirus outbreak in their facility.

  • Alcohol-based hand sanitizer is recommended for daily use but not as a replacement for standard handwashing practices.

Hand Washing vs Sanitizer

Study Design

Researchers wanted to know if the preferred use of alcohol-based hand sanitizer over handwashing was considered a risk factor for increased norovirus outbreaks, and to what magnitude.

Questionnaires related to the norovirus outbreak were distributed to state health departments in Maine, New Hampshire, and Vermont.

62 long-term care facilities reported 73 outbreaks, 29 of which were laboratory confirmed norovirus.

These 73 outbreaks caused illness in 1,830 residents and 1,288 staff. The subset of 29 confirmed norovirus outbreaks caused illness in 1,184 residents and 757 staff.

Source: Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007.

Hand Washing vs Sanitizer Study

Results

Of the facilities reporting staff use of alcohol-based hand sanitizer equally or more often than handwashing, 53% had at least one confirmed outbreak of norovirus. This compares to 18% of the 17 facilities reporting routine use of alcohol-based hand sanitizer less often than handwashing. This confirms that the preferred use of alcohol-based hand sanitizer is a risk factor for viral outbreaks.

Of the facilities who reported this risk factor, 89% experienced a norovirus outbreak, compared to 60% of facilities that did not use alcohol-based hand sanitizer equally or more often than handwashing.

During the outbreak, staff who preferred the use of alcohol-based hand sanitizers were 3 times as likely to have a norovirus outbreak in their facility.

The odds that staff would prefer alcohol-based hand sanitizer for routine hand hygiene were 6 times higher in facilities experiencing norovirus outbreaks.

Are Hand Sanitizers Better?

Implications Today

This study implies that alcohol-based hand sanitizer is not a sufficient replacement for standard handwashing practices. However, their efficacy increases when used together.

Both alcohol-based hand sanitizer and handwashing are recommended for use in and out of clinical settings.

In today’s COVID-19 outbreak, healthcare workers and the general public must stay vigilant in their hand hygiene practices to reduce the spread and flatten the curve.

CDC Hand Washing Guide

Source: When & How to Wash Your Hands

Alcohol-based hand sanitizer and handwashing reduce the spread of germs between people and surfaces.

Both hand hygiene practices require 20 seconds of scrub and drying time to be most effective.

Alcohol-based hand sanitizer must be at least 60% alcohol.

CDC Hand Sanitizer Guide

Source: When & How to Wash Your Hands

Activities in which to consistently practice hand hygiene include preparing food, caring for someone sick, using the toilet, taking out the garbage, playing with animals, touching shared surfaces, and riding public transportation.

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