Hand washing, alcohol-based rubs help curb influenza outbreaks

Study suggests soap and water may be slightly more effective than hand rubs, but both work well.

By — Posted Feb. 2, 2009

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Lathering up with soap and water appears to be marginally better than using an alcohol-based rub for fighting the influenza virus, but both reduce the amount of the pathogen on the hands, says a study in the Feb. 1 Clinical Infectious Diseases.

"For the general public who have ready access to soap-and-water hand hygiene, this is highly effective," wrote Dr. M. Lindsay Grayson, lead author and head of infectious diseases for Austin Health in Melbourne, Australia. "For health care workers where alcohol-based hand rubs are a far more practical and effective option in our current busy hospitals, [these are] also highly effective with comparable results to soap and water."

Researchers tested the hands of 20 health care workers contaminated in the study setting with an influenza virus. After air-drying, 14 had live virus detectable on their hands and, if not cleaned, had it for at least an hour. Soap and water was most effective at getting rid of the contaminant, although only slightly more so than three types of alcohol-based rubs.

"For the general public or health care workers who forget to perform hand hygiene after contamination ... their hands will likely carry large amounts of live influenza virus, and they will be quite infectious and potentially spread the virus," Dr. Grayson continued.

Experts praised the study for documenting the impact of a strategy most expect to work, even though data have been limited regarding flu virus. It also reinforced that hand hygiene, no matter how it is done, is a vital part of infection control.

"The most important thing is to do one of them," said Aaron Glatt, MD, a spokesman for the Infectious Diseases Society of America and president of New Island Hospital in Bethpage, N.Y. "Both soap and water and alcohol hand rubs are clearly effective at diminishing the number of bacteria or virus on the hands."

Hand washing is particularly key in health care settings, and public health officials have been trying to increase this activity for the past several years. The Centers for Disease Control and Prevention released its guidelines on the subject Oct. 25, 2002. Those from the World Health Organization are in process, and WHO is launching its global hand hygiene awareness program, Save Lives: Clean Your Hands, on May 5. The American Medical Association urges both health professionals and the public to adopt hand washing as an important personal priority.

"Health workers need to think a little bit more about hand hygiene as one of the methods for reducing influenza transmission," said John Boyce, MD, lead author of the CDC directive and a member of the working group writing the WHO guidelines. He also is chief of the infectious diseases section at the Hospital of Saint Raphael in New Haven, Conn.

But while both hand hygiene strategies had comparable effects on the flu virus, experts said each had its advantages. Soap and water tends to be cheaper and is recommended to deal with hands that are visibly soiled. Alcohol-based hand rubs are quicker, and tend to be easier on the skin as well as more portable. This aspect is particularly important for health care workers who often have to wash their hands many times in a day.

It's unclear how often flu is transmitted by contact with a person's hands, but the authors suggest that the skin of the six volunteers that never tested positive for the virus may be naturally inhospitable to it.

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Study at a glance

Which hand hygiene method has the most impact on killing the influenza virus?

Methods: Researchers contaminated the hands of 20 health care workers with the H1N1 flu virus and then had them clean their hands in several different ways. All had been vaccinated against the respiratory pathogen. The amount of virus on the skin was measured by culture and reverse-transcriptase polymerase chain reaction.

Results: After air-drying the hands without any soap or other cleanser, 14 of the 20 had culture-detected levels of virus on the skin. Soap and water eliminated more virus than the three alcohol-based hand rubs, although the difference between these strategies was not great.

Conclusion: All means of hand cleaning are effective at reducing influenza virus, although soap and water has the biggest impact. Hand hygiene may be an important public health initiative to reduce transmission during an influenza pandemic.

Source: Clinical Infectious Diseases, Feb. 1 (link)

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External links

"Efficacy of Soap and Water and Alcohol-Based Hand-Rub Preparations against Live H1N1 Influenza Virus on the Hands of Human Volunteers," abstract, Clinical Infectious Diseases, Feb. 1 (link)

"Guideline for Hand Hygiene in Healthcare Settings," Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee in collaboration with the Society for Healthcare Epidemiology of America, the Assn. for Professionals in Infection Control and Epidemiology and the Infectious Diseases Society of America, Oct. 25, 2002 (link)

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