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Alcohol handrub


Q. Does alcohol handrub work?

A. Alcohol handrub works very well, and is more effective than soap and water at disinfecting physically clean hands. However, it is not effective when hands are dirty or soiled and against some organisms.


The evidence very clearly supports the view that it is perfectly acceptable to use alcohol handrub on its own provided none of the indicators for handwashing occur.

In summary – there are a large number of studies that have looked at alcohol and antimicrobial soap and water and compared the two. In 90% of the studies, alcohol handrubs reduced bacterial counts on the hands to a greater degree than the antimicrobial soaps.


All handrubs on the NHS Supply Chain contract have been rigorously and independently tested to ensure that they meet the very latest in EU and UN efficacy standards. The efficacy test programme was developed by leading microbiologists, including those who wrote the European test standards for these products.



Q. Is alcohol handrub always enough?

A. No. Alcohol handrub is excellent for disinfecting clean hands, but if your hands are at all dirty you need to wash with soap and water. Also, alcohol is less effective against some organisms such as Clostridium difficile and some viruses that cause gastroenteritis. Hands should always be washed with soap and water when caring for anyone with diarrhoea or vomiting or there is an outbreak of Clostridium Difficile or other diarrhoeal illness.



Q. Can Muslims use alcohol handrub?

A. This is a very common query which is in essence quite simple to answer. Although alcohol is prohibited in certain religions, many people overlook alcohol as a medical agent. In Islam any substance that man can manufacture or develop in order to alleviate illness or contribute to better health is clearly permitted. Saudi Arabia widely introduced alcohol handrub in healthcare settings in 2003 without encountering difficulties or reluctance. More information can be found in the WHO Guidelines on Hand Hygiene in Health Care.



Q. Are all disinfectant handrubs the same?

A. There are many different products sold as disinfectant handrubs, but according to the World Health Organization (WHO), alcohol-based handrubs are the only products to reduce or inhibit the growth of microorganisms with maximum efficiency. To be most effective, the handrub should contain 60-80% alcohol.



Q. Is alcohol absorbed through the skin when you use alcohol-based handrub?

A. The best available scientific evidence indicates that only a negligible amount of alcohol, too small to have any effect, is absorbed through the skin when alcohol-based handrubs are used.


Q. Can staff become ‘drunk’ by using  alcohol handrub?

A. There is no evidence to suggest this. A study published in the Journal of Hospital Infection in 2004 tried to see whether this was the case, but the results showed that alcohol levels found in blood after using the handrubs was insignificant. For more information, you can access the full article via the Science Direct website.



Q. Does alcohol work against Clostridium difficile?

A. Yes and no. Clostridium difficile (C. diff) is a spore forming bacteria. Alcohol handrub is effective against C. diff which is not within a spore, however will not be effective against C. diff spores. For this reason when looking after a patient with diarrhoea or vomiting including C. diff, handwashing with soap and water is the only acceptable way to perform hand hygiene.



Q. How many times can you use the alcohol handrubs?

A. Some people have advocated that you should wash your hands after every four or five applications of alcohol. There is no reason to do this. It should be down to personal preference and common sense. If your hands feel ‘grubby’ or are visibly dirty: wash them with soap and water at the sink.



Q. Does alcohol dry the hands or sting when applied?

A. Modern alcohol handrubs should not (if used correctly) dry the hands. Some staff may be familiar with the generation of alcohol handrubs which contained no skin softeners (emollients). Today’s generation of handrubs all contain skin softeners that help prevent drying. Of the published studies available, many describe that nurses who routinely use alcohol handrub have less skin irritation and dryness than those using purely soap and water. Alcohol handrub will sting if the staff member has any cuts or broken skin and such areas should be covered with waterproof plasters.

Allergic contact dermatitis due to alcohol-based handrub is very rare. Staff who experience problems should be referred to their occupational health departments.

The use of hand moisturisers should also be promoted to staff.



Q. Will widespread use of alcohol handrub make it likely that bacteria will become resistant to it?

A. There is no evidence to suggest this.