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Risk management




Q. What about the possible dangers of patients drinking the handrubs?

A. Concerns about alcohol handrub being ingested are real and are based on some reported cases where this has happened. It is of the utmost importance that a thorough local risk assessment is undertaken prior to deciding on placement of handrubs.


In reality this means that a number of clinical areas (e.g. areas for caring for and treating patients with confusion, alcohol related clinical conditions, or very young children) may decide to issue staff-carried dispensers. This enables the unit or service to adhere to the principle of point of care availability whilst at the same time minimizing risk of ingestion.  More information on reported risks can be found in the Summary of review of NRLS data for incidents related to alcohol handrub.



Q. What are the fire risks of alcohol handrub?

A. The risk of fire with alcohol handrub is low but, due to the flammability of alcohol, fire is recognised as a hazard. Everything possible therefore should be done to minimise risk.


A thorough local risk assessment should be undertaken when deciding on the placement of the alcohol handrub dispensers. This may mean that in some clinical areas (for example when caring for children or confused patients) staff will need to be issued with personal dispensers of alcohol handrub. This adheres to the principle of point of care availability whilst at the same time minimising any risk to patients.

It is important to educate staff when using alcohol handrubs about the importance of rubbing the hands together until the alcohol has completely dried. This is to counter any chance of static electricity shock from touching metal objects. In the USA where guidelines were published two years ago promoting much more widespread use of alcohol handrub, the fire risk has been addressed in a robust way. A survey published in Infection Control and Hospital Epidemiology in 2003 found that 766 hospitals in the USA had been using alcohol handrubs for an estimated combined total of 1,430 years without a single fire attributed to, or involving, an alcohol dispenser.


There are also risks regarding the storage of alcohol handrub, which need to be managed. NHS Estates issued an alert providing guidance on this in conjunction with the National Patient Safety Agency’s Patient Safety Alert: Clean hands save lives on the provision of alcohol handrub at the point of care.


Finally it is important to emphasise that the benefit of reducing infection greatly outweighs these risks.