Doctors Told Alcohol Gels Are Better Than Washing

By THE ASSOCIATED PRESS

HICAGO, Oct. 25 (AP) — The government issued guidelines today urging doctors and nurses to abandon the ritual of washing their hands with soap and water between patients and instead rub on fast-drying alcohol gels to kill more germs.

The goal, the government said, was to reduce the spread of viruses and bacteria that infect an estimated 2 million hospital patients in the United States each year and kill about 90,000.

Many hospitals, expecting the new guidelines from the Centers for Disease Control and Prevention, have already made the change, and studies show that this can cut their infection rates in half.

Soap and water have been the standard for generations. But washing up properly between each patient can take a full minute and is often skipped to save time, especially in busy intensive care units where the risk of spreading germs is greatest.

While the alcohol-based gels and solutions kill more microbes, the main advantage is that they are easier to use. With vials clipped to their uniforms, nurses can quickly swish their hands while on the move without stopping at a sink. The disease-control centers estimates that this saves an hour in an eight-hour intensive care shift.

"We will end up with more people doing the right thing and cleaning their hands," said Dr. Julie Gerberding, the centers' director.

Dr. Gerberding released the guidelines here at a meeting of the Infectious Disease Society of America.

The solutions are intended only to kill germs, not to remove visible dirt. So hospital workers are still expected to wash up if they get messy hands. Surgeons also have the choice of using the gels or sticking with antimicrobial soap.

Many brands of the gel solutions are available in grocery stores. They contain 60 percent to 90 percent ethanol or isopropanol.

The new guidelines apply only to hospitals and clinics, where there are many particularly nasty microbes, along with sick people who are susceptible to catching them.

At home, where such dangerous germs are far less common, ordinary soap and water are probably all that people routinely need, experts say. But the alcohol gels can make sense in situations where water is not easily available, like at picnics, in portable toilets or on airplanes.

Hospital workers are instructed to clean up between each patient, before they put on gloves, after they take them off, when inserting catheters or when doing anything else that involves contact with body fluids.

Besides giving individual containers of gel to their staff members, hospitals put dispensers at patients' bedsides, in clinics and wherever sick people are seen.

The alcohol dries in seconds without a towel and is so easy to use that "it is almost indefensible now not to clean your hands," said Dr. David Gilbert of Providence Portland Medical Center in Portland, Ore. "People can't say they are too busy anymore."

Using the gels involves squirting a dime-size dollop on one palm and then rubbing the hands together, covering all the surfaces, until the hands are dry.

Dr. Ignaz Semmelweis pioneered medical hygiene in Austria in 1846, when he speculated that doctors spread "cadaverous particles" when they delivered babies after doing autopsies. He insisted that students clean their hands with chlorine.

Introduction of the alcohol gels "is the biggest revolution in hand hygiene since Semmelweis," said Elaine Larson, associate dean for research at the Columbia School of Nursing.