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Hospital Hand Hygiene 'Revolution'

The government issued guidelines Friday 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: reduce the hospital spread of viruses and bacteria that infect an estimated 2 million people in the United States each year and kill about 90,000.

Many hospitals, anticipating the new guidelines from the Centers for Disease Control and Prevention, have already made the change, and studies show 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 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 CDC estimates this saves an hour in an eight-hour intensive care shift.

"We've learned that using alcohol-based products improves adherence to hand hygiene," said Dr. Julie Gerberding, the CDC's director. "We will end up with more people doing the right thing and cleaning their hands."

She released the guidelines in Chicago at a meeting of the Infectious Disease Society of America.

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

Many brands of the solutions are available in grocery stores. They vary in how they look, feel and smell. But all contain 60 percent to 90 percent ethanol or isopropanol, and they are considered equally effective at killing germs.

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 bugs are far less common, experts say ordinary soap and water are probably all people routinely need. But the alcohol gels can make sense in situations where water is not be easily available, such as 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, 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. People can't say they are too busy anymore," said Dr. David Gilbert of Providence Portland Medical Center in Portland, Ore., president of the Infectious Disease Society.

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

Typically, people carry between 10,000 and 10 million bacteria on each hand. The medical profession has long known this is one way disease is transmitted. Dr. Ignaz Semmelweis pioneered the field 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 Columbia School of Nursing. "We used to say `hand washing.' Now it's hand hygiene."

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