Alcohol-based hand gel is more convenient than soap and water, but is it any better at preventing the spread of infection? Maybe not. A recent study found that although the availability of alcohol-based hand gels improved staff adherence to hand hygiene, infection rates didn't drop.

The study involved two similar adult medical/surgical intensive care units (ICUs). At the start of a 2-year study, researchers provided hand gel dispensers to one ICU but not the other; after 1 year, they reversed the assignment. In all, they observed about 300 hours of hand hygiene practiced by nurses, physicians, and other health care workers in the units.

When gel dispensers were available, workers' adherence to hand hygiene rose dramatically: from 37% to 68% in one unit and from 38% to 69% in the other. In addition, workers' hands were cleaner than before the gel dispensers were installed, based on regular culturing of samples taken from workers' hands. Higher microbial loads were associated with fingernails more than 2 mm long, wearing rings, and lack of access to hand gel.

Despite these positive findings, however, researchers found no significant change in infection rates. Although infection rates were relatively low to start with, they were surprised by the results and concluded that better hand hygiene alone won't stop hospital-borne infections. They recommend that hospitals combine hand hygiene initiatives with other measures, such as better cleaning of hospital units, proper insertion and care of catheters, and encouraging health care providers to keep their fingernails short and not wear rings.

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