In Any Setting, How Does Ethanol Hand Sanitizer, Compare to Antimicrobial Soap, When it Pertains to Reducing Bacteria?Tamera Jean-BaptisteUniversity of the Virgin IslandsJune. 18, 2019AbstractThe main focus of this evidence base project is to acquire a more in-dept understanding on the effectiveness of an alcohol-based hand sanitizer versus an antiseptic hand soap for bacterial removal. Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field. According to the studies, alcohol-based hand sanitizer is suggested as an appropriate option to soap and water in hospital and clinical environments, as healthcare practitioners often fulfill tasks in sterile environments and are needed to wash their hands continuously throughout the hospital day. However, research has shown that in some instances washing your hands with soap and water may be more beneficial in cases of C. Difficile. Handwashing with soap and water showed the greatest effectiveness in removing C. difficile and should be the preferred technique over the use of alcohol-based hand rubs when contact with C. difficile is suspected or likely. In most of the articles that were compared most of them were randomized controlled trials and agreed to the fact that hand sanitizers are better in preventing transfer of bacteria from one person to another, due to the bactericidal effect. In this research paper articles were compared with each other to come up with the proper recommendation and conclusion.Key Words: Handwashing, Antiseptic soap, Infection control, Water, Hand sanitizer, Bacteria, EffectivenessIn the HealthCare Setting, How Does Ethanol Hand Sanitizer, Compared Hand WashingOne of the most important things you can do to help prevent and control the spread of many diseases is to wash your hands properly. Good hand hygiene will reduce the risk of transmission from person to person of things like flu, food poisoning and health-related infections. Hands usually carry lots of germs and should be washed in your hands after visiting the toilet, before handling food, when visibly dirty, and after coughing or sneezing.Contaminated hands can spread an excessive amount of infectious illnesses from one individual to another. These illnesses include infections of the gastrointestinal system such as salmonella, and respiratory infections such as influenza. Washing your hands correctly can avoid germs that trigger these illnesses from spreading, such as bacteria and viruses (Centers for Disease Control and Prevention, 2017). The best research question pertaining to this article is In Any Setting, How Does Ethanol Hand Sanitizer, Compare to Antimicrobial Soap, When it Pertains to Reducing Bacteria?Purpose of ProjectThe final purpose of the study was to determine the efficacy of the alcohol-based hand sanitizer to the bacterial removal antiseptic hand soap.Background and Clinical SignificanceTainted hands assume a key job in moving fecal particles from one host then onto the next. An individual who practices inadequate hand cleanliness after defecating can move pathogens to different people through direct contact, contact with inanimate objects and surfaces, and most importantly food preparation. Hand-based transmission of pathogens is abundant to the point that handwashing with cleanser has been contended to be the best intercession to prevent health issues in the population. After reading the articles, the magnitude of the research article would be large. Hand washing is important in nursing because, hand washing prevents spreading bacteria from the patient’s surroundings to the patient themselves. Patients obtain bacteria mainly through environmentally contaminated hands. It is always contaminated with bacteria that are good or bad. Therefore, educating patient with proper hygiene is important. Clinical significance was founded that because alcohol-based hand gels are highly effective, health care professionals should feel confident in replacing soap and water with an alcohol-based gel.Literature ReviewHand hygiene is essential because it protects patients and medical staff. We wash our hands to prevent the spread of microorganisms and the illnesses they trigger. We need to aware of the opportunities for spreading microorganisms and ultimately, when providing patient care, infection. Excellent hand hygiene has been shown by research to avoid health-acquired diseases (HAIs).Search StrategyDatabase used for this research paper was PubMed, CINAHL, Cochrane Library, and EBSCOhost. Using the keywords, “Handwashing”, “Antiseptic soap”, “Infection control”, “Water”, “Hand sanitizer”, “Bacteria”, “Effectiveness”. Critical Appraisal of EvidenceIn three articles there were large sample sizes and the other three articles there were small sample sizes. “The larger the sample, the more representative of the population it is likely to be; the smaller the less accurate the results would be (LoBiondo-Wood, 2017, p. 225).” Studies were randomized controlled trials, which was a level 2. Outcomes of the study after comparing all six articles was that hand sanitizer was a more beneficial, because it eliminated bacteria more than hand washing with soap and water, even if antimicrobial soap was used. However, hand washing with soap and water was preferred over hand sanitizer when tested again Clostridium Difficile. *See Tables 1-6* In the summary tables, it included the design the purpose, the conclusion, result, strength, and level of evidence. From tables 1 through 3 includes summary table for intervention, and from 4 through 6 includes summary tables for comparison.Summary of FindingsIn Table 1, they examined how the hand sanitizer’s antimicrobial efficacy is compared to soap and water handwashing., which poses a tremendous risk. A collection of six secondary schools was used. The research included a total of 53 students and 9 educators. The structure of the research was a quantitative, randomized controlled test and a secondary analysis. In contrast, handwashing with soap and water led in a decrease of 0.50 and 0.25 log per side of E. Both coli and fecal streptococci. Hand sanitizer was considerably easier than handwashing to reduce fecal streptococci concentrations (P= 0.01). The level of evidence for this research was a 2. Overall, participants to the research showed favorable responses as a hand maintenance method to the alcohol-based hand sanitizer(Pickering et al., 2010). In Table 2, This article was collected on Cochrane Library Article, they performed a research. To compare the efficacy of hand rubbing with an alcohol-based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care. A total of 23 healthcare workers were included in the study and analyzed. With hand scrubbing, the average percentage of bacterial contamination reduction was significantly higher than with hand scrubbing (83% v 58%, P=0.012), with a maximum difference of 26% (95% confidence interval 8% to 44%). In each team, the median hand hygiene duration was 30 seconds. When concluded, they found out that hand rubbing with an alcohol-based alternative is considerably more effective in decreasing manual contamination during regular patient care than handwashing with antiseptic soap (Girou, 2002).In Table 3, The aim of this research is to determine whether hand gels depending on alcohol are effective in decreasing bacteria spread. The volunteers were 24 students, and 10 faculty members at the State University of Maringa´. Their ages ranged from 18 to 58 years. As expected, the best hand gel described was Sterillium, which reduced the population of E. coli in the application time of 60 seconds. Approximately 90% more bacteria on the fingers than the reference liquor (Hilburn et al., 2003).In Table 4, This Cochrane Review summarizes studies assessing the impacts of encouraging hand washing on the incidence of diarrhea in daycare centers, colleges, groups, or hospitals among kids and adults. They included 22 randomized controlled trials carried in both high-income nations (HICs) and low-and middle-income nations (LMICs) after looking for appropriate tests up to 27 May 2015. 69,309 kids and 148 adults were registered in these studies. The level of evidence is 2. Promoting hand washing in high-income nations (HICs) and low- and middle-income nations (LMICs) can decrease the occurrence of diarrhea by around 30%. Less is understood about how to assist individuals to retain long-term hand washing practices (Ejemot-Nwadiaro et al., 2015).In Table 5, the aim of this practice was to examine the risk reduction obtained by using a microbial quantitative risk assessment strategy based on exposure to bacteria from hand contamination after diaper altering with and without antibacterial soaps during hand washing. While the customer may think that washing hands with soap results in’ smooth’ fingers, they may not be microbiologically smooth. After diapering, adequate hand washing is a home or day care exercise that could easily decrease or practically eliminate the danger of transmission of disease. The designs indicate that this danger is mildly lowered with the use of an antimicrobial formulation, but this requires further assessment. The strategy to threat assessment enables relative assessment of products and protocols that can provide enhanced security of public health (Gibson et al., 2002).In Table 6, the purpose of the study is to evaluate common hand hygiene choice for efficacy in removing Clostridium difficile. The comparison as among 10 volunteers with hands experimentally contaminated by nontoxigenic C. difficile. The design was a randomized crossover. Which researchers concluded that handwashing with soap and water was the most effective way to remove C. Difficile and should be used over alcohol-based hand rubs. when in contact with C. Difficile (Oughton et al., 2009). Practice Recommendations, Integration into Practice & Dissemination of FindingsIn conclusion, the research question compared six articles that explained the benefits of handwashing with antimicrobial soap and water versus the benefits of using ethanol-based hand sanitizer. Ethanol-Bases hand sanitizer was proven to be the best in preventing cross contamination from person to person. Even though ethanol-based sanitizer was proven to be best, antimicrobial soap was proven to be the best choice when it comes to removing C. Difficile and should be used over hand sanitizer. “Everyone should understand the facts on hand hygiene and hand sanitizer based. Which is ethanol-based alcohol destroys most of the poor germs that makes you ill and is the best way to wash your hands in healthcare environments. However, hand sanitizer based on alcohol does not destroy C. difficile, a prevalent infection associated with health care that creates serious diarrhea. Patients with C. difficile should wash their hands with water and soap and ensure that their healthcare suppliers always carry gloves when they take care of them. Hand sanitizer based on alcohol is more efficient and less drying than soap and water and does not generate superbugs that are resistant to antibiotics (Centers for Disease Control and Prevention, 2017). These finding support a change in practice, because it educates others on the importance of handwashing and the use of hand sanitizer. The basis of this foundation is information founded using scholar databases, and Cochrane reviewed articles. The strength of the intervention in this study is a level 2, which is a randomized controlled trial.The recommendations can be disseminated by either publications, conferences, consultations, and training programs. The key stakeholders are individuals such as nurses, doctor and other medical related professions. It can also relate to patients that have an immunodeficiency, or other health issues that require them to always practice hand hygiene. Lastly, some recommendation pertaining to change is educating patient and the community with the importance of handwashing with soap and water or hand sanitizers. Some people may think that washing their hand with soap and water can be adequate, however making sure that they know the benefits of using hand sanitizer can help in reducing the transfer of bacteria’s from one person to another.Appendix ATable 1Table 2Table 3Table 4Table 5Table 6ReferenceCenters for Disease Control and Prevention. (2017). Clean Hands Count. [online] Available at: https://www.cdc.gov/features/handhygiene/index.html [Accessed 4 Jul. 2019].Ejemot-Nwadiaro, R., Ehiri, J., Arikpo, D., Meremikwu, M. and Critchley, J. (2015). Hand washing promotion for preventing diarrhoea. Cochrane Database of Systematic Reviews.Gibson, L., Rose, J., Haas, C., Gerba, C. and Rusin, P. (2002). Quantitative assessment of risk reduction from hand washing with antibacterial soaps. Journal of Applied Microbiology, 92(s1), pp.136S-143S.Girou, E. (2002). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial.Gould, D., Moralejo, D., Drey, N., Chudleigh, J. and Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews.Hilburn, J., Hammond, B., Fendler, E. and Groziak, P. (2003). Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. American Journal of Infection Control, 31(2), pp.109-116.Langley, J. (2002). From Soap and Water, to Waterless Agents: Update on Hand Hygiene in Health Care Settings. Canadian Journal of Infectious Diseases, 13(5), pp.285-286.LOBIONDO-WOOD, G. (2017). NURSING RESEARCH. 9th ed. Saint Louis, Missouri: MOSBY, p.225.Oughton, M., Loo, V., Dendukuri, N., Fenn, S. and Libman, M. (2009). Hand Hygiene with Soap and Water Is Superior to Alcohol Rub and Antiseptic Wipes for Removal of Clostridium difficile. Infection Control & Hospital Epidemiology, 30(10), pp.939-944.Pickering, A., Davis, J., Boehm, A. and Mwanjali, M. (2010). Efficacy of Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar es Salaam, Tanzania. The American Journal of Tropical Medicine and Hygiene, 82(2), pp.270-278.