Lately, media coverage of articles claiming bacteria is becoming resistant to hand sanitizer has gotten quite a bit of attention in the infection prevention space. However, before we sound the alarms, it is important to look beyond just the titles of these articles and see the facts.
The information is based on an Australian study using a mouse gut colonization model, that tested alcohol tolerance of E. faecium bacteria collected from 1997 to 2015 with different concentrations of alcohol. The results of the study suggest that the more recently collected bacteria were more resistant to the alcohol than the older samples. An important thing to note here, is that the study is saying the bacteria were “more tolerant” of the alcohol, not that they are resistant.
One article suggested that these results show that “hand rubs containing higher concentrations of alcohol will be needed to overcome this resistance.” I would agree this is true, and has been so for the past few decades. In fact, Didier Pittet, Epidemiologist at the University of Geneva Hospitals and Clinics in Switzerland, and the leader of the WHO hand hygiene initiative since 2005, states that the backbone of that initiative is the use of hand sanitizers containing at least 60 to 80 percent alcohol. “Their use in hospitals over the past two decades is thought to be largely responsible for declining infection rates in many health care settings, including rates of infections with the dreaded Methicillin-resistant Staphylococcus aureus (MRSA).” Pittet also says that the study is well written but “its only clinical relevance is to reinforce what experts have been saying all along -- make sure you use enough alcohol for long enough to kill all the germs.”
There have been found to be some limitations to the study, even the researchers themselves admit that there might be other confounders than just the alcohol sanitizer, because they don’t fully understand the adaptive forces that are led to the VRE development in their research. Also, more studies are needed to determine if the same resistance occurs outside of Australia, in human subjects, as opposed to mice, and with other types of bacteria.
Now, we don’t want to discredit the work that has been done, the findings are interesting and highlight a need for rigorous adherence to hand hygiene protocols. As Didier Pittet stated, it reinforces an important message that all healthcare staff should follow, making sure we not only use hand sanitizer but use it properly – with a high enough concentration of alcohol and for 20-30 seconds – to ensure the best results.
As one article said, don’t throw away the hand sanitizer yet. Per experts when it comes to preventing infection, alcohol-based hand rubs are still your best friend. Hand sanitizer has proven effective in the fight against most deadly infections, including MRSA – so there is absolutely a need to maintain usage of alcohol-based handrubs in healthcare to achieve overall patient safety.