Frequently Asked Questions about Hand Hygiene for Healthcare Personnel Responding to COVID-2019

·         Laboratory data demonstrate that 60% ethanol and 70% isopropanol, the active ingredients in CDC-recommended alcohol-based hand sanitizers, inactivates viruses that are genetically related to, and with similar physical properties as, the 2019-nCoV.

·         CDC recommends the use of alcohol-based hand sanitizers with greater than 60% ethanol or 70% isopropanol as the preferred form of hand hygiene in healthcare settings.

·         Alcohol-based hand sanitizers DO NOT kill ALL types of germs, such norovirus, some parasites, and Clostridium difficile. Hand sanitizers also may NOT remove harmful chemicals, such as pesticides and heavy metals like lead. In contrast, hand washing mechanically removes pathogens, hence reduces the amounts of all types of germs, pesticides, and metals on hands.

What method of hand hygiene is recommended for healthcare personnel in response to COVID-2019?	The CDC continues to recommend the use of alcohol-based hand rub (ABHR) as the primary method for hand hygiene in most clinical situations1. ABHR effectively reduces the number of pathogens that may be present on the hands of healthcare personnel after brief interactions with patients or the care environment. In addition, frequent use of ABHR formulated with emollients is less damaging to the skin than frequent hand washing. This factor, along with ease of use and greater access, leads to greater overall compliance with use of ABHR than hand washing with soap and water.  Hands should be washed for at least 20 seconds with soap and water when visibly soiled, before eating, and after using the restroom.
Are benzalkonium chloride-containing hand rub products an acceptable alternative to ABHR for COVID-19?	CDC does not have a recommended alternative to hand rub products with greater than 60% ethanol or 70% isopropanol as active ingredients. Benzalkonium chloride, along with both ethanol and isopropanol, is deemed eligible by FDA for use in the formulation of healthcare personnel hand rubs.  However, available evidence indicates benzalkonium chloride has less reliable activity against coronavirus than either of the alcohols.
Can healthcare facilities substitute unformulated ethanol in concentrations greater than 60% or isopropanol greater than 70% for use as alcohol-based hand rub?	Given the drying effect of alcohols and the importance of maintaining skin integrity of healthcare personnel with their need to perform hand hygiene frequently, alcohols should not be used unless properly formulated with emollients.

References:

1.        https://www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene-faq.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fhcp-hand-hygiene-faq.html

2.        https://www.cdc.gov/handwashing/pdf/hand-sanitizer-factsheet.pdf

Accessed 6 April 2020