The provision of alcohol-based products to improve compliance
with hand hygiene
About this Report
Hand hygiene is considered to be a primary measure in reducing
the spread of healthcare associated infection (HAI). NHS Quality
Improvement Scotland (NHS QIS) has issued advice to NHSScotland on
the use of alcohol gel to improve hand hygiene in hospitals.
Alcohol gel is a substance that can be used to clean hands without
using water. We have advised that alcohol gel should be provided in
hospitals for all staff who may come into contact with patients,
and for hospital visitors, particularly where handwashing
facilities are limited. However, alcohol gel should complement, not
replace, existing handwashing facilities.
Objectives of the Health Technology Assessment (HTA)
The objectives of this HTA are as follows:
- to review the existing literature on the effectiveness and
costs and benefits of alcohol-based hand hygiene products¿
- to assess whether the added benefits of improving hand hygiene
are likely to offset the additional costs.
The clinical effectiveness of alcohol-based hand hygiene
products is assessed in terms of improvements in hand hygiene
compliance and reductions in HAI through hand hygiene. For the
purpose of this report, the term ¿hand hygiene¿ refers only to
handwashing with soap and water and the use of alcohol-based hand
- Despite the lack of unequivocal evidence, the potential benefit
of providing alcohol-based hand hygiene products is likely to
outweigh the costs and therefore these should be available for use
by all NHSScotland staff working in clinical areas. Alcoholbased
hand hygiene products should also be provided for the use of
visitors, particularly where handwashing facilities are
- Staff planning local initiatives to improve hand hygiene should
note that multi-component interventions are more likely to be
effective and sustainable than single-component interventions.
Although such initiatives are more resource intensive, these have
greater potential to be cost effective.
- Robust evaluation of any hand hygiene intervention should be
carried out. This will require compliance and/or infection rates to
be audited both before and after the intervention and possible
influences on these rates to be taken into account. Comparator
groups should be included wherever possible.
- Studies of the effectiveness of hand hygiene interventions
should be published. This will allow a body of literature to be
established which could subsequently be synthesised to identify the
most effective interventions for particular clinical
Published Date: 10 May 2005