Bloodborne pathogens (BPPs) are microorganisms, such as viruses and bacteria, transmitted through human blood and other potentially infectious materials. These pathogens, including Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV), pose a serious infection risk upon exposure. While alcohol-based hand sanitizers are a standard tool for general hand hygiene, they are considered an unreliable and insufficient method for eliminating bloodborne threats. They should not be used as a primary solution following any exposure incident involving blood or bodily fluids.
The Mechanism of Alcohol-Based Hand Sanitizers
Alcohol-based hand sanitizers (ABHS) rely on a high concentration of ethyl alcohol (ethanol) or isopropyl alcohol (isopropanol) to destroy microorganisms. For maximum efficacy, the alcohol concentration needs to be within a range of 60% to 95%. This chemical action works by rapidly dissolving the outer fatty layer, or lipid membrane, that surrounds certain types of viruses and bacteria.
The alcohol also denatures, or structurally breaks down, the functional proteins within the microbial cells. This process quickly inactivates many common bacteria and is highly effective against viruses that possess a lipid envelope, such as HIV and the Hepatitis B and C viruses. ABHS is a convenient option for routine hand hygiene in non-soiled situations because alcohol achieves this destruction without the need for water.
Why Sanitizers Fail Against Specific Bloodborne Threats
Hand sanitizers fail to provide adequate protection against bloodborne pathogen exposure for two primary reasons, despite their effectiveness against enveloped viruses. The first limitation is their inability to neutralize certain hardy microorganisms. Alcohol is less reliable against non-enveloped viruses, which lack the fragile outer lipid membrane that alcohol targets.
These resilient pathogens, like the Norovirus, are protected by a tough protein shell (capsid), which resists alcohol’s destructive action. While HIV and Hepatitis viruses are enveloped, other pathogens transmitted via blood exposure may be non-enveloped, requiring a more robust germicidal agent. The second reason for failure is physical interference caused by organic material.
When hands are visibly soiled with blood, tissue, or other bodily fluids, the alcohol cannot make direct contact with the microorganisms. The organic matter physically shields the pathogens, significantly reducing the sanitizer’s ability to denature proteins and dissolve membranes. This “glove effect” renders the hand sanitizer ineffective precisely when a bloodborne pathogen threat is most present.
Essential Steps for Addressing Potential Exposure
The protocol for addressing potential bloodborne pathogen exposure involves a two-step process: physical removal followed by chemical disinfection. Regulatory bodies, such as the Occupational Safety and Health Administration (OSHA), mandate these standards in workplace settings. The initial and most important action is to wash the exposed area thoroughly with soap and running water for at least 20 seconds.
This physical scrubbing action removes the bulk of the organic material and washes away pathogens, including those resistant to alcohol. This physical removal is the gold standard, especially when hands are visibly soiled with blood or other potentially infectious materials.
Surface Disinfection
After cleaning hands, any contaminated surfaces must be cleaned and disinfected using an approved chemical agent. This disinfectant must be an EPA-registered product specifically labeled as effective against bloodborne pathogens, such as a freshly prepared 1:10 bleach solution. The product must remain wet on the surface for the manufacturer’s specified contact time to ensure the chemical reaction kills the pathogens. Following cleanup, all contaminated materials must be disposed of in designated biohazard waste containers.