Hand antiseptics, most commonly formulated as alcohol-based hand rubs (ABHRs), are chemical agents designed to reduce the number of viable microorganisms on the hands. These products typically contain a concentration of alcohol between 60% and 95% to effectively denature proteins and dissolve the cell membranes of transient microbial flora. Their primary advantage over traditional handwashing with soap and water is the speed and portability they offer for hand hygiene when hands are not visibly dirty. They are the preferred method for routine hand decontamination in many low-risk situations when access to a sink is limited.
Routine Situations for General Use
The use of hand antiseptics is recommended whenever individuals are in public settings and cannot immediately wash their hands. A primary moment for application is after engaging with shared surfaces that harbor numerous microorganisms throughout the day. This includes touching items such as grocery cart handles, elevator buttons, gas pump keypads, or handrails on public transportation.
Antiseptics should also be applied after handling items that exchange hands frequently, such as paper currency or coins. Before consuming food or drink in a public space, such as a cafe or outdoor event, using an ABHR provides a quick way to clean hands.
Another common use is immediately following respiratory hygiene actions, specifically after coughing, sneezing, or blowing the nose, especially if a tissue was not used or immediately discarded. While soap and water is ideal for these moments, the hand rub offers a rapid alternative to minimize the spread of pathogens from the hands to other surfaces or people.
Specific Guidance for Clinical and High-Risk Settings
In professional and high-stakes environments, the use of hand antiseptics is guided by the World Health Organization (WHO) framework known as the “Five Moments for Hand Hygiene.” This framework dictates when hand decontamination must occur around patient care. These moments serve as a model for any individual caring for the sick or vulnerable, even outside a hospital.
Hand hygiene must be performed before touching the patient and immediately before any clean or aseptic procedure, such as changing a dressing or administering medication. Conversely, antiseptic use is required after an exposure risk to body fluids or after any physical contact with the patient.
The final moment demands hand decontamination after touching the patient’s immediate surroundings, such as the bed rails or medical equipment. For caregivers outside of formal healthcare, this framework translates to using an antiseptic before and after administering first aid, handling a newborn or infant, or caring for an elderly individual with a compromised immune system. In these settings, alcohol-based rubs are often preferred due to their superior compliance rates and effectiveness against most vegetative bacteria.
Limitations and When Handwashing is Required
Hand antiseptics are not a universal substitute for washing with soap and water. The most common limitation occurs when hands are visibly soiled with dirt, blood, or bodily fluids. The presence of organic material can physically block the alcohol from contacting the microorganisms, rendering the antiseptic ineffective.
Physical washing with soap and water is mandatory after using the restroom or before eating or preparing food. Furthermore, alcohol-based products do not effectively neutralize or remove harmful chemicals like pesticides or heavy metals.
A significant biological limitation is the inability of alcohol to kill bacterial spores, notably those produced by Clostridium difficile (C. difficile). When caring for a patient with confirmed or suspected C. difficile infection, or during outbreaks of diarrheal illness like Norovirus, handwashing with soap and water is the required protocol. Additionally, the product must be applied correctly—using enough volume to cover all hand surfaces and rubbing until the hands are completely dry to ensure necessary contact time.