Introduction to hand hygiene

Audits of Emergency Departments have shown that hand hygiene is performed adequately less than 60% of the time. Reasons cited include the frequency that providers and staff enter rooms, the irritating effects on skin, rules that require hand hygiene even if the patient “is not touched”, and the need to react to emergent conditions. Nevertheless, infection control practices, hospital policy, and Joint Commission track and report this metric as part of assessing hospital quality. Quality initiatives to improve compliance can consist of staff education, period audits, and wide spread availability of alcohol foam. An increase of compliance rates have been shown to improve to over 90%.

Hand hygiene ethyl alcohol foam canister wall dispenser

Hand hygiene ethyl alcohol alcohol foam dispenser.

Effect of hand hygiene foam on breathalyzer

However, providers noted that hand hygiene may be falsely elevating the measurement of patient’s breath alcohol concentration (BAC). This test is often part of the the assessment of a patient presenting with altered mental status, when alcohol intoxication is the suspected etiology. A falsely elevated value could delay the evaluation of patient that has a more serious pathology such as intracranial hemorrhage.

Breathalyzer with elevated measurement

Breathalyzer measurement of patient when the tester had just cleaned their hand with hand hygiene ethyl alcohol foam.

Breathalyzer with no alcohol detected

Repeat breathalyzer measurement after tester put on exam gloves.

Testing alcohol foam effects on breath alcohol measurement

A total of 10 volunteer test subjects were tested. A tester using a standard fuel cell sensor breathalyzer with stated accuracy of +/-0.005% BAC was used to evaluate the breath alcohol concentration of known sober test subjects. The tester first performed standard hand hygiene using soap & water, and evaluated the subjects to confirm a 0.00% BAC. The tester then performed hand hygiene using 62.5%v/v ethyl alcohol from a standard foam dispenser and waited 1 minute before measuring the BAC of the test subjects. The process was repeated with and without the tester wearing properly fitted nitrile gloves.