FAQ's - ABHR & Hand Washing


Q: How do I use ABHR?

Q: What if my hands are clean?
Q: When should I wash my hands? 
Q: What are the advantages of alcohol-chlorhexidine hand rub over alcohol-only rub?
Q: Why have ABHR solutions and not gels been recommended?
Q: Why do my hands sting when I apply an ABHR product?
Q: Will it matter if my hands are wet when I apply the ABHR?
Q: Can I bring in my own moisturising cream from home?
Q: Why do I have to decontaminate my hands after removing gloves? I thought the gloves stopped ‘bugs’ getting onto my hands!

Q: What happens if someone accidentally drinks ABHR?
Q: Where is it best to position the ABHR in a hospital?
Q: Does it matter if the ABHR is on a wall or a trolley? 
Q: Who is responsible for maintaining the product, brackets and signage?
Q: What happens in the case of an adverse event?
Q: Can we recycle or “top up” the bottles? 
Q: Will over-use of ABHRs result in resistance?
Q: How many times can staff use the ABHR?
Q: Should hand hygiene be performed prior to donning non-sterile gloves?

 
Q: How do I use ABHR?
A: Push the pump to get the metered amount, rub over all surfaces of your hands until evaporated. No need to wash your hands after use, this is a waterless system. If your hands are visibly soiled we recommend you wash them with soap and water.
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Q: What if my hands are clean?
A: Even when our hands look clean many germs may be still present which could transmit disease or other infections. ABHR is effective against many types of viruses and bacteria, which are invisible to our eyes. To offer the best protection to everyone we recommend that you use the ABHR regularly.
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Q: When should I wash my hands?
A: If hands are visibly soiled, or contaminated with blood or body fluids, then hand washing with plain or anti-microbial soap is recommended. The same is advised following known or suspected exposure to bacterial spores (e.g. Clostridium difficile), non-enveloped viruses (e.g. norovirus), or parasites. Washing hands with soap and water is preferred because it guarantees a mechanical removal effect. (see Appendix 5)
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Q: What are the advantages of alcohol-chlorhexidine hand rub over alcohol-only rub?
A: The addition of chlorhexidine to ABHR is associated with a persistent effect for at least three hours after application. Alcohol-only hand rub results in an immediate effect on pathogens, but has no persistent activity (20).
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Q: Why have ABHR solutions and not gels been recommended?
A: Laboratory studies have found that ABHR solutions reduce bacterial counts on the hands of volunteers to a greater degree than similar hand gels tested (22)
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Q: Why do my hands sting when I apply an ABHR product?
A: Stinging demonstrates pre-damaged epidermal tissue, most commonly caused by irritant-contact dermatitis related to excessive use of soap or detergents. The use of an ABHR may lead to an improvement in the condition of the hands because it contains an emollient, does not remove skin lipids and does not require paper towel for drying. However, if symptoms persist, medical opinion should be sought (see Appendix 24). Do not apply ABHR to broken skin.
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Q: Will it matter if my hands are wet when I apply the ABHR?
A: Yes, having wet hands dilutes the solution thus decreasing its effectiveness. The product must be applied to dry hands.
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Q: Can I bring in my own moisturising cream from home?
A: No, many hand creams inactivate the components in ABHRs. The products used in each hospital should be chosen for their compatibility with the ABHR in use.
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Q: Why do I have to decontaminate my hands after removing gloves? I thought the gloves stopped ‘bugs’ getting onto my hands!
A: The use of gloves does not replace the need for hand decontamination. ABHR should be used before and after glove use (see Appendix 9).
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Q: What happens if someone accidentally drinks ABHR?
A: Most ABHRs on the market contain very unpleasant tasting products, which make consumption unlikely. The risk of poisoning from ingestion of ABHR is uncommon but there has been some diarrhoea and vomiting reported where accidental ingestion has occurred. There is potential for serious clinical effects if large amounts are ingested. It is recommended that care be taken with the placement of ABHR in high-risk areas, (paediatrics, psychiatric units, drug and alcohol units, psycho-geratic units etc) (see section 4.4).
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Q: Where is it best to position the ABHR in a hospital?
A: Ideally ABHR should be located in high traffic flow areas (according to the guidelines) or common areas such as near reception, outside lift wells, entrance to wards/clinics. To help increase the public usage of the ABHR it is best if it’s highly visible. As mentioned previously it is recommended that care be taken with the placement of ABHR in high-risk areas, (paediatrics, psychiatric units, drug and alcohol units, psycho-geratic units etc).
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Q: Does it matter if the ABHR is on a wall or a trolley?
A: No it doesn’t matter but the product should be secured to the area by means of an appropriate bracket according to the guidelines. This is aimed to help reduce the risk of splashes, spills or the product misplacement.
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Q: Who is responsible for maintaining the product, brackets and signage?
A: This will be unique to each site/facility. The HH program should take responsibility for ensuring an appropriate system is in place.
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Q: What happens in the case of an adverse event?
A: Each facility is responsible for the products used in their facility and must have resources in place to manage any adverse events. Material Safety Data Sheets (MSDS) should be available for each product, as well as clearly documented internal procedures/policies to be followed. It is up to each individual facility to make sure all involved are educated on the procedure to follow in case of an adverse event. 
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Q: Can we recycle or “top up” the bottles?
A: No, because the outside of the ABHR bottles, and the pump often become contaminated, they should generally be discarded and not re-used. Attempts to recycle/re-use ABHR bottles have unfortunately proven to be cost ineffective in Australia to date.

 
Q: Will over-use of ABHRs result in resistance?
A: Unlike other antiseptics and antibiotics, there is no reported or likely resistance to ABHRs.  Indeed, the more it is appropriately used, the less antibiotic-resistant bacteria are able to spread.


Q: How many times can staff use the ABHR?
A: As often as is required.  There is no need to wash hands with soap and water unless they are visibly soiled.
 
Q: Should hand hygiene be performed prior to donning non-sterile gloves?
A: Hand hygiene should be performed regardless of the use of gloves when an indication for hand hygiene applies.  Usually there will be patient contact or the start of a procedure after the donning of gloves. The fact of donning gloves by itself does not constitute an indication for hand hygiene.