29 Mar Hand Washing or Hand Sanitiser, Which is Better.
A fly swatter is a device with no innate efficacy exhibited by the device itself but whose efficacy resides solely in the skillful hand and decisiveness of the user (loosely regulated pesticidal device). Hand washing efficacy is much like the fly swatter, totally dependent on how well and decisively it is execution by those same hands (food-contact, drug-antimicrobials, & cosmetic-soap regulated territory).
When considering the effectiveness of hand washing and sanitiser use, we need to recognise that human pathogens and opportunistic pathogens, exist in multidimensional continuums in terms of survival, chemical resistance to antimicrobial compounds, and efficacy of hand washing etc. Because each microorganism exists in their own multifaceted conditions for existence and survival, there can be no “one size fits all” approach to control and prevention of disease in respect to hand hygiene.
At one end of the hand washing efficacy continuum are viruses that are harder to remove from hands than bacteria and the even larger parasite cysts and eggs. This is because size matters. The smaller the pathogen, the more easily trapped in the cracks and creases of our epidermis and our stratum corneum. Here we need to realise that aggressive or “good quality hand washing” is more critical in going after viruses as opposed to our usually larger prey, bacteria. Multiple studies indicate that in addition to surfactant action, friction (good old fashioned elbow grease) at the rinsing stage is perhaps the most critical period of hand washing in its ability to dislodge viruses from skin surfaces. That said, you only have so many highly aggressive hand washing (hand washing events) a day to remove viruses before hands begin to dry out and become sore, even when using the gentlest of soaps.
In another continuum of antimicrobial action we have organisms at one end like C. difficile whose spores are entirely resistant to alcohol hand sanitisers (as discussed in the C. diff blog). And indeed, norovirus is not far from C. diff in terms of chemical resistance.