ABHR Limitations
ABHR is not the recommended HH product in the following situations; when washing hands with soap and water is preferred (1):
Bacterial spores
Alcohol has virtually no activity against bacterial spores or protozoan oocysts. Washing hands with soap and water is preferred in this situation because it is the best method of physically removing spores from the hands. For example, after known or suspected exposure to Clostridium difficile, soap and water hand washing is preferred (1).
Contact precautions are highly recommended during C. difficile outbreaks, in particular glove use and handwashing following glove removal after caring for patients with diarrhoea. However, ABHRs are considered the gold standard to protect the patients from the multitude of harmful organisms transmitted by the hands of HCWs, and thus should continue to be used in all other patient care instances within the same facility. Discouraging ABHR use in response to diarrhoeal infections attributable to C. difficile will jeopardise overall patient safety in the long term (1). See WHO guidelines on managing a C. difficile outbreak.
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From: World Alliance for Patient Safety. WHO Guidelines on Hand Hygiene in Healthcare: First global patient safety challenge clean care is safer care. World Health Organisation; 2009. Appendix 2.
Non-enveloped (non-lipophilic) viruses
Alcohol has a poor activity against some non-enveloped viruses. (e.g. rotavirus, norovirus, polio, Hepatitis A). However, there is conflicting evidence suggesting that ABHR is more effective than soaps in reducing virus titres on finger pads (1,25,26). Thus, in norovirus outbreaks it is usually best to reinforce the use of ABHR, unless hands are visibly soiled – when soap and water HH is preferred.
Parasites
Alcohol has a poor activity against tropical parasites. Hand washing is preferred.