Megan J. DiGiorgio MSN, RN, CIC, FAPIC

Alcohol-based hand rubs (ABHR) have been used successfully in healthcare for over two decades. Despite their longevity, there are still myths around ABHR that exist today. Busting common myths can help healthcare workers (HCW) better understand how to appropriately use these products and better care for their skin.

Myth #1 Alcohol-based hand rubs dry out my skin. The truth is that a well-formulated ABHR hasnegligible impact on the skin. In a recent, robust study that compared the impact of three types of alcohol on the stratum corneum, or outermost layer of the skin, ethyl alcohol was shown to be the mildest alcohol tested clinically, even at high-frequency usage of 100 times per day.The challenge we face is that many healthcare workers have strong beliefs around this topic, and convincing them otherwise can be difficult.

Soap and water is usually the culprit when it comes to skin damage. Soap and water lifts and suspends oil, dirt, and other organic substances from hands so they can be rinsed down the drain. But as soap lifts dirt, it can also remove the natural components of the skin, corneocytes and lipids, that keep skin healthy. When skin is already damaged,application of ABHR can cause stinging and burning because nerve receptors are activated within the epidermis. The ABHR is often blamed because it adds insult to injury, but it was really the soap and water that created the condition in the first place. Because soap and water is soothing and does not elicit the same sensation as ABHR, HCW continue to use soap and water and therefore exacerbate the problem.

Myth #2 It’s a necessary to wash my hands after using ABHR a certain number of times.The truth is that the recommendation to wash hands with soap and water after a certain number of ABHR uses (e.g. 5) is outdated and originated from when ABHR were first introduced into the market and build-up of emollients was problematic with these early products. Fast forward to today, ABHR have come a long way. Well-formulated products can more effectively deliver skin care ingredients without resultant “sticky-tacky” buildup, so the need to wash after a certain number of ABHR uses is no longer necessary. That said, the Centers for Disease Control and Prevention and the World Health Organization both recommend washing hands with soap and water if hands are visibly soiled or contaminated.Otherwise, using an ABHR is preferred over soap and water due to superior efficacy, speed of use, convenience, and better skin benefits.

Myth #3ABHR cause antibiotic resistance. The truth is that ABHR do not cause antibiotic resistance. The mechanism of action of oral antibiotics is completely different than topical ABHR. The alcohol quickly kills a broad spectrum of germs and is not left behind on your skin to allow for microorganisms to become resistant. In fact, a primary prevention approach to reduce the need for antibiotics is effective hand hygiene, and hand hygiene is widely recognized as one of the single most important measures for preventing the transmission of pathogens in healthcare settings.


  1. Cartner R, Brand N, Tian K, et al. Effect of different alcohols on stratum corneum kallikrein 5 and phospholipase A2 together with epidermal keratinocytes and skin irritation. Int J Cosmetic Sci. 2016;doi: 10.1111/ics.12364. [Epub ahead of print].
  2. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. MMWR 2002;51:RR-16.
  3. World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge: clean care is safer care. Published 2009. Accessed March 1, 2015.
  4. Widmer AF. Replace and washing with use of a waterless alcohol hand rub? Clin Infect Dis. 2000;31:136-43.

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