Frequently Asked Questions about Hand Hygiene for Healthcare Personnel Responding to COVID-2019

What method of hand hygiene is recommended for healthcare personnel in response to COVID-2019?

The CDC continues to recommend the use of alcohol-based hand rub (ABHR) as the primary method for hand hygiene in most clinical situations1. ABHR effectively reduces the number of pathogens that may be present on the hands of healthcare personnel after brief interactions with patients or the care environment. In addition, frequent use of ABHR formulated with emollients is less damaging to the skin than frequent hand washing. This factor, along with ease of use and greater access, leads to greater overall compliance with use of ABHR than hand washing with soap and water.  Hands should be washed for at least 20 seconds with soap and water when visibly soiled, before eating, and after using the restroom.

Are benzalkonium chloride-containing hand rub products an acceptable alternative to ABHR for COVID-19?

CDC does not have a recommended alternative to hand rub products with greater than 60% ethanol or 70% isopropanol as active ingredients. Benzalkonium chloride, along with both ethanol and isopropanol, is deemed eligible by FDAexternal icon for use in the formulation of healthcare personnel hand rubs2.  However, available evidence indicates benzalkonium chloride has less reliable activity against coronavirus than either of the alcohols3.

How should healthcare organizations respond to severe shortages of ABHR?

Healthcare organizations that encounter severe shortages of ABHR (and have exhausted supply chain access to efficacious products) may consider local production of formulations as described by the FDA Policy for Compounding of Certain Alcohol-Based Hand Sanitizer Productsexternal icon. This policy remains in effect through April 30, 2020. Formulations included in the FDA guidance are consistent with World Health Organization production guidancepdf icon. These locally produced products are intended for routine healthcare personnel hand cleaning, must not contain active ingredients other than those specified in the FDA guidance, and should not take the place of other regulated skin antiseptics (e.g. surgical hand rub). To avoid contamination with spore-forming organisms, WHO formulations require a 72-hour post-production quarantine. Organizations should revert to the use of commercially produced, FDA-approved product once such supplies again become available.

Can healthcare facilities substitute unformulated ethanol in concentrations greater than 60% or isopropanol greater than 70% for use as alcohol-based hand rub?

Given the drying effect of alcohols and the importance of maintaining skin integrity of healthcare personnel with their need to perform hand hygiene frequently, alcohols should not be used unless properly formulated with emollients.


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