In our May 2011 What’s New in the Patient Safety World column “” we noted the possible association of new automated water faucets with bacterial colonization, particularly Legionella species. Thus, an intervention intended to reduce transmission of infection possibly having the unintended consequence of actually increasing transmission of infection!
Now a new paper (Blaney 2011) raises a possible association between use of alcohol-based sanitizers and norovirus outbreaks in long-term care facilities. That, of course, does not mean that the alcohol-based hand sanitizers actually cause norovirus spread. More likely it means that they are simply not effective in eradicating norovirus from the hands. Keep in mind that we see a similar situation with C. difficile infections, where the hand sanitizers are not effective in preventing spread.
Current CDC recommendations regarding prevention of norovirus spread call for washing hands with running water and plain soap or antiseptic soap and caution that the use of alcohol-based or other hand sanitizers is controversial at the present time.
So while we generally promote the use of alcohol-based hand sanitizers as a good hand hygiene practice, it may have unintended consequences when certain pathogens are prevalent in a facility.
Blaney DD, Daly ER, Kirkland KB, et al. Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007. Am J Infect Control 2011; 39: 296–301
CDC. Updated Norovirus Outbreak Management and Disease Prevention Guidelines. MMWR 2011; 60(RR03): 1-15