Vi är glada att ECDC tog emot våra synpunkter om handhygien vid förra kampanjen och ändrade sitt budskap.

https://bghr.se/en-paminnelse-till-ecdc-om-handhygienens-vikt/

synpunkter på den nya kampanjen

1. Tvål och vatten bör inte ersättas av alkoholbaserade produkter som har en lägre effekt mot patogener.
2. Om något ska ersätta tvål och vatten för handhygien, bör det vara mer effektivt eller förbättra tillgängligheten.
3. Hygienlösningar med dokumenterat högre effekt än traditionell handsprit bör inte uteslutas från rekommendationer. Snarare bör de uppmärksammas och presenteras som ett komplement till tvål och vatten, eller fungera som ersättning vid brist på tillgång.
4. Vårdens hygienrutiner har stor betydelse för allmänhetens hygien och bör därför beaktas vid beslutsfattande. Med tanke på att framtidens sjukvård riskerar att inte kunna hantera alla patienter på samma sätt som idag, och att utvecklingen pekar på fler sjuka, måste förebyggande åtgärder bli en större del av sjukvårdens arbete.

2025-06-10 Svar från ECDC

Dear Anders, 

Many thanks for your email and interest in ECDC.

The results and relevant recommendations of the point-prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities refer to the use of alcohol-based hand rubs for hand hygiene by healthcare-providers in healthcare settings with the purpose to limit the transmission of pathogenic microorganisms to residents of these facilities from other residents or the environment through the hands of healthcare workers.

Alcohol-based hand rubs are considered the gold-standard for hand hygiene in healthcare settings, as indicated in the evidence-based guidelines on hand-hygiene in healthcare by the World Health Organization. This conclusion is based on several factors including the following: 1) alcohol-based hand rubs rapidly and effectively inactivate a wide array of potentially harmful microorganisms on hands (including bacteria, fungi and viruses – in the case of ethanol, both enveloped and non-enveloped viruses), 2) they can promote improved compliance with hand hygiene by making the process faster and more convenient, and 3) adverse effects are minimal and tolerance is better than other products leading to better acceptability.

Optimal compliance with the recommended five moments of hand hygiene is possible with readily available alcohol-based hand rubs, e.g., through dispensers at the point of care.

Hand washing with soap and water is recommended when the hands are visibly dirty or soiled (e.g., with blood or other body fluids) and after using the toilet. It is also preferred in cases of potential exposure to spore-forming microorganisms, such as in cases of outbreaks of Clostridioides difficile infection.

We hope this is helpful for you.

Warm regards

Leigh

2025-06-10 Svar från oss på BGHR

Dear Leigh,

Thank you again for your detailed response and for referencing the WHO guidelines as a foundation for ECDC’s recommendations.

I would, however, like to respectfully offer a complementary perspective regarding the current reliance on alcohol-based hand rubs (ABHRs) as the gold standard – both in terms of antimicrobial spectrum and practical efficacy over time.

Scientific test protocols such as EN 1500, which underlie many of the current validations for ABHRs, specifically require reapplication within one minute due to alcohol’s rapid evaporation. This highlights a well-recognised limitation: the effective contact time is often too short to ensure sustained microbial reduction under practical use conditions, especially in real-world clinical environments.

There are now non-alcoholic alternatives that are both scientifically validated and demonstrably broader in antimicrobial spectrum – including activity against non-enveloped viruses such as norovirus – while offering extended residual effects and significantly reduced risk of skin irritation, flammability, and VOC emissions. These  products present a necessary evolution in hand hygiene, particularly in health services where repeated daily application is the norm.

Moreover, in Sweden, approximately 20% of healthcare professionals suffer from hand-related skin problems. Many themselves attribute this to frequent alcohol-based sanitising – often 50–60 times per shift. This raises occupational health concerns, especially as skin integrity plays a critical role in innate immune defense.

From a sustainability and chemical safety perspective, the trend is also shifting. Sweden has already begun phasing out the term handsprit in favour of handdesinfektion – reflecting a broader shift toward function-based, rather than substance-specific, approaches. Additionally, ethanol is now under EU review for potential classification as a CMR substance, and its use in disinfectants may face restrictions.

As ECDC continues to lead in infection prevention strategies, I would encourage further evaluation of these developments – both in terms of hand hygiene efficacy and long-term safety, sustainability, and health system resilience.

Clean regards, 

Anders