Alcohol-based hand sanitiser in healthcare facilities

Background

Alcohol-based hand rub (ABHR) is commonly used for infection control in healthcare facilities, usually in the form of liquid or gel for hand hygiene. ABHRs are recognised as fundamentally important to patient safety and care.

ABHR containers are typically located in many different areas of facilities, and their contents are commonly accessible by members of the public and patients. Activities involving storing and handling ABHR containers should aim to control and minimise risks to health and safety of employees and other persons, whilst balancing the requirements for effective infection prevention and control practices.

Recent incidents have involved the misuse of liquid ABHRs.

1. A patient was admitted to intensive care after consuming ABHR in an emergency department.
   The patient, who had a known history of alcohol intoxication, consumed about 300 millilitres of ABHR containing more than 70% alcohol. The 600mL bottle was located in the emergency department where patients and members of the public could easily pick up the bottle and remove the lid.
2. A patient set fire to their bed and blanket in a four-bed room. The ABHR was used as an accelerant. The patient also threw the ABHR at an employee’s face causing an eye injury and contaminating their clothing.

Safety issues

ABHR contains high amounts of ethanol or ethyl alcohol (generally between 60%-95%).

The easy accessibility of ABHR can pose risks where vulnerable people are present, for example patients with clinical conditions such as alcohol dependence or other behaviours of concern. Conducting a risk assessment of accessible areas to consider where vulnerable patients may be present can assist in identifying areas of increased risk.

Accidental or deliberate misuse of ABHR can cause health risks to employees and members of the public, such as:

• alcohol poisoning from the ingestion of ABHR
• fire, if used as a fire accelerant
• eye injury.

Recommended ways to control risks

The following measures may help to reduce the risk of harm from the misuse of ABHR in areas of healthcare facilities where vulnerable people may be present:

• Conduct risk assessments with consideration to potential misuse of ABHR, including ingestion or use as an accelerant in clinical settings.
• Follow manufacturer’s recommended risk controls (if any) specified in safety data sheets.
• Ensure emergency responses are available, for example eye wash facilities and fire extinguishers.

In clinical settings where the ABHR may pose an increased risk, control access by:

• Replacing free-standing ABHR containers with a secure dispensing system.
• Placing ABHR bottles within brackets, dispensing units or tamper-resistant closures.
• Reducing the volume of ABHR that can be obtained from a container, for example by using smaller containers or single use containers.

• Using a different form of ABHR that is harder to ingest or ignite, for example gels (which are thicker/more viscous) or wipes.

  Legal duties

  Employers have duties under the Occupational Health and Safety Act 2004. These include, so far as is reasonably practicable:

  • Providing and maintaining for their employees a working environment that is safe and without risks to health.
  • Ensuring persons other than employees are not exposed to risks to their health and safety arising from the employer’s conduct.
  • Consulting with employees and any Health and Safety Representatives (HSRs) on matters that are likely to, or directly affect them when:
    • identifying or assessing hazards or risks at the workplace
    • making decisions about risk control measures at the workplace
    • proposing changes to the workplace, plant or work processes that may affect health and safety.