By Marian Beck Clore, RN, BSN, ICP
Healthcare providers, especially infection control practitioners (ICPS), are recognizing that alcohol-based hand sanitizers are an effective alternative to washing hands with soap and water. When alcohol-based hand soap dispensers are conveniently located, more frequent hand cleansing is encouraged, less time is required and better compliance is promoted. Some facilities support the idea of mounting liquid hand sanitizing containers onto walls between patient rooms, near patient beds, in dirty utility rooms, etc. Bottles of hand sanitizers are kept in other easy-to-reach places, such as patient bedside stands or healthcare workers (HCWs)' pockets.
The problem? Alcohol-based gels, foams and liquids are extremely flammable and are classified as hazardous materials.
Alcohol-based hand sanitizers were evaluated for use by the safety committee at Duane L. Waters Hospital, a correctional hospital providing inpatient and outpatient care to incarcerated patients. For those unfamiliar with a correctional setting, certain directives and operational procedures must be followed. Hazardous materials are classified as "critical tools" and prisoner access is limited and controlled at all times. Hazardous materials are to be stored in secure, labeled lockers or rooms designed for the purpose of storing flammable or combustible material. The custody and fire inspectors, after reviewing the MSDS sheets, denied the use of these products inside this facility. The innocent-looking hand cleanser could be used by a prisoner as a potential weapon against staff, other prisoners or the physical plant.
Since these products are deemed hazardous, other high-risk correctional centers, such as forensic or psychiatric facilities, juvenile detention centers, jails and parole centers should evaluate carefully before approving the use of alcohol-based hand sanitizers in their facilities.
Inquiries to the local fire department revealed that the fire codes approve hand-sanitizing products which are packaged and labeled according to the National Fire Protection Agency (NFPA) and Occupational Ssafety and Health Administration (OSHA) standards. These products should be stored as any other flammable liquid would. Fire department officials were extremely surprised to hear that liquid hand sanitizers were so widely used, and at the same time, so highly flammable.
While not statistically validated, experimentation was performed using six bottles of hand sanitizing gels, foams and liquids. The MSDS sheets for these products listed the flammability ratings of "3" and "4" (extremely flammable). Ignition testing produced the following results: Instantaneous combustion occurred; there was visible heat radiation, with no actual flame; and boiling was evident and visible. The facility fire inspector stated that he compared the combustion of alcohol-based hand sanitizers to that of napalm, as both have very similar ingredients and burning patterns.
When the ignition source was introduced to alcohol-impregnated antimicrobial hand wipes (flammability rating of "2"), no flame, fire or heat were produced until the alcohol had evaporated. At that time, the paper ignited just as any other sheet of paper would.
The alcohol-impregnated hand wipes contain less alcohol and are not much more effective than washing with soap and water, according to the "Draft Guideline for Hand Hygiene in Healthcare Settings," developed and sponsored in 2001 by the Centers for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC), Society for Healthcare Epidemiology of America (SHEA), Association of Professionals in Infection Control and Epidemiology (APIC) and Infectious Diseases Society of America (IDSA).
Because of its lower flammability rating and relative safety, hand wipes have been approved by the fire inspector for use in our correctional facility.
Hand-wipe containers will be installed in key locations, such as at the hospital entrance where prisoners are searched by the custody staff, between patient rooms, in the lunch room, in examination and treatment rooms and on medication carts, etc. As staff members are trained and become aware of the convenience of the hand wipes, they will utilize them more frequently. The apparatus that hold the hand-wipe containers on to the wall have been chosen carefully for safety and have been approved for use in our prison hospital. Individually wrapped antiseptic hand wipes are additionally available for staff to use when soap and water or wall-mounted hand wipes are not available.
Hopefully, this article has brought awareness to all who evaluate and select waterless alcohol-based hand sanitizers. There has certainly not been much talk about the safety of mounting large containers of flammable liquids to hospital, clinic, and day care facility walls. Everyone must evaluate the safety of using these products versus washing with alcohol-impregnated hand wipes or good old soap and water.
Marian Beck Clore, RN, BSN, ICP, is the infectious disease/safety coordinator for the Michigan Department of Corrections, Duane L. Waters Hospital in Jackson, Mich.