According to the Centers for Disease Control and Prevention (CDC), the main symptoms of the flu include fever, coughing, sore throat, runny or stuffy nose, headaches, body aches, chills and fatigue.1 In addition to these, H1N1 flu infection may also include vomiting and diarrhea, and in rare cases, conjunctivitis.1 The CDC states that flu activity is widespread in the United States and that hospitalizations anad deaths have risen above expectations. On June 11, 2009, the World Health Organization (WHO) declared that a global pandemic of H1N1 flu is underway

For health care workers, hand washing is the single most important intervention to prevent the spread of disease. Numerous epidemics have been traced back to the contaminated hands of healthcare workers, including reports of epidemic keratoconjunctivitis.3 

Practitioner Compliance
Despite these concerns, compliance with hand-washing guidelines remains a problem in most healthcare settings and does not usually exceed 40%, even under controlled-study conditions.4 The factors associated with low rates of compliance are a lack of availability of sinks, skin irritation with repeated exposure, high work volume and low perceived risk. Compliance also depends on the time required to perform adequate hand washing relative to the time available.4

Washing hands for 15 seconds achieves a microbial kill of 100.6-1.1; this rate increases to 101.8-2.8 when hands are washed for 30 seconds. However, hand-washing of less than 10 seconds is common in many clinical settings.5

The Alternative to Hand Washing
Studies have shown that solutions containing 60% to 70% alcohol are effective on gram-positive, gram-negative and spore-forming bacteria, as well as fungi and viruses.6 These preparations are 100 times more effective than antimicrobial soaps. And, the time necessary for hand disinfection with alcohol-based antiseptics is only 25% of regular hand-washing.6

These products are a great alternative for those who are not within proximity of a sink and others who simply do not have the time to wash their hands. Standard hand washing can irritate the skin, and many available gels contain moisturizing emollients. Sanitizing gels are associated with significantly less irritation/dryness by both objective and subjective measures.7 In addition, alcohols are non-toxic and lack allergenic potential.

Alcohol products should contact all surfaces of the hands and fingers, and artificial nails are discouraged because preparation may not come into contact with the interface between the nails. Remember—alcohols evaporate quickly from the skin, which is why they do not have sustained activity and require repeated application.

Most dispensers produce about 1mL of product, so larger hands may require more than one pump.8 Soap and water should be used after approximately 10 to 12 applications of alcohol gel, as the hands may feel slightly sticky.

Stay Healthy
In a contact lens practice, soap and water must be used prior to handling a contact lens to reduce lens residue and ocular irritation. It only takes a few seconds to ensure that you and your practice stays healthy during this and every flu season.

For more information on H1N1 in your practice and at home, visit

1. 2009 H1N1 Flu. Situation Update. Available at: (Accessed November 2009).
2. Pandemic (H1N1) 2009. Available at: (Accessed November 2009).
3. Larson EL, Bryan JL, Adler LM, Blane C. A multifaceted approach to changing handwashing behavior. Am J Infect Control. 1997 Feb;25(1):3-10.
4. Gould D, Drey N. Preventing the spread of acute respiratory viral infections. Nurs Stand. 2009 Oct 7-13;24(5):44-9.
5. Rofter M. Hand washing and hand disinfection. In: Mayhall CG. Hospital Epidemiology and Infection Control. 1st ed. Baltimore. Williams and Wilkins. 1996: 1052-68.
6. Mitka M. Hand washing, a key anti-flu strategy, often neglected by health care workers. JAMA. 2009 Nov 4;302(17):1850-1.
7. Boyce JM, Kelliher S, Vallande N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol. 2000 Jul;21(7):442-8.
8. Larson EL, Eke PI, Wilder MP, Laughon BE. Quantity of soap as a variable in handwashing. Infect Control. 1987 Sep;8(9):371-5.