CDC gives hand to alcohol-based rubs. ('Revolution' in Hygiene).

SAN DIEGO -- "Rub-a-dub-dub" is about to take on a whole new meaning in U.S. health care.

New guidelines on hand hygiene released by the Centers for Disease Control and Prevention promote the use of alcohol-based "rubs," Dr. John M. Boyce said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The guidelines--which apply to all health care settings, not just hospitals--recommend traditional hand washing after using the restroom or for hands that are soiled or have visible blood, bodily fluids, or other proteinaceous materials on them, since alcohol is not very good at cleaning. For hands that are not visibly soiled, use an alcohol-based rub; if that's unavailable, wash with soap, explained Dr. Boyce, who has been a paid consultant for two companies that make hand rubs, Gojo Industries and Bode Chemie.

Health care workers who have never used the alcohol-based rubs often erroneously fear that the products will dry out their hands and cause irritant contact dermatitis--a leading reason for low compliance with hand washing, noted Dr. Boyce, a clinical professor of medicine at Yale University, New Haven. Three randomized comparisons in the last 2 years found that alcohol-based rubs were less irritating than washing with soap and water.

The guidelines advise medical employers to provide hand lotions and creams to workers to minimize irritant contact dermatitis. Institutions should make hand hygiene a priority, monitor compliance and provide feedback to employees, and educate patients and their families to remind workers about hygiene.

In a new and controversial recommendation, the guidelines warn against wearing artificial fingernails or nail extenders during direct contact with patients at high risk for infection because long nails may harbor bacteria.

Federal officials hope that dismal rates of compliance with hand-hygiene guidelines last issued by the CDC in 1985 and by other organizations in 1988 and 1995 will improve with the convenience and user friendliness of the alcohol-based rubs. A 1999 study found, for example, that only 30% of physicians and 52% of nurses complied with hand-washing recommendations.