Hand hygiene in the new millennium: drawing the distinction between efficacy and effectiveness.

Recently, much attention has been focused on hand hygiene in health care with the publication of a new national guideline. In the guideline, washing hands with soap and water is replaced by rubbing hands with an alcohol hand rub as the primary means of hand hygiene to be used by healthcare personnel involved in routine patient care. The rationale behind this shift is the documented increased antimicrobial efficacy of alcohol hand rubs over washing hands with either plain soap and water or an antimicrobial soap. In addition, there is the potential for increased compliance with hand hygiene because hand rubbing requires less time, results in less skin irritation, and does not require proximity to a sink. The only caveat is that the hands must be free from visible soiling prior to the use of an alcohol hand rub. Two articles appearing in this issue of Infection Control and Hospital Epidemiology raise important issues pertaining to the position of alcohol hand rubs in the new guideline.