The impact of alcohol-based and chlorhexidine-based disinfectants on hand microorganisms, skin tolerance and nosocomial infections among healthcare workers

Background: Hand hygiene is critical for preventing hospital-acquired infections (HAIs), yet the comparative effects of alcohol-based versus chlorhexidine-based disinfectants on microbial load, skin tolerance and infection rates among healthcare workers (HCWs) remain underexplored within the same clinical setting. Objectives: To compare the impact of alcohol-based and chlorhexidine-based disinfectants on hand microbiota reduction, skin tolerance and the incidence of HAIs among HCWs. Methods: This retrospective cohort study analyzed 136 healthcare workers at a single hospital. Participants were divided into two phases: an alcohol-based disinfectant phase from January 1, 2022, to June 30, 2022 and a chlorhexidine-based disinfectant phase from July 1, 2022, to December 31, 2022. Bacterial counts pre- and post-disinfection, skin condition assessments and hospital acquired infection (HAI) rates were analyzed. Results: Immediate bactericidal efficacy was superior in the alcohol group (1.60 ± 0.15 CFU/cm²) compared to the chlorhexidine group (2.80 ± 0.61 CFU/cm², P < 0.001). Chlorhexidine exhibited more sustained antimicrobial effects, with superior efficacy at 4 hours post-disinfection (7.20 ± 1.32 CFU/cm² vs. 9.53 ± 1.66 CFU/cm² for alcohol, P < 0.001). Skin tolerance was better for chlorhexidine. HAI incidence was slightly lower in the chlorhexidine group (3.80%) compared to the alcohol group (5.76%, P = 0.427). Conclusion: Alcohol provides immediate bactericidal action and chlorhexidine offers prolonged effects. It is recommended to use disinfectants according to the preferences of healthcare personnel.