Soap + water, or alcohol sanitiser rub, for #SarsCov2?
A thread:
These are alternative methods for different scenarios:
Use soap for routine use (not surgical) with water & towels: it's better
https://twitter.com/PalliThordarson/status/1236549305189597189
Use as much as you like for a good lathering and to rinse.

For use on-the-go e.g. in/out of shops, public transport:
Use alcohol sanitiser, so always carry container(s).

But there's a messaging problem: much material conflates these 2 methods
e.g. in @WHO Director @DrTedros demo he conflates these at 20 secs https://twitter.com/colinbro/status/1257722527968870405?s=20

and this hand hygiene survey by @LSHTM at https://twitter.com/SafeSurfaceSci/status/1257600943824216065?s=20
conflates rub/wash as if equivalent.

But they differ: the WHO 2009 Handbook https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf
p41 says "Alcohols are not good cleansing agents and their use is not recommended when hands are dirty":

Further "The ideal volume of product to apply to the hands is not known and may vary for different formulations." (glyerine, additives)
This WHO handbook proves that Alcohol kills bacteria better than soap; but for viruses like #SARSCoV2? this lacks update even for #SARSCoV1.

The scenarios for use are different, and
The user must know not to mix them:
The antiviral action of 70% alcohol only works at around that % of water.
So mistaken dilution of alcohol e.g. if applied to wet hands, or splashed, or partial washing off, ruins its antiviral effect.

So why do many hand hygiene stations, with full plumbing for soap+water, also offer alcohol kit?
After a full #ClinicalHandWash, the use of alcohol, far from being additive or synergistic, just prolongs the whole procedure, so risking full diligence of the #ClinicalHandWash.

and use of the hand to operate the alcohol dispenser is yet another opportunity for this potential fomite to re-contaminate the newly-disinfected hands - see

Thanks for making it this far, for variety here's a new video of @PalliThordarson's work on hand disinfection for #Covid19

Thanks to @doctorcaldwell for many of these issues on how to update our hand hygiene structures and processes to beat #COVID19 in hospitals, clinics, care homes, our homes and workplaces.
Look forward to comment from #InfDis experts.
@TheIHI @CDCgov @DrGregorSmith @claireekt