The CDC recommended hand hygiene with alcohol-based rubs EXCEPT when which condition applies?

• A. When hands are visibly soiled or after contact with Bacillus anthracis, Clostridioides difficile, or norovirus; hand washing with soap and water is required
• B. Alcohol-based hand rubs should be used at all times
• C. Soap and water is never required
• D. Use only water after patient contact

Answer: (A)

Alcohol-based hand rubs are great for quick, routine hand hygiene because they kill most germs quickly without water. But there are important situations where they don’t work well and you need soap and water.

If hands are visibly dirty or soiled with organic material, the sanitizer is less effective because the dirt can shield microbes. In these cases, washing with soap and water and rubbing hands together removes the soil and microbes more reliably.

Certain pathogens are also not reliably killed by alcohol-based sanitizers, notably spores of Bacillus anthracis and Clostridioides difficile, and the non-enveloped virus norovirus. For exposures to these organisms, handwashing with soap and water is required to physically remove them.

So, the exception to using alcohol-based rubs is when hands are visibly soiled or after contact with those specific organisms, where soap and water must be used. The other statements are not correct because alcohol rubs aren’t always appropriate and soap and water isn’t never required; using only water after patient contact is not the standard practice—soap and friction are still needed.