A large-scale investigation of alcohol-based handrub (ABHR) volume: hand coverage correlations utilizing an innovative quantitative evaluation system

Abstract

Background Current hand hygiene guidelines do not provide recommendations on a specific volume for the clinical hand rubbing procedure. According to recent studies volume should be adjusted in order to achieve complete coverage. However, hand size is a parameter that highly influences the hand coverage quality when using alcohol-based handrubs (ABHR). The purpose of this study was to establish a quantitative correlation between applied ABHR volume and achieved hand coverage. Method ABHR based hand hygiene events were evaluated utilizing a digital health device, the Semmelweis hand hygiene system with respect to coverage achieved on the skin surface. Medical students and surgical residents (N = 356) were randomly selected and given predetermined ABHR volumes. Additionally, hand sizes were calculated using specialized software developed for this purpose. Drying time, ABHR volume awareness, as well spillage awareness were documented for each hand hygiene event. Results Hand coverage achieved during a hand hygiene event strongly depends on the applied ABHR volume. At a 1 ml dose, the uncovered hand area was approximately 7.10%, at 2 ml it decreased to 1.68%, and at 3 ml it further decreased to 1.02%. The achieved coverage is strongly correlated to hand size, nevertheless, a 3 ml applied volume proved sufficient for most hand hygiene events (84%). When applying a lower amount of ABHR (1.5 ml), even people with smaller hands failed to cover their entire hand surface. Furthermore, a 3 ml volume requires more than the guideline prescribed 20–30 s to dry. In addition, results suggest that drying time is not only affected by hand size, but perhaps other factors may be involved as well (e.g., skin temperature and degree of hydration). ABHR volumes of 3.5 ml or more were inefficient, as the disinfectant spilled while the additional rubbing time did not improve hand coverage. Conclusions Hand sizes differ a lot among HCWs. After objectively measuring participants, the surface of the smallest hand was just over half compared to the largest hand (259 cm2 and 498 cm2, respectively). While a 3 ml ABHR volume is reasonable for medium-size hands, the need for an optimized volume of handrub for each individual is critical, as it offers several advantages. Not only it can ensure adequate hand hygiene quality, but also prevent unnecessary costs. Bluntly increasing the volume also increases spillage and therefore waste of disinfectant in the case of smaller hands. In addition, adherence could potentially decrease due to the required longer drying time, therefore, adjusting the dosage according to hand size may also increase the overall hand hygiene compliance.

The difference in the surface coverage ratio by an adapted hand rubbing technique and the WHO technique; a randomized group comparison

“…Insu cient amount of ABHR applied for the hand size has been discussed as responsible for the poor dorsal coverage in many previous studies [17,18,19], and we also found that the ratio of the participants with insu cient dorsal coverage increased as the hands were larger. While taking our data, we also observed that many participants tended to focus more on rubbing the crotch of the ngers rather than the dorsal surface of the hand at the "palm over dorsum" step, which follows the ndings from the study by Durso et al [20].…”

“…The 1.1 ml ABHR used in our study could obtain a mean total coverage of over 90% for both sides of the hands, only for small hands. Voniatis et al reported that 3 ml is a reasonable volume for medium-sized hands [17], whereas Kenters et al reported that 2.25 ml is needed to cover both sides of the hands adequately (82-90%), although the hand size of the participants was not described in their report [18].…”

“…Additionally, showing the missed areas by heatmaps is visually informative when assessing the coverage of the hand. Some such studies have compared the differences and relation between the amount and the hand size [17,26].…”

Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU

“…The findings of this study suggest that a volume of 1.5 mL ABHR is relative to be sufficient or not, depending not only on the size of the hands [ 37 ], but also the competency of the HCW, given the overwhelming effect of learning. HCWs having smaller hands are more likely to produce fine coverage, but the difference was non-significant.…”

Monitoring of alcohol-based hand rubs in SARS-CoV-2 prevention by HS-GC/MS and electrochemical biosensor: A survey of commercial samples

“…According to the principal health agencies, ABHRs must contain at least 60%v/v alcohol, to have an effect as disinfectants on pathogens, including SARS-CoV-2 [8] . Scientific literature has evidenced that, in addition to the alcohols concentration, other factors that contribute to sanitation must be taken into account, such as the minimum friction time and the amount of sanitiser applied on the hands [9] , [10] .…”