Efficacy of Novel Alcohol-Based Hand Rub Products at Typical In-Use Volumes

Macinga, David R.; Edmonds, Sarah; Campbell, Esther; Shumaker, David J.; Arbogast, James W.

doi:10.1086/669514

“…A recent survey of ABHR dispensers in U.S. hospitals found that outputs ranged from 0.6 mL to 1.3 mL, and that product dry-times ranged from 12 s to 26 s [16]. Whether healthcare workers use more than one dispenser actuation is unknown; anecdotally, it is expected they most frequently do not.…”

Section: Discussionmentioning

confidence: 99%

The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs

Macinga

¹

,

Shumaker

²

,

Werner³

et al. 2014

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BackgroundAlcohol-based hand rubs (ABHR) range in alcohol concentration from 60-95% and are available in a variety of delivery formats, such as rinses, gels, and foams. Recent studies suggest that some ABHR foams dry too slowly, thereby encouraging the use of inadequate volumes. This study investigates the influence of product volume, delivery format, and alcohol concentration on dry-time and antimicrobial efficacy of ABHR foams, gels and rinses.MethodsABHR dry-times were measured using volunteers to determine the influences of product volume, delivery format, and alcohol concentration. ABHR efficacies were evaluated according to the European Standard for Hygienic Hand Disinfection (EN 1500) using 3-mL application volumes rubbed for 30 s, and additionally, using volumes of the products determined to rub dry in 30 s.ResultsVolumes of six ABHR determined to rub dry in 30 s ranged from 1.7 mL to 2.1 mL, and the rate of drying varied significantly between products. ABHR dry-times increased linearly with application volume and decreased linearly with increasing alcohol concentration, but were not significantly influenced by product format. An ABHR foam (70% EtOH), rinse (80% EtOH), and gel (90% EtOH) each met EN 1500 efficacy requirements when tested at a volume of 3 mL, but failed when tested at volumes that dried in 30 s.ConclusionsApplication volume is the primary driver of ABHR dry-time and efficacy, whereas delivery format does not significantly influence either. Although products with greater alcohol concentration dry more quickly, volumes required to meet EN 1500 can take longer than 30 s to dry, even when alcohol concentration is as high as 90%. Future studies are needed to better understand application volumes actually used by healthcare workers in practice, and to understand the clinical efficacy of ABHR at such volumes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-511) contains supplementary material, which is available to authorized users.

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“…87 12119120 Some studies have indicated that rigid adherence to standardized step-by-step technique may not be as critical by demonstrating that sufficient pathogen reductions could be achieved by instructing HCP simply to cover their hands with hand hygiene product (ie, the "reasonable application" approach) regardless of technique used. 104 ' 122 However, the studies finding reasonable application equivalent to a standardized technique had protocols using 3 mL of product, and it is unclear how often this volume is used in clinical practice 125 (due to longer drying times associated with use of higher volumes). 126 5.…”

Section: Methods For Hand Hygiene Adherence Measurementmentioning

confidence: 99%

“…The standard dispenser actuation for ABHRs is 1.1 mL, although a recent study showed variability from 0.6 to 1.3 mL of product dispensed with each actuation. 125 Two studies published in 2013 report conflicting findings on whether 1.1 mL is sufficient to meet the US Food and Drug Administration (FDA) requirement for log reductions. 125127 C. Tolerability 1.…”

Section: Methods For Hand Hygiene Adherence Measurementmentioning

confidence: 99%

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Ellingson

¹

,

Haas

²

,

Aiello

³

et al. 2014

Infect. Control Hosp. Epidemiol.

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Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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“…12119120 Some studies have indicated that rigid adherence to standardized step-by-step technique may not be as critical by demonstrating that sufficient pathogen reductions could be achieved by instructing HCP simply to cover their hands with hand hygiene product (ie, the "reasonable application" approach) regardless of technique used. 104 ' 122 However, the studies finding reasonable application equivalent to a standardized technique had protocols using 3 mL of product, and it is unclear how often this volume is used in clinical practice 125 (due to longer drying times associated with use of higher volumes). 126…”

Section: Recent Studies Have Shown That Training Hcp Onmentioning

confidence: 99%

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Ellingson

¹

,

Haas

²

,

Aiello

³

et al. 2014

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Efficacy of Novel Alcohol-Based Hand Rub Products at Typical In-Use Volumes

Cited by 17 publications

References 4 publications

The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs

The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

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