Summary
Background
Manufacturers’ recommended dosages for alcohol-based hand rubs are typically determined
by measuring product efficacy using a model protocol such as EN 1500; however, anecdotal
reports and informal observation suggests that in many cases users self-titrate to
much lower doses in real-world application.
Aim
To examine the interdependence of alcohol-based hand-rub volume on in-vivo efficacy
using the EN 1500 standard test method, on drying time on users’ hands, and on their
perceptions of acceptability.
Methods
Three formulations were studied using EN 1500 and a modification of this method. The
modification used volumes ranging from 0.5 to 3.0 mL and 30 s application. Drying
times were recorded and user acceptability was established using a three-point scale
(too long, OK, or too short). Dying times were analysed in relation to hand surface
area.
Findings
The drying time for all three products increased as a function of volume. The drying
time displayed a positive association with volume and a negative association with
hand surface area. The optimum volume for user acceptability was between 1.5 and 2 mL,
yielding a drying time of between 20 and 30 s.
Conclusion
Whereas EN 1500 is appropriate for establishing the efficacy of a hygienic hand-rub
formulation compared to a benchmark, it does not reflect actual in-use conditions
or the likely clinical effectiveness of the product. In particular, it fails to address
the need to optimize the volume of application and user acceptability of the product.
Keywords
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References
- Guidelines on hand hygiene in health care.2009 (Available at:) ([last accessed February 2016])
- Epic 3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.J Hosp Infect. 2014; 86: S1-S70
- Hygenic hand disinfection.Infect Control. 1984; 5: 18-22
- Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.Lancet. 2000; 356: 1307-1312
- My five moments for hand hygiene: a user-centred design approach to understand, train, monitor and report hand hygiene.J Hosp Infect. 2007; 67: 9-21
- Guide to local production: WHO recommended hand rub formulations.2010 ([last accessed February 2016])
BS EN 1500: 2013. Chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2).
ASTM International. E-1174-06. Standard test method for evaluation of the effectiveness of health care personnel or consumer handwash formulations. 2006. West Conshohocken, PA, ASTM International.
- Standard test method for determining the bacteria-eliminating effectiveness of healthcare personnel hand rub formulations using hands of adults.ASTM International, West Conshohocken, PA2015
Federal Register/Vol. 80, No. 84/Friday, May 1st, 2015/Proposed Rules.
- Hand hygiene: why, how and when?.2009 (Available at:) ([last accessed February 2016])
- Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance.Jt Comm J Qual Patient Saf. 2015; 41: 4-12
- Product dose considerations for real-world hand sanitiser efficacy.Antimicrob Resist Infect Control. 2013; 2: P101
- Should alcohol based handrub be customized to healthcare workers’ hand size?.Infect Control Hosp Epidemiol. 2016; 37: 219-221
- Hand surface area estimation formula using 3D anthropometry.J Occup Environ Hyg. 2010; 7: 633-639
- Advancement of the standard in vivo hand rub test methods: a critical comparison of the health care personnel handwash (ASTM E1174) and the hygiene handrub (EN1500).BMC Proc. 2011; 5: P269
- Less and less – influence of volume on hand coverage and bactericidal efficacy in hand disinfection.BMC Infect Dis. 2013; 13: 472
- The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs.BMC Infect Dis. 2014; 14: 511
- Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy.Am J Infect Control. 2012; 40: 328-331
- Comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs: formulation matters.Am J Infect Control. 2012; 40: 521-525
BS EN 1500: 1997. Chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2).
- Impact of the amount of hand rub applied in hygienic hand disinfection on the reduction of microbial counts on hands.J Hosp Infect. 2010; 74: 212-218
Health and Safety Executive. Packaging and labelling requirement for biocidal products. http://www.hse.gov.uk/biocides/eu-bpr/packaging-labelling-requirements.htm [last accessed July 2016].
Article info
Publication history
Published online: January 04, 2017
Accepted:
December 20,
2016
Received:
March 3,
2016
Identification
Copyright
© 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
