Advertisement

Hand antisepsis without decreasing efficacy by shortening the rub-in time of alcohol-based handrubs to 15 seconds

Published:September 09, 2019DOI:https://doi.org/10.1016/j.jhin.2019.09.004

      Summary

      Background

      A previous study among neonatal intensive care unit (NICU) nurses showed that the antibacterial efficacy of alcohol-based handrubs (ABHR) can be achieved in 15 s instead of 30 s with a significant increase in the frequency of hand antisepsis. This study aimed to examine 15-s vs 30-s antisepsis performance by measuring microbial load on fingertips and compliance among nurses in a low-risk gynaecological ward.

      Methods

      An independent trained observer monitored the frequency and compliance with hand antisepsis during shifts in a crossover design. Fingertips including thumbs were rinsed in soy broth before hand rubbing at the beginning of a shift and then hourly to determine the bacterial load. Performance activity was assigned to the contamination class of the Fulkerson scale. Immediately before the lunch break, volunteers cleaned their hands for a randomly determined application time of 15 or 30 s.

      Results

      Examination of bacterial load on fingertips revealed no difference between 15 vs 30 s application time. Controlled hand antisepsis before the lunch break also showed no difference in efficacy for either test series. Participants rubbing for 15 s were more likely to perform hand antisepsis compared with those rubbing for 30 s (P=0.2). The compliance increased from 54.7% to 69.5% in the 15-s trial.

      Discussion

      Shortening the duration for hand antisepsis did not decrease efficacy. Shortening the application time to 15 s should be considered within the critical components of a successful multimodal intervention strategy to improve hand-hygiene compliance in clinical practice.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Larson E.
        A causal link between handwashing and risk of infection? Examination of the evidence.
        Infect Control Hosp Epidemiol. 1988; 9: 28-36
        • Pittet D.
        • Hugonnet S.
        • Harbarth S.
        • Mourouga P.
        • Sauvan V.
        • Touveneau S.
        • et al.
        Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
        Lancet. 2000; 356: 1307-1312
        • Pittet D.
        • Allegranzi B.
        Boyce J, and World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts . The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations.
        Infect Control Hosp Epidemiol. 2009; 30: 611-622
        • Mathai E.
        • Allegranzi B.
        • Kilpatrick C.
        • Pittet D.
        Prevention and control of health care-associated infections through improved hand hygiene.
        Indian J Med Microbiol. 2010; 28: 100-106
        • Ellingson K.
        • Haas J.P.
        • Aiello A.E.
        • Kusek L.
        • Maragakis L.L.
        • Olmsted R.N.
        • et al.
        Strategies to prevent healthcare-associated infections through hand hygiene.
        Infect Control Hosp Epidemiol. 2014; 35: 937-960
        • Eckmanns T.
        • Bessert J.
        • Behnke M.
        • Gastmeier P.
        • Rüden H.
        Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect.
        Infect Control Hosp Epidemiol. 2006; 27: 931-934
        • Marra A.R.
        • Noritomi D.T.
        • Westheimer Cavalcante A.J.
        • Camargo T.Z.S.
        • Bortoleto R.P.
        • Durao Jr., M.S.
        • et al.
        A multicenter study using positive deviance for improving hand hygiene compliance.
        Am J Infect Control. 2013; 41: 984-988
        • Pittet D.
        Improving compliance with hand hygiene in hospitals.
        Infect Control Hosp Epidemiol. 2000; 21: 381-386
        • Teare L.
        • Cookson B.
        • Stone S.
        Hand hygiene. Use alcohol hand rubs between patients: they reduce the transmission of infection.
        BMJ. 2001; 323: 411-412
        • D'Agata E.M.C.
        • Horn M.A.
        • Ruan S.
        • Webb G.F.
        • Wares J.R.
        Efficacy of infection control interventions in reducing the spread of multidrug-resistant organisms in the hospital setting.
        PLoS One. 2012; 7e30170
        • Allegranzi B.
        • Sax H.
        • Pittet D.
        Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.
        J Hosp Infect. 2013; 83: S3-S10
        • Pires D.
        • Soule H.
        • Bellissimo-Rodrigues F.
        • Gayet-Ageron A.
        • Pittet D.
        Hand hygiene with alcohol-based hand rub: how long is long enough?.
        Infect Control Hosp Epidemiol. 2017; 38: 547-552
        • Kramer A.
        • Pittet D.
        • Klasinc R.
        • Krebs S.
        • Koburger T.
        • Fusch C.
        • et al.
        Shortening the application time of alcohol-based hand rubs to 15 seconds may improve the frequency of hand antisepsis actions in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2017; 38: 1430-1434
        • Paula H.
        • Becker R.
        • Assadian O.
        • Heidecke C.D.
        • Kramer A.
        Wettability of hands during 15-second and 30-second handrub time intervals: A prospective, randomized crossover study.
        Am J Infect Control. 2018; 46: 1032-1035
        • Larson E.
        • Lusk E.
        Evaluating handwashing technique.
        J Adv Nursing. 1985; 10: 547-552
        • Hayden M.K.
        • Blom D.W.
        • Lyle E.A.
        • Moore C.G.
        • Weinstein R.A.
        Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients' environment.
        Infect Control Hosp Epidemiol. 2008; 29: 149-154
        • Stiefel U.
        • Cadnum J.L.
        • Eckstein B.C.
        • Guerrero D.M.
        • Tima M.A.
        • Donskey C.J.
        Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients.
        Infect Control Hosp Epidemiol. 2011; 32: 185-187
        • Landelle C.
        • Verachten M.
        • Legrand P.
        • Girou E.
        • Barbut F.
        • Brun Buisson C.
        Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection.
        Infect Control Hosp Epidemiol. 2014; 35: 10-15
      1. EN 1500:2017-10. Chemical disinfectants and antiseptics – hygienic handrub – test method and requirements (phase 2/step 2). 2017–10 (Available at:) ([last accessed September 2019])
        • Sax H.
        • Allegranzi B.
        • Chraïti M.-N.
        • Boyce J.
        • Larson E.
        • Pittet D.
        The World Health Organization hand hygiene observation method.
        Am J Infect Control. 2009; 37: 827-834
        • Chamberlain A.N.
        • Halablab M.A.
        • Gould D.J.
        • Miles R.J.
        Distribution of bacteria on hands and the effectiveness of brief and thorough decontamination procedures using non-medicated soap.
        Zbl Bakt. 1997; 285: 565-575
        • Bingham J.
        • Abell G.
        • Kienast L.
        • Lerner L.
        • Matuschek B.
        • Mullins W.
        • et al.
        Health care worker hand contamination at critical moments in outpatient care settings.
        Am J Infect Control. 2016; 44: 1198-1202
        • Kampf G.
        • Ruselack S.
        • Eggerstedt S.
        • Nowak N.
        • Bashir M.
        Less and less-influence of volume on hand coverage and bactericidal effectiveness in hand disinfection.
        BMC Infect Dis. 2013; 13: 472
        • Shumaker D.
        • Macinga D.R.
        • Edmonds S.
        • Arbogast J.W.
        Skin care science and new influence of alcohol-based hand rub format on dry time and effectiveness.
        Am J Infect Control. 2012; 40: e39
        • Voss A.
        • Widmer A.F.
        No time for handwashing!? Handwashing versus alcoholic rub: Can we afford 100 % compliance?.
        Infect Control Hosp Epidemiol. 1997; 18: 205-208