Evidence-based hand hygiene: Liquid or gel handrub, does it matter?

• Published in: Antimicrobial resistance & infection control 2023-02, Vol.12 (1), p.12-12, Article 12
• Main Authors: Voniatis, Constantinos, Bánsághi, Száva, Veres, Dániel Sándor, Szerémy, Péter, Jedlovszky-Hajdu, Angela, Szijártó, Attila, Haidegger, Tamás
• Format: Article
• Language: English
• Subjects: 2-Propanol; Alcohol; Anti-Infective Agents; Automation; Compliance; Data collection; Disease control; Disinfectants; Disinfection & disinfectants; Drug resistance; Drying; Efficiency; Ethanol; Evaporation; Evaporation rate; Hand Disinfection - methods; Hand Hygiene - methods; Handrub formulation; Handrub spillage; Hands; Health aspects; Health care; Humans; Hygiene; Infection control; Medical students; Optimised volume; Personal hygiene; Personalized hand hygiene; Statistical analysis; Students; Volume awareness
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-023-01212-4

Recent studies put under scrutiny the prevailing hand hygiene guidelines, which incorporate quantitative parameters regarding handrub volume and hand size. Understanding the criticality of complete (i.e., efficient) hand hygiene in healthcare, objectivization of hand hygiene related parameters are paramount, including the formulation of the ABHR. Complete coverage can be achieved with optimal Alcohol-Based Hand Rub (ABHR) provided. The literature is limited regarding ABHR formulation variances to antimicrobial efficiency and healthcare workers' preference, while public data on clinically relevant typical application differences is not available. This study was designed and performed to compare gel and liquid format ABHRs (the two most popular types in Europe) by measuring several parameters, including application time, spillage and coverage. Senior medical students were invited, and randomly assigned to receive pre-determined ABHR volumes (1.5 or 3 ml). All the 340 participants were given equal amounts of gel and liquid on two separate hand hygiene occasions, which occurred two weeks apart. During the hand hygiene events, by employing a digital, fully automated system paired with fluorescent-traced ABHRs, disinfectant hand coverage was objectively investigated. Furthermore, hand coverage in relation to the participants' hand sizes was also calculated. Additional data collection was performed regarding volume differences and their effect on application time, participants' volume awareness (consciousness) and disinfectant spillage during the hand hygiene events. The 1.5 ml ABHR volume (commonly applied in healthcare settings) is insufficient in either formulation, as the non-covered areas exceeded significant (5%+) of the total hand surface area. 3 ml, on the contrary, resulted in almost complete coverage (uncovered areas remained below 1.5%). Participants typically underestimated the volume which they needed to apply. While the liquid ABHR spreads better in the lower, 1.5 ml volume compared to the gel, the latter was easier handled at larger volume. Drying times were 30/32 s (gel and liquid formats, respectively) when 1.5 ml handrub was applied, and 40/42 s when 3 ml was used. As the evaporation rates of the ABHR used in the study are similar to those available on the market, one can presume that the results presented in the study apply for most WHO conform ABHRs. The results show that applying 1.5 ml volume was insufficient, as large part of the hand surfa