title: Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern.
abstract: OBJECTIVE
  Although alcohol-based hand rinses and gels have recommended application times of 30 to 60 seconds, healthcare workers usually take much less time for hand hygiene. We compared the efficacies of four alcohol-based hand rubs produced in Europe (hand rinses A, B, and C and one gel formulation) with the efficacy of the European Norm 1500 (EN 1500) reference waterless hand antisepsis agent (60% 2-propanol) at short application times.
  
  
  METHODS
  Comparative crossover study.
  
  
  METHODS
  Infection Control Program laboratory of a large tertiary-care teaching hospital.
  
  
  METHODS
  Twelve healthy volunteers.
  
  
  METHODS
  Measurement of residual bacterial counts and log reduction factors following inoculation of fingertips with Staphylococcus aurens American Type Culture Collection (ATCC) 6538, Pseudomonas aeruginosa ATCC 15442, and a clinical isolate of Enterococcus faecalis.
  
  
  RESULTS
  All hand rinses satisfied EN 1500 standards following a single application for 15 and 30 seconds, but reduction factors for the gel formulation were significantly lower for all tested organisms (all P < .025).
  
  
  CONCLUSIONS
  Under stringent conditions similar to clinical practice, all three hand rinses proved to be more efficacious than the marketed alcohol-based gel in reducing bacterial counts on hands. Further studies are necessary to determine the in vivo efficacy of alcohol-based gels and whether they are as efficacious as alcohol-based rinses in reducing the transmission of nosocomial infections.
authors.affiliation: Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Sasi
authors.initials: S
authors.lastname: Dharan
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hugonnet
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000494:pharmacology*; D018592:Cross-Over Studies; D013293:Enterococcus faecalis / Q000302:isolation & purification; D000431:Ethanol / Q000008:administration & dosage / Q000494:pharmacology*; D005782:Gels; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards*; D006801:Humans; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D005782:Gels; D000431:Ethanol