title: Hand rub dose needed for a single disinfection varies according to product: a bias in benchmarking using indirect hand hygiene indicator.
abstract: BACKGROUND
  The 3ml volume currently used as the hand hygiene (HH) measure has been explored as the pertinent dose for an indirect indicator of HH compliance. A multicenter study was conducted in order to ascertain the required dose using different products.
  
  
  METHODS
  The average contact duration before drying was measured and compared with references. Effective hand coverage had to include the whole hand and the wrist. Two durations were chosen as points of reference: 30s, as given by guidelines, and the duration validated by the European standard EN 1500. Each product was to be tested, using standardized procedures, by three nosocomial infection prevention teams, for three different doses (3, 2 and 1.5ml).
  
  
  RESULTS
  Data from 27 products and 1706 tests were analyzed. Depending on the product, the dose needed to ensure a 30-s contact duration in 75% of tests ranging from 2ml to more than 3ml, and to ensure a contact duration exceeding the EN 1500 times in 75% of tests ranging from 1.5ml to more than 3ml. The aftermath interpretation is the following: if different products are used, the volume utilized does not give an unbiased estimation of the HH compliance. Other compliance evaluation methods remain necessary for efficient benchmarking.
authors.affiliation: Unité d'Hygiène et Epidémiologie, Groupement Hospitalier Sud Hospices Civils de Lyon, France. raphaele.girard@chu-lyon.fr
authors.forename: Raphaële
authors.initials: R
authors.lastname: Girard
authors.forename: Martine
authors.initials: M
authors.lastname: Aupee
authors.forename: Martine
authors.initials: M
authors.lastname: Erb
authors.forename: Anne
authors.initials: A
authors.lastname: Bettinger
authors.forename: Alice
authors.initials: A
authors.lastname: Jouve
mesh_terms: D019985:Benchmarking; D015982:Bias; D003257:Consumer Product Safety; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004202:Disinfectants / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D063373:Hand Hygiene / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D004202:Disinfectants
keywords: Benchmarking; Compliance; Hand hygiene; Hand rub