title: Evaluating the tolerability and acceptability of an alcohol-based hand rub - real-life experience with the WHO protocol.
abstract: BACKGROUND
  Optimizing user satisfaction with alcohol-based hand rubs (ABHR) may be vital to enhance hand hygiene performance. This study tested the tolerability and acceptability of a new ABHR (EVO9; Ecolab) in healthcare workers under daily working conditions and evaluated the practicability of the corresponding WHO protocol.
  
  
  METHODS
  We strictly applied the WHO single product ABHR evaluation protocol. A trained observer assessed hand skin conditions of healthy volunteers using at least 30 ml ABHR per day during their clinical work at baseline, day 3-5 and one month (visit 1-3). Participants rated ABHR tolerability and acceptability at visit 2 and 3. Additionally, we registered study time for participants and study team.
  
  
  RESULTS
  Among 46 volunteers, 76% were female; 37% nurses, 28% physicians. Skin was observer-rated "not" or "incidentally" dry in 64.4%, 77.8%, and 90.9% participants at visit 1, 2, and 3, respectively. EVO9 was scored ≥5 (progressive scale, 1-7) for appearance, intactness, moisture content, and sensation by 95.7%, 97.7%, 88.9%, and 97.8% participants at visit 3, respectively. All WHO benchmarks were exceeded except for "speed of drying" at visit 2, and "texture" at visit 2 and 3. Cumulative study time expenditure was 14 days for the observer and four days for participants.
  
  
  CONCLUSIONS
  EVO9 was well tolerated and accepted according to the WHO single ABHR evaluation protocol with the potential for improvement for stickiness. The WHO protocol is feasible but requires considerable time and logistics. It does not preclude bias, in this case especially due to the necessary switch to personal dispensers.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Raemistrasse 100, Zurich, CH-8091 Switzerland.
authors.forename: Aline
authors.initials: A
authors.lastname: Wolfensberger
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Raemistrasse 100, Zurich, CH-8091 Switzerland.
authors.forename: Nina
authors.initials: N
authors.lastname: Durisch
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Raemistrasse 100, Zurich, CH-8091 Switzerland.
authors.forename: Juliane
authors.initials: J
authors.lastname: Mertin
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Raemistrasse 100, Zurich, CH-8091 Switzerland.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Ajdler-Schaeffler
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Raemistrasse 100, Zurich, CH-8091 Switzerland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
keywords: Acceptability; Alcohol-based hand rub; Hand hygiene; Tolerability; World Health Organization