Dose considerations for alcohol-based hand rubs.
BACKGROUND
Manufacturers' recommended dosages for alcohol-based hand rubs are typically determined by measuring product efficacy using a model protocol such as EN 1500; however, anecdotal reports and informal observation suggests that in many cases users self-titrate to much lower doses in real-world application.


OBJECTIVE
To examine the interdependence of alcohol-based hand-rub volume on in-vivo efficacy using the EN 1500 standard test method, on drying time on users' hands, and on their perceptions of acceptability.


METHODS
Three formulations were studied using EN 1500 and a modification of this method. The modification used volumes ranging from 0.5 to 3.0 mL and 30 s application. Drying times were recorded and user acceptability was established using a three-point scale (too long, OK, or too short). Dying times were analysed in relation to hand surface area.


RESULTS
The drying time for all three products increased as a function of volume. The drying time displayed a positive association with volume and a negative association with hand surface area. The optimum volume for user acceptability was between 1.5 and 2 mL, yielding a drying time of between 20 and 30 s.


CONCLUSIONS
Whereas EN 1500 is appropriate for establishing the efficacy of a hygienic hand-rub formulation compared to a benchmark, it does not reflect actual in-use conditions or the likely clinical effectiveness of the product. In particular, it fails to address the need to optimize the volume of application and user acceptability of the product.
Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
M A C
MAC
Wilkinson
Deb Group Ltd, Denby, Derbyshire, UK.
K
K
Ormandy
Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK. Electronic address: tina.bradley@uhb.nhs.uk.
C R
CR
Bradley
Hospital Infection Research Laboratory, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
A P
AP
Fraise
Deb Group Ltd, Denby, Derbyshire, UK.
J
J
Hines
D000438:Alcohols / Q000008:administration & dosage*; D003890:Desiccation; D004202:Disinfectants / Q000008:administration & dosage*; D005260:Female; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D008297:Male; D013997:Time Factors; D014838:Volunteers
D000438:Alcohols; D004202:Disinfectants
Alcohol-based hand rubs; EN 1500; Hand hygiene; User acceptability