Alcohol-Based Handrub Formulated Developed Specifically for High-use Environments Can Improve Key Skin Condition Measures While Maintaining Aesthetics and Antimicrobial Efficacy

Abstract

Use of electronic-compliance-monitoring (ECM) systems has shown that hand-hygiene compliance (HHC) measured by visual observation is significantly overestimated. It is expected that as use of ECM becomes prevalent, there will be significant increases in compliance. As HHC increases, the trade-offs of skin care and aesthetics become apparent to the user, resulting in lower compliance. Traditional methods of increasing emollients to improve skin care often negatively impact aesthetics and efficacy. The objective is to formulate a product that is both aesthetically preferred and provides superior skin care even under high-use (100x/day). Test products were a standard alcohol-based handrub foam (ST-ABHR), one designed for high-frequency use (HF-ABHR), and a lotion control. A forearm-controlled application test was used to evaluate hydration, barrier function (TEWL), and redness. Test products were applied 20x and 100x over 8 hours for 5 days. Healthcare workers (HCW) evaluated aesthetics and antimicrobial efficacy was assessed using ASTM E1174. It was demonstrated that high-frequency use (100x/day) of a traditional ABHR resulted in a compromised skin barrier. It was also demonstrated that after 5 days of high use, skin hydration increased by 31%, barrier function improved by 24%, and skin redness reduced by 38% for HF-ABHR compared to ST-ABHR. Subjective evaluations by HCW showed HF-ABHR had equivalent aesthetics to ST-ABHR. Finally, efficacy of both ABHRs were at parity, meeting FDA requirements. Traditional products are likely not good enough to promote high levels of HHC without resulting in damaged skin. It is possible to formulate an ABHR that delivers superior skin care under high-use conditions, while maintaining aesthetics and antimicrobial efficacy. It is critical for an ABHR to deliver in these three areas to sustain increased compliance for improved efficacy. ABHRs designed for a high-compliance environment can enable HCW to practice better hand hygiene without tacky build-up or compromising skin condition.