Abstract
BackgroundThe World Health Organization has called for the development of improved methodologies to evaluate alcohol-based handrub (ABHR) efficacy, including evaluation at “short application times and volumes that reflect actual use in healthcare facilities”. The objective of this study was to investigate variables influencing ABHR efficacy, under test conditions reflective of clinical use.MethodsThe test product (60% V/V 2-propanol) was evaluated according to a modified EN 1500 methodology, where application volumes of 1 mL, 2 mL, and 3 mL were rubbed until dry. Statistical analyses were performed to investigate the relative influences of product volume, hand size, and product dry-time on efficacy, and hand size and hand contamination on product dry-time.ResultsMean log10 reduction factors (SD) were 1.99 (0.66), 2.96 (0.84) and 3.28 (0.96); and mean dry-times (SD) were 24 s (7 s), 50 s (14 s), and 67 s (20 s) at application volumes of 1 mL, 2 mL, and 3 mL, respectively (p ≤ 0.030). When data were examined at the individual volunteer level, there was a statistically significant correlation between dry-time and log reduction factor (p < 0.0001), independent of application volume. There was also a statistically significant correlation between hand surface area and dry-times (p = 0.047), but no correlation between hand surface area and efficacy (p = 0.698).ConclusionsWhen keeping other variables such as alcohol type and concentration constant, product dry-time appears to be the primary driver of ABHR efficacy suggesting that dosing should be customized to each individual and focus on achieving a product dry-time delivering adequate efficacy.
Highlights
The World Health Organization has called for the development of improved methodologies to evaluate alcohol-based handrub (ABHR) efficacy, including evaluation at “short application times and volumes that reflect actual use in healthcare facilities”
We have demonstrated the importance of product volume on mean log10 reduction factors (RFs)
Log10 RFs and dry-times of 60% V/V 2-propanol were evaluated at multiple application volumes using a modification of EN 1500 where products were rubbed into the hands until dry (Table 1)
Summary
The World Health Organization has called for the development of improved methodologies to evaluate alcohol-based handrub (ABHR) efficacy, including evaluation at “short application times and volumes that reflect actual use in healthcare facilities”. Several groups have recently investigated the relationships between key ABHR use variables such as product volume, hand size, product dry-times, and log reduction factors using standard EN 1500 methodology [4,5,6]. These studies suggest that hand size and product drytime are important variables, but the relative importance. Our group has developed a modified EN 1500 methodology, where the test product is rubbed until dry as prescribed in ASTM E 2755 [10, 11] Using this method, we have demonstrated the importance of product volume on mean log reduction factors (RFs). The objectives of this study were to further evaluate the impact of ABHR volume on efficacy, and to investigate the relationships between hand size, dry-time, and efficacy, using a modified EN 1500 methodology where volunteers rubbed test product until hands were dry
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