Efficacy of alcohol-based gels compared with simple hand wash and hygienic hand disinfection

A recent research letter on the limited efficacy of alcohol-based hand gels has alerted the global infection control community and raised the question of the true significance of data obtained according to EN 1500. It has been described that a 1 min simple hand wash reduces artificial contamination of hands by a log(10) reduction factor of 2.8 and a 1 min reference hand disinfection with 2-propanol (60%, v/v) by a factor of 4.6 steps. The EN 1500 gel data show that the 30 s efficacy of most gels is closer to a simple hand wash than to the reference hand disinfection. The 30 s efficacy of most alcohol-based liquid products and one gel, however, is almost identical to the reference hand disinfection. In many European countries alcohol-based liquid products have been established as a standard practice in hygienic hand disinfection for decades. Replacement of these products with most available gels would be a step backward in terms of efficacy and has still to be seen critically from the efficacy point of view.