Alcohol-based hand rubs can fulfil efficacy requirements of EN 1500 in 15 seconds

Correct hand hygiene is widely regarded as an important measure to prevent healthcare-associated infections. Guidelines on how to perform hand antisepsis are often inspired by laboratory tests that focus on reproducibility rather than ease of use. These cumbersome recommendations can become barriers to hand hygiene, as optimal user acceptance requires a small rub volume and a short application time with an intuitive rubbing technique. Here we modified the EN 1500 to test the efficacy of hand rubs under more user-friendly conditions, using a highly intuitive rubbing technique in 15 seconds.

The efficacy of an ethanolic and a propanolic hand rub in inactivating E. coli on the hands of volunteers was tested according to EN 1500 with modifications in rubbing technique and time. Pre-tests were conducted to find a suitable volume for "responsible application", a procedure without clearly defined steps. Finally, 20 volunteers applied both rubs for 15 seconds using 3 mL and "responsible application" and 5 mL using the WHO 6-step technique.

Both hand rubs, ethanolic and propanolic, were non-inferior to an unmodified EN 1500 reference for both application methods, 3 mL with "responsible application" and 5 mL with the WHO 6-step method.

Reducing the complexity of hand rub application can have a positive impact on hand hygiene adherence. With our results showing that antimicrobial efficacy comparable to an unmodified EN 1500 can be achieved in 15 seconds using an intuitive rubbing technique, further barriers to more user-friendly hand rub application have been removed.