Beyond hand rubs: quaternary ammonium compound wipes as a water-sparing alternative for protein-contaminated hand...

Hand hygiene alternatives such as antiseptic handwipes formulated with quaternary ammonium compounds (QACs) are increasingly marketed for their portability and skin-friendly properties.

To compare the effectiveness of QAC wipes, handwashing, and hydrogen peroxide-enhanced alcohol-based hand rubs (ABHRs) in removing micro-organisms from hands contaminated with proteinaceous organic matter.

A self-controlled cross-over trial recruited 15 volunteers who received standardized hand hygiene training. Participants underwent three intervention methods: (1) handwashing with non-antimicrobial soap and running water for 60 s; (2) hand rubbing with 70% ethanol + 0.2% hydrogen peroxide for 30 s; and (3) hand wiping with QAC wipes for 60 s. Both hands were contaminated with Staphylococcus aureus (1.0-9.0 × 10⁶ cfu/mL) and supplemented with 3% bovine serum albumin. The microbial reduction was quantified using log₁₀ cfu/hand for three regions (fingers, palm, and dorsum).

The efficacy of QAC wipes in bacterial removal from all three hand regions was non-inferior to soap, whereas its performance was significantly superior to that of hand rub. Wipes and soap showed lower efficacy on the dorsum compared to the fingers (P < 0.001). The efficacy ranking across hand regions was: fingers > palm > dorsum, and the overall intervention efficacy ranking was: soap = wipes > hand rub.

When QAC wipes are used under conditions of organic contamination with a 60 s procedural wiping protocol, the efficacy is not inferior to handwashing with soap. Hand rubs show significantly lower efficacy in protein-rich environments.