Table 2 Characteristics of studies investigating the influence of alcohol-based handrub application time
Author Date Country | Design | Setting | Participants | Tested ABHR application times | Outcome measure(s) | Data collection method | Standardisation | Results |
|---|---|---|---|---|---|---|---|---|
Dharan et al (2003) [30] Switzerland | Within-subject NRT | Laboratory | 12 volunteers | 15 s 30 s | Bacterial load on hands | Fingertips | Product 4 ABHR—1. 80% ethanol (w/v) rinse; 2. 95% ethanol (w/v) rinse; 3. 75% isopropanol (v/v) & 0.5% chlorhexidine rinse 4. 60% isopropanol gel Reference 2-propanol 60% (v/v) ABHR volume 3 ml Application technique ABHR was applied to the cupped fingertips of the right hand, which were disinfected by rubbing of the thumb against fingertips and fingernails Artificial contamination (S. aureus, Pseudomonas aeruginosa, Enterococcus faecalis) | Mean log10 RF at 30 s significantly higher than 15 s for all ABHR products (P < 0.01) |
Rotter et al (2009) [25] Austria | Within-subject RCT | Laboratory | 15 volunteers | 15 s 30 s 60 s | Bacterial load on hands | Fingertips | Product liquid ABHR 2-propanol 60% (v/v) ABHR volume 3 ml Application technique 6-steps Artificial contamination (E. coli) | Mean log RF (SD) 15 s: 3.5 (0.8) 30 s: 3.7 (0.8) 60 s: 4.5 (0.8) Significant between 30 s & 60 s (P < 0.01); and between 15 s & 60 s (P < 0.001) |
Kramer et al (2017) [16] Germany | RCT | Clinical | 14 nurses | 15 s 30 s | Bacterial load on hands | Fingertips | Product ABHR 45% (w/w) propan-2-ol + 30% (w/w) propan-1-ol + 0.2% mecetroniumetile sulfate Average ABHR volume used 3.4 ml Application technique 6-steps | Mean log RF (SD) 15 s: 1.24 (0.68) 30 s: 1.31 (0.61) (P = 0.59) |
Pires et al (2017) [24] Switzerland | Within-subject RCT | Laboratory | 1) 23 HCWs 2) 18 HCWs | 1) 10 s 15 s 20 s 30 s 45 s 60 s 2) 15 s 30 s | Bacterial load on hands | Fingertips | Product ABHR isopropanol 60% (v/v) ABHR volume 3ml Application technique 6-steps Artificial contamination (E. coli) | Mean log10 reduction after 15 s non-inferior to 30 s; 0.11 log10 lower (95% CI, − 0.46–0.24) All durations resulted in a reduction in bacterial count (P < 0.001) Reductions after 10, 15 or 20 s not different to 30 s (P = 0.174, 0.312, 0.720) Reductions after 30 s higher than 45 or 60 s (P = 0.004, 0.011) |
Pires et al (2019) [23] Switzerland | Within-subject RCT | Laboratory | 18 HCWs | 15 s 30 s | Bacterial load on hands | Fingertips | Product ABHR isopropanol 60% (v/v) ABHR volume customized to hand size Small hands: 2.2 ml (IQR 2.2–2.4); Medium hands: 2.3 ml (IQR 2.2–2.3); Large hands: 3.2 ml (IQR 3.0–3.4) Application technique variations 6-steps according to daily routine Artificial contamination (E. coli & S. aureus) | Log10 RF 15 s non-inferior to 30 s -0.06 log10 (95% CI, − 0.34–0.22; P = 0.659) |
Harnoss et al (2020) [18] Germany | Crossover RCT | Clinical | 14 nurses | 15 s 30 s | Bacterial load on hands | Fingertips | Product liquid ABHR 45% (w/w) propan-2-ol + 30% (w/w) propan-1-ol + 0.2% mecetroniumetile ABHR volume 4 ml Application technique 6-steps | Mean log10 RF (SD) 15 s: 0.92 (0.47) 30 s: 0.89 (0.45) (P = 0.638) |