Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare

Abstract

Background The effectiveness of hand rubbing with alcohol-based handrub (ABHR) is impacted by several factors. To investigate these, World Health Organization (WHO) commissioned a systematic review. Aim To evaluate the impact of ABHR volume, application time, rubbing friction and hand size on microbiological load reduction, hand surface coverage or drying time. Methods Medline, CINAHL, Web of Science and ScienceDirect databases were searched for healthcare or laboratory-based primary studies, published in English, (1980- February 2021), investigating the impact of ABHR volume, application time, rubbing friction or hand size on bacterial load reduction, hand coverage or drying time. Two reviewers independently performed data extraction and quality assessment. The results are presented narratively. Findings Twenty studies were included in the review. Categories included: ABHR volume, application time and rubbing friction. Sub-categories: bacterial load reduction, hand size, drying time or hand surface coverage. All used experimental or quasi-experimental designs. Findings showed as ABHR volume increased, bacterial load reduced, and drying times increased. Furthermore, one study showed that the application of sprayed ABHR without hand rubbing resulted in significantly lower bacterial load reduction than poured or sprayed ABHR with hand rubbing (− 0.70; 95%CI: − 1.13 to − 0.28). Evidence was heterogeneous in application time, volume, technique, and product. All studies were assessed as high risk of bias. Conclusions There is insufficient evidence to change WHO recommendation of a palmful of ABHR in a cupped hand applied for 20–30 s or manufacturer-recommended volume applied for about 20 s (Centers for Disease Control and Prevention). Future hand hygiene research should standardise volume, application time, and consider hand size.

Comparison of two alcohol hand rubbing techniques regarding hand surface coverage among hospital workers: a quasi-randomized controlled trial

“…As stated in a recent systematic review, HH research should consider ABHR volume, application time, and hand size [33]. Our study followed this by standardizing both the volume and the application time, and considering hand size by applying the size of the medical gloves in the randomization process to minimize the hand size differences between the two techniques.…”

“…Significant differences in coverage between hand sizes within both technique groups were found; therefore, studies comparing techniques without descriptions of both the ABHR volume and hand size, may reflect differences in volume-hand size relationship between the groups. There is a growing consensus that volume should ideally be customized [30], and this should be considered in future research on hand hygiene techniques [33].…”

Knowledge, Attitudes, and Perceptions Towards Hand Hygiene of Optometry Students Pre- and Peri-COVID-19 at a Tertiary Institution in Johannesburg, South Africa

“…It is surprising however to see that there was not an increase in the knowledge related to hand rubbing with ABHR, as one would assume that the requirement of hand sanitization with the COVID-19 pandemic would possibly have influenced the opinion of the 2022 group. A recent review appeared 47 discussing the fact that although hand rubbing with ABHR has been the standard in almost all healthcare settings, the influence of the application time, hand size, the volume of ABHR used and the friction to the hand have been insufficiently studied. The conclusion was that the afore mentioned factors should be considered in further HH research, but that it was insufficient to influence the WHO recommendations for ABHR.…”

Sticky apps, not sticky hands: A systematic review and content synthesis of hand hygiene mobile apps

“…In fact, the SureWash app had previously been evaluated for effectiveness in improving technique. SureWash was used daily by 47 university staff and students in a four-week prospective cohort study [55]. By the end of the study period, 81% had reached proficiency in their technique.…”

“…Most apps (84/90, 93%) scored highest on the functionality dimension and lowest on information quality (50/90, 56%). Only two of the apps (SureWash Hand Hygiene and SureWash Hand Hygiene Pro) had been formally trialed/tested, [55,56] but not in robust randomized controlled trial (RCT) experiments. We reviewed the SureWash apps individually, as they are two different versions.…”