November 02, 2017
2 min read

Only 15 seconds for alcohol-based hand rubs safe, effective

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According to researchers, reducing the recommended application time for hand rubs improved hand hygiene compliance rates with no significant difference in efficacy during a clinical study in a German NICU.

The study included a clinical observation trial in which nurses applied alcohol-based hand rubs (ABHRs) for either 15 or 30 seconds. Researchers said hand antisepsis actions were significantly more frequent in the group with the shortened application time.

“Because time pressure and workload are recognized barriers to compliance, reducing the currently recommended 20-30 seconds duration of ABHR application, using tested and well-evaluated hand rub formulations, may constitute a further step toward improving compliance with hand hygiene recommendations in clinical practice,” Axel Kramer, MD, head of the Institute for Hygiene and Environmental Medicine at the University Hospital of Greifswald in Greifswald, Germany, and colleagues wrote in Infection Control & Hospital Epidemiology.

Currently, WHO recommends applying ABHRs for 20 to 30 seconds, according to Kramer and colleagues. The CDC recommends they be applied until hands feel dry, a process it says should take around 20 seconds.

According to Kramer and colleagues, the current recommendations have raise several concerns. Even though recommended times to apply ABHRs have decreased over the past several years, Kramer and colleagues said the current suggestions may still be too long for practicing clinicians. However, there also have been concerns that shortening the time too much will lead to a decrease in the antimicrobial efficacy of ABHRs.

The researchers evaluated the efficacy of commercially available liquid ABHRs in vitro in an experiment in which 15 volunteers applied the hand rubs for 15 or 30 seconds. The ABHRs were “equal or even more effective” within 15 seconds vs. 30 seconds, with log reduction factors greater than 5 for Staphylococcus aureus, Enterococcus hirae, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis and greater than 4 for Candida albicans when applied for 15 seconds, according to Kramer and colleagues.

The clinical observation trial included 14 RNs working in the NICU at the University Hospital of Greifswald who were trained several times on the correct hand-rubbing technique and randomly assigned to 15- or 30-second groups. Researchers tested the bacterial colony count on the nurses’ hands at the beginning of their shifts, before the first application of a routinely available ABHR and hourly during their 8-hour shifts. Independent observers monitored their adherence.

According to Kramer and colleagues, not only was the frequency of use significantly higher in the 15-second group, there was no significant difference in antimicrobial efficacy and no influence on possible accumulation of bacteria on nurses’ hands compared with the 30-second group.


“Because there were no differences in antimicrobial efficacy of the ABHRs among both groups and because the reduction of the recommended application time was associated with a significantly increased frequency of hand antisepsis actions, a reduction of the time for hand rubbing can be recommended to encourage health care workers to perform hand antisepsis, provided that the ABHR in use has proven efficacy after 15 seconds,” Kramer and colleagues wrote. “This efficacy does not extend to all available ABHRs, and particularly not gel formulations of ABHRs.” – by Gerard Gallagher

Disclosures: Please see the study for all authors’ relevant financial disclosures.