Back to basics: hand hygiene and isolation

Lin Huang, G. Khai; Stewardson, Andrew J.; Lindsay Grayson, M.

Factors that can affect results include in-vitro vs. in-vivo testing methodology (e.g., European Norm 1500 vs. ASTM E1174 vs. glove juice techniques), the species and inoculum of pathogens tested, the volume of ABHR utilized and the time between ABHR application and assessment of pathogen kill. Overall, the optimum ABHR formulation has not been clearly established [53] [54] [55] [56] [57] [58] . Edmonds et al. [55] evaluated 12 different ABHR formulations and did not find that alcohol content (within the WHO recommended range) influenced efficacy. Contrary to previous reports, gel or foam ABHR preparations were not shown to be inferior to solutions or rinses, although design flaws have subsequently been highlighted with this study [56] . A key issue with all these studies is that they utilize in-vivo models to extrapolate to clinical effectiveness, whereas multiple other factors, including healthcare worker product preference, ease or accuracy of various dispensers and hand hygiene compliance, are also critical factors in this equation. Gels and foams appeared to be equally acceptable to healthcare workers in one study [59] , whereas solutions were preferred in others [13, 14, 16, 17] .