( v / v ) with a recommended volume of 1.1 mL per application do not ensure complete coverage of both hands and do not achieve current ASTM efficacy standards .
The ICPIC taskforce observes that the antimicrobial efficacy of ABHR is affected by several factors other than the technique used , such as the volume of product applied , duration of handrubbing ( drying time ), and hand size : “ Healthcare workers frequently apply suboptimal amounts of ABHR and use a poor hand hygiene technique that may not be sufficient to cover all surfaces of the hands and achieve desired bacterial load reduction . WHO guidelines recommend that “ a palmful of the product is sufficient to cover all surfaces ” while the CDC recommends using the manufacturer-recommended volume .
Current studies suggest that the greater the volume of ABHR applied , the higher the antimicrobial efficacy . One study of healthcare personnel suggested that ABHR dispensers should be adjusted to provide the recommended volume of ABHR in one single pump . Confounding the issue further is that ABHR volumes of less than 1 mL often result in dry time of less than 15 seconds , while studies suggest that dry times of 15 seconds or longer should be applied to achieve bacterial load reduction , according to Suchomel , et al . ( 2018 ) who found that there was a statistically significant correlation between dry-time and log reduction factor , independent of application volume . There was also a statistically significant correlation between hand surface area and dry-times , but no correlation between hand surface area and efficacy .
The ICPIC taskforce suggests that in the future , technology could provide the ideal ABHR volume that is linked to the hand size and customized to each healthcare worker ’ s hand-surface size and affiliated drying time needed . The issue of drying time is an important one , as is the duration of friction . Studies suggest that the optimal duration of ABHR handrubbing to ensure adequate hand decontamination is at least 15 seconds . They add , “ With the recommended technique , the palms are covered in 15 seconds in the same manner as with 30 seconds of rubbing .”
Reducing the application time is associated with increased frequency of ABHR usage and hand hygiene compliance , but when observing adherence to hand hygiene technique , only 7 percent of healthcare workers attained full coverage of all hand surfaces , with the thumb and fingertips being the most commonly missed areas , according to Park , et al . ( 2014 ). The ICPIC taskforce reminds us that “ The volume of ABHR applied and the duration of friction affect the dry time ( how long the hands must be rubbed before they feel dry ), which , in turn , affects the antimicrobial efficacy of the handrub .” Price , Gozdzielewska and Alejandre , et al . ( 2022 ) found insufficient evidence to change current hand hygiene guideline recommendations regarding ABHR volume and application time .
The taskforce recommends establishing the optimal duration for handrubbing and to develop ABHR formulations with a faster drying time , to prevent healthcare workers from using insufficient amounts of ABHR that dry quicker . They say it is critical to examine the relationship between the ABHR volume applied and the duration of friction to determine the optimal duration for handrubbing and ideal formulation for effective hand hygiene practices .
This leads us to ask if formulation and / or format of ABHR can impact its effectiveness ? WHO ( 2009 ) and the 2022 SHEA / IDSA / APIC Practice Recommendation regarding hand hygiene strategies both include liquid , gel , or foam as options for the selection of ABHRs .
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