Impact of the amount of hand rub applied in hygienic hand disinfection on the reduction of microbial counts on hands

Two different hand rubs were tested in order to investigate the minimum volume required for microbicidal efficacy according to the European Norm EN 1500; we also sought to determine whether there is a correlation with hand size. Eight male volunteers with big hands (mean 184 cm(2)) and eight female volunteers with significantly smaller hands (mean 148 cm(2); P < 0.001) participated in our study. Application of 2 mL of both products (P) provided mean log(10) reductions significantly smaller than those of the reference disinfectant (R) (product A: P = 3.34, R = 4.00, P = 0.001; product B: P = 3.37, R = 3.75, P = 0.022). Higher volumes (product A: 3 and 4 mL; product B: 2.5, 3 and 4 mL) ensured that the pass criteria of the European Norm (EN) 1500 were fulfilled. For both products log(10) reductions increased with increasing product volume until a plateau was reached. For the smaller female hands, this plateau level was reached after applying 3 mL of product A and 2.5 mL of product B. The plateau level on male hands was observed after treating the hands with >= 4 mL of product A and 3 mL of product B. The increase in product volume also correlated with the decrease in the number of volunteers considering the product volume applied as insufficient. In conclusion, the applied volume for hygienic hand rub should not fall below 3 mL in order to achieve maximum benefit. (C) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.