Revisiting the hand wipe versus gel rub debate

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Background: The Centers for Disease Control and Prevention’s guidelines for hand hygiene state that the use of alcohol-based
hand wipes is not an effective substitute for the use of an alcohol-based hand rub or handwashing with an antimicrobial soap
and water. The objective of this study was to determine whether a hand wipe with higher ethanol content (65.9%) is as effective
as an ethanol hand rub or antimicrobial soap in removing bacteria and spores from hands.
Methods: In two separate experiments, the hands of 7 subjects were inoculated with a suspension of Serratia marcescens or
Geobacillus stearothermophilus. Subjects washed with each of 3 different products: 65.9% ethanol hand wipes (Sani-Hands
ALC), 62% ethanol gel rub (Purell), and antimicrobial soap containing 0.75% triclosan (Kindest Kare).
Results: Atotal of 56 observationswere analyzed for Smarcescens removal and 70 observationswere analyzed forG stearothermophilus
removal. The rank order of product efficacy for both bacteria and spore removal was antibacterial soap . 65.9%ethanol hand wipes
.62%ethanol hand rub. Mean S marcescens log reductions (6SD) for the 65.9% ethanol alcohol wipe, 62%ethanol alcohol rub, and
antimicrobial foam soap were 3.44 6 0.847, 2.32 6 1.065, and 4.44 6 1.018, respectively (P , .001). Mean G stearothermophilus log
reductions for the 65.9% ethanol wipe, 62% ethanol rub, and antimicrobial foam soap were 0.51 6 0.26, 20.8 6 0.32 increase over
baseline, and 1.72 6 0.62, respectively (P , .001).
Conclusion: The alcohol-based hand wipe containing 65.9% ethanol was significantly more effective than the 62% ethanol rub in
reducing the number of viable bacteria and spores on the hands.
Key Words: Hand hygiene; waterless; hand sanitizer; alcohol; antimicrobial.
Copyright ª 2010 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights
reserved. (Am J Infect Control 2010;38:678-82.)