Rapid Assessment of 3 Personal Carry Hand Hygiene Products

Background: Mount Sinai Hospital is a 472 bed, tertiary care hospital with ~4000 employees. Hand hygiene compliance increased from 40 to only 69% over 4 years despite education, posters and hand hygiene audits with feedback. A study at our institution in 2008 showed the most common reasons for lack of compliance were lack of reliable access to alcohol hand rub, skin damage and emollient build up with the present product. We therefore evaluated personal carry alcohol hand rub products for our hospital. Personal carry alcohol hand rub products are portable sized products which can be carried attached to clothing or in an individual’s pocket.

Objective: To trial a rapid method of assessing acceptability and tolerability of handrub based on the World Health Organization’s (WHO) “Protocol for Evaluation and Comparison of Tolerability and Acceptability of Different Alcohol-based Handrubs”.

Methods: Using a modification of the WHO protocol, we tested 3 unscented personal carry alcohol based hand rub products (A, B, C) containing at least 70% v/v ethanol marketed in our area. Two products were foam (A, B) and 1 was gel (C). Hospital staff was invited to participate by institution-wide emails, posters and hospital newsletter. Sixty participants were randomized to a single blind crossover evaluation in August of 2009. Each participant was randomized to evaluate 2 products for 3-5 days with a 3-4 day washout period. Participants completed questionnaires assessing acceptability and tolerability for each product. An observer objectively evaluated participants’ hands before and after product usage. This evaluation required a full time position for a period of 1 month to sign up participants, answer questions and follow up participants for the duration of their participation.

Results: Most participants were full time (90%), female (73%) and nursing (43%) employees. Participants preferred foam to gel (OR=5.0; 95% CI: 2.1-11.7). Product A was preferred overall to the other two products (72.5%; p=0.01). Texture (76% vs. 33%; p<0.01), speed of drying (82% vs. 56%; p<0.01), application (84% vs. 51%; p<0.01) and overall evaluation (78% vs. 53%; p=0.01) of foam was more pleasant than gel. There were no statistically significant differences in colour, texture, irritation, drying effect, ease of use, speed of drying and application ratings between A and B, but smell was different between these two products (pleasant ratings: 80% A; 40% B; p<0.01). There was an overall positive correlation between smell and overall evaluation of the product (Pearson’s correlation coefficient= 0.40; p<0.01). There were no differences with the observer’s objective hand evaluation comparing hands before and after each product was used.

Conclusions: The WHO evaluation, with site specific modifications, worked well for rapid assessment of acceptability and tolerability of hand hygiene products. Further studies are needed to assess whether hand hygiene adherence improves when product is changed.