Reducing the exposure time for hygienic hand disinfection from 30 to 15 seconds: Is it a good idea?

Both in professional articles and at international industry meetings, there has long been a debate about halving the contact time of alcohol-based hand disinfectants for hygienic hand disinfection from 30 to 15 seconds. Here you can find out what the discussion is about and what speaks in favour of it from the user's point of view and against it from the manufacturer's point of view.

In favour of its shortening from the user's point of view: When there is time pressure, it is better to disinfect briefly than not at all!

If healthcare workers do not always disinfect their hands strictly according to the guidelines, this is usually not due to laziness, but often simply because of time pressure. The more invasive someone works and the more foreign materials are necessary, the more indications there are for hand disinfection. In an intensive care setting, for example, there could easily be 200 daily indications per patient. Assuming a compliance rate of 80 %, there would still be 40 moments per patient in which the necessary disinfection of the hands is dispensed with! In order to achieve the best possible hand hygiene compliance, the shortening of the exposure time for hygienic hand disinfection could be quite helpful from the user's point of view. This is also confirmed by a study that investigated how often employees disinfect their hands and how well compliance is maintained if a contact time of 15 seconds was previously implemented [1]. The fact that testing standards require manufacturers to conduct tests with a large safety buffer does not necessarily mean that alcohol-based hand disinfectants are not effective when exposure times are shortened. Various studies have shown that sufficient efficacy can also be achieved within 15 seconds exposure time [2-5]. The fact that the requirements of the test standards are not met might be less relevant for many employees in inpatient care than the knowledge that they can protect their patients even with an exposure time of 15 seconds.

Against its shortening from the manufacturer's point of view: Ensure effectiveness according to the applicable standard and observe volume!

Even if the desire from the user's point of view to increase compliance by using the shortest possible exposure time is understandable, manufacturers cannot support the shortening of hygienic hand disinfection to 15 seconds for regulatory reasons. They are subject to an extensive set of standards and methods that specify exactly how products must be tested and what may be advertised. This means that products tested on the basis of the currently valid EN standards, e.g. EN 1500:2013, must be tested for effectiveness with an exposure time of at least 30 seconds. Manufacturers cannot therefore make reliable statements for shorter exposure times. If users nevertheless want to deviate from the advertised exposure time, they should independently assess the risk for the respective use. In addition, the study situation should be critically evaluated because studies on shortening the exposure time often do not meet the methodological requirements of the valid EN standards [6]. It is also important to remember that the effectiveness of hygienic hand disinfection depends not only on the type of disinfectant used, but also on the complete wetting of the hands with the disinfectant! This depends on the amount of disinfectant used (the volume), the rub-in technique and the exposure time. If the exposure time is reduced to 15 seconds, there is a risk that users in a hurry will use too small a volume of hand disinfectant in order to have dry hands again after only 15 seconds. However, hands are complicated surfaces and the importance of the volume to be used is often underestimated. If the volume is too low, the disinfectant will soak into the application site or evaporate and can no longer be spread on the back of the hand, between the fingers and on the fingernails. In short, if the volume is reduced, sufficient wetting of the hands is not guaranteed, which is at the expense of effectiveness.

Conclusion: In the discussion about compliance, it should not only be considered whether hand disinfection was carried out. The decisive factor is whether the hand disinfection carried out is actually effective. It cannot be ruled out with certainty that the protection of patients and hospital staff is risked by shortening the exposure time for alcohol-based hand disinfection.

Sources:

1. Kramer A et al. (2017) Shortening the application time of alcohol-based hand rubs to 15 seconds may improve the frequency of hand antisepsis actions in a neonatal intensive care unit. Infect Control Hosp Epidemiol 38: 1430–1434. https://doi.org/10.1017/ice.2017.217
   
   
2. Pires D et al. (2017) Hand hygiene with alcohol-based hand-rub: How long is long enough? Infect Control Hosp Epidemiol 38: 547–552. https://doi.org/10.1017/ice.2017.25
   
   
3. Harnoss JC et al. (2020) Hand antisepsis without decreasing efficacy by shortening the rub-in time of alcohol-based handrubs to 15 seconds. J Hosp Infect 104: 419–424. https://doi.org/10.1016/j.jhin.2019.09.004
   
   
4. Pires D et al. (2019) Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based randomized experimental study with different loads of Staphylococcus aureus and Escherichia coli. Clin Microbiol Infect 25: 851–856. https://doi.org/10.1016/j.cmi.2018.10.012
   
   
5. Paula H et al. (2018) Wettability of hands during 15-second and 30-second handrub time intervals: A prospective, randomized crossover study. Am J Infect Control 46: 1032–1035. https://doi.org/10.1016/j.ajic.2018.02.015
   
   
6. Eggerstedt S et al. (2018) Alcohol-based hand rubs must meet the requirements of EN 1500. Infect Control Hosp Epidemiol 39: 1018. https://doi.org/10.1017/ice.2018.129