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Should alcohol-based handrub volume be customized according to the size of healthcare workers’ hands?


Hand hygiene promotion is the most important tool to prevent health-care associated infections. While hand hygiene compliance has been well studied and promoted for the last 20 years, less attention has been devoted to study the quality of hand hygiene action.


We aimed to evaluate the amount of alcohol-based handrub (ABHR) needed to ensure appropriate hand antisepsis, depending on the healthcare workers (HCW) hand size.


This was an experimental study based on the microbiological laboratory, evaluating 15 healthy HCWs with different hand sizes performing hand hygiene following the World Health Organization (WHO) recommended sequence, with 6 different volumes of 2-propanol 60% hand rub. According to the European Norm 1500 (EN1500) standard, bacterial count was measured on the HCWs’ finger tips at baseline, after one friction without ABHR, then after each application of ABHR from 0.5mL to 3mL. The primary outcome was the log10 reduction measured after each AHBR application. Generalized linear mixed models were performed to analyze the results.


Among the 15 participants, 10 were female (66.7%), 4 had small hands, with a mean (±SD) hand surface area (HSA) of 332.9 ± 22.2cm2, 6 had medium size hands (mean HSA= 404.2 ± 9.7cm2) and 5 had large hands (mean HSA= 473.2 ± 40.4cm2). The log10 reduction was significantly decreased for each supplemental 0.5ml of AHBR (0.28 log10; 95%CI: 0.23 to 0.34, p<0.001) after adjustment on hand size and baseline log10 count. The log10 reduction was significantly lower for large hands compared to small hands (-1.19 log10; 95%CI: -1.61 to -0.76, p<0.001), and significantly lower for medium hands compared to small hands (-0.57 log10; 95%CI: -0.98 to -0.15, p=0.007). HCWs with large hands achieved a mean reduction of only 1.42 log10 ± 1.31, after rubbing their hands with 3mL of ABHR.


These results suggest the need of customizing the volume of ABHR used for hand hygiene, according to the size of the HCWs’ hands, for ensure appropriate hand antisepsis and patient safety.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Bellissimo-Rodrigues, F., Soule, H., Gayet-Ageron, A. et al. Should alcohol-based handrub volume be customized according to the size of healthcare workers’ hands?. Antimicrob Resist Infect Control 4 (Suppl 1), P302 (2015).

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