A randomized crossover study to test the tolerability of three alcohol-based handrubs: Preliminary results

Introduction: Hand hygiene with alcohol-based handrubs (ABHR) is the gold standard of care in healthcare facilities (HCF), and prevents healthcare-associated infections. The COVID-19 pandemic caused a global shortage of ABHR, which resulted healthcare facilities often using different products than normally. Consumption of ABHR more than doubled at HUG, and compliance stayed the same. Other HCF showed a decrease in compliance among healthcare workers (HCWs). Some of this effect could be due to the differences in tolerability of various formulations. Low tolerability is a known barrier to hand hygiene compliance, but there is little literature about which types of handrub have better dermal tolerance. Objectives: This crossover study aimed to compare the tolerability and acceptability of 3 different ABHR formulations in 39 volunteers. The ABHRs tested are already used in HCF and have passed the EN1500 norms. The main objective of the study is to determine which types of ABHRs and emollients are most likely to have high dermal tolerability in heavy use settings. Methods: The methods for this study were adapted from the WHO Protocol for evaluating handrub tolerability (Method 2). The participant population consisted of people that did not already use ABHR heavily, thus excluding most categories of HCW. 39 participants were randomized to 3 different ABHR formulations: 3 are ethanol-based (one with superfatting agents), and one is isopropanol-based. Participants tested each of the 3 solutions over a series of 5-day intervention weeks, each followed by a 9-day washout week. They kept a daily log of handrubbing sessions, and returned to investigators for a skin assessment after each intervention period. Results: Product acceptability and skin condition and were evaluated both by the participants themselves and a trained observer. A total of 24 components related to tolerability were analyzed for each participant weekly. Preliminary results show a marked difference in the acceptability of the formulations. Full results will be analyzed in July, 2021. Conclusion: Compliance of caregivers is crucial for patient safety, and determining which ABHRs have the best tolerability is likely to increase HCW satisfaction and compliance.