Revisiting the hand wipe versus gel rub debate: is a higher-ethanol content hand wipe more effective than an ethanol gel rub?

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 A total of 56 observations were analyzed for S marcescens removal and 70 observations were analyzed for G 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 (±SD) for the 65.9% ethanol alcohol wipe, 62% ethanol alcohol rub, and antimicrobial foam soap were 3.44 ± 0.847, 2.32 ± 1.065, and 4.44 ± 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 ± 0.26, -0.8 ± 0.32 increase over baseline, and 1.72 ± 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.