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Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review

Published online by Cambridge University Press:  07 November 2016

John M. Boyce*
J. M. Boyce Consulting, Middletown, Connecticut
Philip M. Polgreen
Department of Internal Medicine and Department of Epidemiology, University of Iowa, Iowa City, Iowa
Mauricio Monsalve
Department of Computer Science, University of Iowa, Iowa City, Iowa Centro de Investigacion para la Gestion Integrada de Desastres Naturales, Chile
David R. Macinga
GOJO Industries, Akron, Ohio
James W. Arbogast
GOJO Industries, Akron, Ohio
Address correspondence to John M. Boyce, MD, J. M. Boyce Consulting, 62 Sonoma Ln, Middletown, CT 06457 (



Recently, the US Food and Drug Administration requested that a “maximal use” trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers.


To establish how frequently volunteers should be exposed to ABHR during a maximal use trial.


Retrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems.


We reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour.


Of 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour.


Hand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial.

Infect Control Hosp Epidemiol 2017;38:189–195

Original Articles
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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