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Letter to the Editor Regarding “Efficacy of Alcohol Gel for Removal of Methicillin-Resistant Staphylococcus Aureus from Hands of Colonized Patients”

Published online by Cambridge University Press:  23 April 2015

Andreas F. Widmer*
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Sarah Tschudin-Sutter
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Address correspondence to Andreas F. Widmer, MD, MSc, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland (
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Letters to the Editor
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

To the Editor—We have read with great interest the article by Sunkesula et alReference Sunkesula, Kundrapu, Macinga and Donskey 1 on the effectiveness of alcohol 70% v/v against methicillin-resistant Staphylococcus aureus in a clinical study. Surprisingly, 2 mL of a commonly used, registered handrub product failed in 27 (40%) of 67 instances to completely eradicate MRSA. This result might be explained by several issues that were not discussed in detail in the article: (1) the hand hygiene product used has been previously shown to have a lower mean microbial reduction factor compared with reference alcohol—therefore not meeting the European Standards (EN 1500) requirements within 30 seconds of application,Reference Kramer, Rudolph, Kampf and Pittet 2 (2) the volume of 2 mL might not have been sufficient, and (3) it is unclear whether the hand hygiene technique as outlined by the World Health Organization was strictly adhered to in this study. We recently found compliance with all 6 steps of the technique among healthcare workers at our institution to be as low as 8.5%, despite high compliance with hand hygiene indications.Reference Tschudin-Sutter, Sepulcri, Dangel, Schuhmacher and Widmer 3 Several studies showed that training in hand hygiene significantly improves antimicrobial effectiveness.Reference Widmer and Dangel 4 By any means, this study is important and might explain why many studies failed to decrease the spread of methicillin-resistant Staphylococcus aureus despite high compliance with hand hygiene.


Financial support. None reported.

Potential conflicts of interest. Both authors report no conflicts of interest relevant to this article.


1. Sunkesula, V, Kundrapu, S, Macinga, DR, Donskey, CJ. Efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients. Infect Control Hosp Epidemiol 2015;36:229231.Google Scholar
2. Kramer, A, Rudolph, P, Kampf, G, Pittet, D. Limited efficacy of alcohol-based hand gels. Lancet 2002;359:14891490.Google Scholar
3. Tschudin-Sutter, S, Sepulcri, D, Dangel, M, Schuhmacher, H, Widmer, AF. Compliance with the WHO hand hygiene technique: a prospective observational study. Infect Control Hosp Epidemiol 2015;36:482483.Google Scholar
4. Widmer, AE, Dangel, M. Alcohol-based handrub: evaluation of technique and microbiological efficacy with international infection control professionals. Infect Control Hosp Epidemiol 2004;25:207209.Google Scholar