Having just returned from the National IPAC-Canada
Conference and seeing the excitement that Prof. Didier Pittet can bring during
his talk and book signings (as seen in the picture with my colleague Olivia
Lattimore being more than just a little star struck), coming across an article
that talks about hand size versus the amount of alcohol-based hand rub (ABHR)
that needs to be used seemed like fate.
I’m not that big – 5 feet 5 inches if I stand with my very
best posture and as one would assume, with a shorter frame I have fairly small
hands (at least I think a ring size of 4.5 is pretty small). I’ve generally had more problems finding
gloves that fit than ever thinking about whether the amount of hand sanitizer I
use or is automatically dispensed is sufficient. It’s funny, we know when a glove is too big
or too small and the problems that can occur with that, yet with hand
sanitizers we all think one size fits all.
The article published in 2015
by Bellissimo-Rodrgues et al concludes that healthcare professionals need
to consider the size of their hands when it comes to using ABHR products to
ensure that adequate coverage, and therefore efficacy of the product, can be
met. Their study investigated whether the volume of ABHR used by healthcare
workers affects the residual bacterial concentration on their hands according
to hand size, and found that bacterial reduction was significantly lower for
large hands compared with small hands. This highlights the need for customizing
the volume of alcohol-based hand rub for the most effective hand hygiene.
As the researchers acknowledged, "Over the past 20 years, ABHRs have become the preferential tool
for hand hygiene in healthcare settings because of their high antimicrobial
efficacy, tolerability, and accessibility. There is common sense and
microbiologic evidence that the volume of ABHR used should be large enough to
cover the whole surface area of both hands, but there is no consensus on how
much is the minimum necessary, and whether healthcare worker hand size
influences it."
For the study prior to each contamination procedure,
participants washed their hands with 5mL of plain soap for 1 minute. Hands were
then contaminated artificially by inserting them into the bacterial suspension
5 seconds, and held up to dry for 3 minutes. After the first contamination
procedure, baseline bacterial recovery was obtained using the fingertip method.
As a next step, participants washed their hands, re-contaminated them in the
same way as before, and undertook a hand friction action with no ABHR and a
second baseline recovery of bacteria was performed. Next the study participants applied the ABHR varying every 0.5
mL from 0.5 to 3 mL. The participants with
large hands were investigated further with the application of 4, 5, and 6 mL of
ABHR. The bacterial recovery step was
repeated with each application.
The researchers found that overall there were no differences
between the hand size categories and the average level of contamination of
hands at baseline. As the volume of ABHR was increased, there was an associated
decrease in the mean bacterial count and they also found that bacterial
reduction was inversely and significantly associated with hand surface area.
The study without a doubt demonstrates a strong relationship
between the reduction of bacterial count on hands and the amount of ABHR used
for hand hygiene. The researchers
concluded that it is a matter of concern that HCWs with large hands could not
achieve a minimum of 2 log reduction of bacteria on their hands by the
application of 3 mL of ABHR, the volume recommended by most manufacturers. That
concern gets greater when we realize that the mean application volume of ABHR
in clinical practice may be lower than 1 mL.
So? How big are your
hands? If you have large hands, the next
time you use hand sanitizer you may want to consider using 2 pumps!
Bugging Off!
Nicole
