Geles Antibacteriales

Journal of Hospital Infection (2004) 56, S13–S15

www.elsevierhealth.com/journals/jhin

Efficacy of alcohol-based gels compared with simple
hand wash and hygienic hand disinfection
G. Kampfa,b,*, C. Ostermeyerc
a

Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstraße 27, 22525 Hamburg, Germany
¨
¨
Institut fur Hygiene und Umweltmedizin, Ernst-Moritz-Arndt Universitat Greifswald,Walther-RathenauStr. 49a, 17489 Greifswald, Germany
c
Bode Chemie GmbH & Co., Microbiology, Melanchthonstraße 27, 22525 Hamburg, Germany
b

KEYWORDS
Alcohol-based gels;
Efficacy; Simple hand
wash; Hygienic hand
disinfection; EN 1500

Summary A recent research letter on the limited efficacy of alcohol-based
hand gels has alerted the global infection control community and raised thequestion of the true significance of data obtained according to EN 1500. It has
been described that a 1 min simple hand wash reduces artificial contamination of hands by a log10 reduction factor of 2.8 and a 1 min reference hand
disinfection with 2-propanol (60%, v/v) by a factor of 4.6 steps. The EN 1500
gel data show that the 30 s efficacy of most gels is closer to a simple hand
wash than to thereference hand disinfection. The 30 s efficacy of most
alcohol-based liquid products and one gel, however, is almost identical to the
reference hand disinfection. In many European countries alcohol-based liquid
products have been established as a standard practice in hygienic hand
disinfection for decades. Replacement of these products with most available
gels would be a step backward in termsof efficacy and has still to be seen
critically from the efficacy point of view.
Q 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights
reserved.

Introduction
A recent research letter alerted the global infection
control community to the limited efficacy of alcoholbased hand gels1 and has led to controversy over the
use of hand gels in hospitals and the significance oftest norm EN 1500. It was questioned what type and
level of antimicrobial efficacy an alcohol-based hand
*Corresponding author. Address: Bode Chemie GmbH & Co.,
Scientific Affairs, Melanchthonstraße 27, 22525 Hamburg,
Germany. Tel.: þ 49-40-54006-0; fax: þ 49-40-54006-128.
E-mail address: guenter.kampf@bode-chemie.de

rub should have if used in hospitals. Although many
gels have been reportedto be significantly less
effective than the reference hand disinfection,1,2 it
remains unclear what exactly this means in practice.
A recent study has looked at the intra-laboratory
reproducibility of the EN 1499 reference hand wash
with a simple soap and the EN 1500 reference hand
disinfection with 2-propanol (60%). Both procedures
are carried out for 1 min. We have now assigned the
EN1500 efficacy data of alcohol-based gels and liquid
products derived from various publications into this
wider frame between simple hand wash and hygienic
hand disinfection.

0195-6701/$ - see front matter Q 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jhin.2003.12.026

S14

Material and methods
EN 1499 hand wash
EN 1499 is thestandard by which antiseptic liquid
soaps must demonstrate efficacy under practical
conditions in comparison with the reference nonmedicated soap (sapo kalinus) tested on Escherichia coli K12 (NTCC 10538). The product should be
significantly more effective than the reference
soap.3
A product is compared with the reference soap
on artificially contaminated hands using a crossover design with 12 – 15volunteers. Hands are
washed for 1 min with soft soap, dried with paper
towels, immersed in the contamination fluid up to
the mid-metacarpals for 5 s with fingers spread, and
then allowed to air dry for 3 min. Fingertips are
rubbed for 1 min in a petri dish containing a liquid
broth. Counts of organisms obtained at this stage
are designated ‘pre-values’. A specified volume of
the test...