Literature review of factors influencing the effectiveness of handrubbing with alcohol-based handrubs within clinical practice

Research output: Contribution to journalMeeting abstractpeer-review


Effective hand hygiene is the single, most important factor in preventing the spread of healthcare-associated infections. Two main components of effective hand hygiene within clinical settings include opportunity and technique. The former relates to the WHO’s five moments for hand hygiene. Evidence suggests that compliance with opportunity improves when alcohol-based handrub (ABHR) is available. However, evidence for the most effective handrubbing technique remains limited and inconsistencies in guidelines exist.

An integrative literature review of factors influencing the effectiveness of handrubbing with ABHRs within clinical practice was conducted. The literature search was conducted systematically using CINAHL, MEDLINE, PROSPERO, ScienceDirect and Web of Science electronic databases. The search was limited to sources available in the English language and published between the years 1980–2015.

The search resulted in 26 eligible papers, including 16 experimental and 10 observational studies. Six themes emerged, including the effectiveness of handrubbing technique, influence of ABHR volume, duration of the handrubbing procedure, the effect of mechanical rubbing, the effect of hand size and acceptability of handrubbing technique. Technique, level of compliance with protocol, ABHR volume, time and friction were all shown to influence the effectiveness of handrubbing. Handrubbing with 3 ml of ABHR for at least 30 seconds using the six-step technique appears to yield the best results in antimicrobial efficacy. An interesting finding was that certain areas on hands might be more important than others during hand decontamination.

This review identified factors influencing the effectiveness of the handrubbing procedure which should be standardised for healthcare workers. The importance of covering all surfaces of the hands on the efficacy of handrubbing remains uncertain; thus, further research is required to investigate the contribution of each of the six steps to the effectiveness of the handrubbing procedure.

Declaration of interest
I do not have any conflict of interests to declare.
Original languageEnglish
Pages (from-to)S41
JournalJournal of Infection Prevention
Issue number1S
Publication statusPublished - 2016


  • literature review
  • effectiveness
  • handrubbing
  • alcohol-based handrubs
  • clinical practice


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