Bertrand Souweine Alexandre Lautrette Claire Aumeran Marcel Be ´ne ´dit Jean Michel Constantin Miche `le Bonnard Dominique Gue ´lon Georges Amat Bruno Aublet Richard Bonnet Ousmane Traore ´ Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study Received: 27 August 2008 Accepted: 19 February 2009 Published online: 15 April 2009 Ó Springer-Verlag 2009 B. Souweine Á A. Lautrette CHU Clermont-Ferrand, unite ´ de re ´animation me ´dicale, Po ˆle REUNNIRH, Ho ˆp G Montpied, 63003 Clermont-Ferrand, France C. Aumeran Á O. Traore ´( ) ) CHU Clermont-Ferrand, service d’hygie `ne hospitalie `re, Po ˆle REUNNIRH, Ho ˆp G Montpied, 63003 Clermont-Ferrand, France e-mail: otraore@chu-clermontferrand.fr Tel.: ?33-4-73754885 Fax: ?33-4-73751183 M. Be ´ne ´dit CHR Moulins, service de re ´animation me ´dicale, 03000 Moulins, France J. M. Constantin Á M. Bonnard Á D. Gue ´lon CHU Clermont-Ferrand, de ´partement d’anesthe ´sie re ´animation, Ho ˆp G Montpied, 63003 Clermont-Ferrand, France G. Amat CHR Vichy, unite ´ de re ´animation polyvalente, 03200 Vichy, France B. Aublet CHU Clermont-Ferrand, service d’e ´pide ´miologie me ´dicale et biostatistiques, Ho ˆp G Montpied, 63003 Clermont-Ferrand, France R. Bonnet CHU Clermont-Ferrand, laboratoire de bacte ´riologie, Ho ˆp G Montpied, 63003 Clermont-Ferrand, France Abstract Objective: We com- pared handwashing (HW) and alcohol-based handrub (ABH) for skin tolerance, acceptability, and hand hygiene compliance in health- care workers (HCWs) in a multicen- tric study. Design and setting: Before/after study over two periods (P1 and P2) in seven ICUs. Monitoring of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in two ICUs (U4 and U6). Subjects and patients: All HCWs of the seven ICUs, and the patients of U4 and U6 without MRSA carriage on admission. Interventions: Hand- washing was available in P1 and P2. ABH was introduced after P1 and available throughout P2. HCWs completed questionnaires on skin tolerance in P1 and P2, and on acceptability in P2. Compliance with hand hygiene was assessed in P1 and P2 using a standardized method. ICU- acquired MRSA colonization/infec- tion in U4 and U6 was recorded. Measurements and main results: Hand erythema was reported during P1 and P2 by 21.7 and 11% of HCWs, respectively (P = 0.01), itching by 15.8 and 7.1% (P = 0.02), oozing by 0.8 and 1.1% (P = 0.82), and bleed- ing by 4.2 and 1.1% (P = 0.1). ABH was considered easier and quicker than HW (P \ 0.01), but overall acceptability did not differ between the two. Compliance increased from 51% (334/647) in P1 to 60% (251/ 418) in P2, P \ 0.01. No significant reduction in MRSA colonization/ infection between P1 and P2 (P = 0.30) was observed, but the study was underpowered. Conclu- sions: Self-report questionnaires show that when ABH is available in ICUs, fewer unpleasant skin sensa- tions are reported. ABH is considered to be easier and quicker to use than HW and compliance is improved after glove removal. Keywords Nosocomial infection Á Hand hygiene Á Handwashing Á Alcohol-based handrub Á Guideline Adherence Á Perception Intensive Care Med (2009) 35:1216–1224 DOI 10.1007/s00134-009-1485-5 ORIGINAL