Major article Acceptability and tolerability of liquid versus gel and standard versus virucidal alcohol-based hand rub formulations among dental students Fritz Stauffer MD a , Marion Griess DMD b , Gabriele Pleininger a , Anara Zhumadilova DDS, PhD c , Ojan Assadian MD, DTMH d, * a Division for Infection Control, Bernhard Gottlieb University Clinic of Dentistry, Vienna, Austria b General Outpatients Clinic, Bernhard Gottlieb University Clinic of Dentistry, Vienna, Austria c School of Science and Technology, JSC Nazarbayev University, Astana, Kazakhstan d Clinical Institute for Hospital Hygiene, Medical University of Vienna, Vienna, Austria Key Words: Hand hygiene Epidemiology Dentistry Compliance Comparison WHO Background: Hand hygiene is effective to prevent the transmission of microorganisms in health care settings, but compliance remains low, even when easy access to hand cleaning agents is provided. Objective: Formulation of alcohol-based hand rub (ABHRs) may influence staff compliance to hand hygiene. The aim of this prospective longitudinal study (1 week) was to investigate possible differences of 4 different gel or liquid ABHR formulations, with or without virucidal claim among dental students. Methods: Participants were randomly assigned to dental treatment cubicles, equipped with either a gel or a liquid based ABHRs, with our without a virucidal claim. Participants assessed the subjective acceptability and the tolerability of test formulations on their hands over a period of 1 week using the 14 item, 7-point Lickert scale World Health Organization questionnaire. Results: All tested ABHRs passed the subjective acceptability criteria of 50% above 4 for the items “color and fragrance” and for all other items of >75% above 4 and may be regarded as “good.” Significant differences were observed between the 2 gels but not between the 2 liquid ABHRs. For subjective skin tolerability, no significant difference was observed between the liquid formulations after 1 consecutive week of application. However, the difference between the 2 gels was highly significant. Conclusion: Virucidal ABHR formulations may be better accepted and tolerated over prolonged periods by dental students than anticipated. The user acceptability of ABHRs depend more on the specific product’s formula than its general category. Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Hand hygiene (HH) prevents effectively the transmission of microorganisms in health care settings; however, compliance still remains low. 1-7 Although easy access to fast-acting HH agents is available, usually, average compliance ranges between 35% and 45%. 8-11 HH promotion and campaigns can increase compliance to 70% to 85%, yet the effect shows no sustainability. 9,11 Compliance with HH depends on 2 factors: “hardware” such as sufficiently and conveniently located sinks, appropriate dispensers for alcohol-based hand rubs (ABHRs) and soap, water faucets, and sufficient paper towels and “software” such as staff knowledge on guidelines and protocols, active participation in HH promotion at individual and institutional levels, presence of role models for HH, and institutional priority for HH. Key reasons given for not dis- infecting hands includes the lack of time, limited access to hand rubs, the perception that peers and supervisors do not follow HH as recommended, and the belief that frequent hand disinfection irri- tates the skin of the hands and may lead to chronic irritation and hand eczema. 12 In recent years, the formulation of ABHRs, being in liquid or gel form, was identified as one factor influencing staff compliance to HH, with conflicting results. 13,14 Additionally, the availability of a broad range of different liquid and gel-based ABHRs now includes standard formulations against bacteria and formulations with the additional claim to be virucidal. 15,16 Standard ABHRs are suitable for the control of bacterial organisms and are generally only recom- mended in situations where viral organisms may be of less concern. 17 Because of the required higher ethanol concentration * Address correspondence to Ojan Assadian, MD, DTMH, University Professor, Clinical Institute for Hospital Hygiene, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail address: ojan.assadian@meduniwien.ac.at (O. Assadian). Supported by the Bernhard Gottlieb University Clinic of Dentistry. Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.05.004 American Journal of Infection Control xxx (2013) e1-e5