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Title: Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care : a crossover study
Authors: O'Donoghue, M 
Ho, JMC 
Pittet, D
Suen, LKP 
Issue Date: 2019
Source: Antimicrobial resistance and infection control, 29 Oct. 2019, v. 8, 165, p. 1-10
Abstract: Background: Hand hygiene is a critical component of infection control. Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Alcohol-based hand rub (ABHR) can lead to improved compliance. We aimed to determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol.
Methods: Thirty six elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to determine product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During the 3-day testing period, participants were provided with their own portable bottle of ABHR. A research nurse objectively assessed the skin integrity of the hands at baseline and throughout the study. Skin moisture content was determined using a Scalar Moisture Checker Probe (Science Technology Resources, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period.
Results: Both products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content had improved by the end of the study. Residents preferred either of the test products to the liquid formulation currently in use by the LTCF.
Conclusions: Overall, the elderly were willing to use ABHR for hand hygiene. Both products were well tolerated and preferred over the usual product provided by the LTCF. However, forgetfulness and difficulty rubbing the product over the hands due to finger stiffness posed a challenge for some residents. This could be overcome by using healthcare worker-assisted hand hygiene at specified times each day and prompts to serve as reminders to perform hand hygiene.
Keywords: Hand hygiene
Alcohol-based hand rub
Long-term care facility
Elderly hand hygiene
World health organization
Publisher: BioMed Central
Journal: Antimicrobial resistance and infection control 
EISSN: 2047-2994
DOI: 10.1186/s13756-019-0610-7
Rights: © The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (, which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver( applies to the data made available in this article, unless otherwise stated.
The following publication O’Donoghue, M., Ho, J.M.C., Pittet, D. et al. Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care: a crossover study. Antimicrob Resist Infect Control 8, 165 (2019), 1-10 is available at
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