Antisepsis that uses running water and an aqueous solution is usually referred to as a “scrub”. Scrubs are commonly used by surgical staff for hand antisepsis during pre-surgical preparation, and contain agents, such as chlorhexidine gluconate or povidone iodine. Scrubbing involves wetting the hands and forearms with water, systematically applying the scrub solution using hands or sponges and rinsing under running water. This process typically takes up to six minutes. The term “rub” usually refers to hand antisepsis procedures and products that do not require running water. The most commonly used rub products contain at least 60% alcohol (v/v).

Alcohol-based rubs have a well-established role in infection control strategy in healthcare settings for routine hand sanitization,^1–4 including hospitals, outpatient clinics, laboratory settings, community settings and for hand sanitization in surgical contexts.^5–8 The ubiquitous usage of alcohol-based rubs is based on evidence for reduced infectious transmission, low cost, and their high acceptability and tolerability relative to other methods of sanitization.^9,10 Nevertheless, there have been some concerns associated with the usage of alcohol-based hand sanitizers, such as religious objections, abuse potential, and flammability.³ These concerns, combined with a desire to optimize infection control and user acceptability, has led to the development of several non-alcohol based hand rub products. These products use antimicrobial agents such as triclosan, chlorhexidine, iodophors or quaternary ammonium compounds; various combinations and formulations have been developed (e.g., water-based, foams, gels, nanocapsules).^11,12

The purpose of this report is to review the evidence regarding the effectiveness of non-alcohol based hand sanitizer (rubs) for reducing infection rates and infection transmission in the healthcare setting for both healthcare workers and non-healthcare personnel. Another objective of this report is to summarize evidence-based guidelines regarding the use of non-alcohol based hand rubs.

Contents

• Context and Policy Issues
• Research Questions
• Key Findings
• Methods
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• Summary of Evidence
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• Conclusions and Implications for Decision or Policy Making
• References
• Appendix 1. Selection of Included Studies
• Appendix 2. Characteristics of Included Publications
• Appendix 3. Critical Appraisal of Included Publications
• Appendix 4. Main Study Findings and Author’s Conclusions
• Appendix 5. Additional References of Potential Interest

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