“Until recently, scientific literature was scant with regard to hand hygiene technique. CDC and WHO guidelines provide general guidance on technique and recommend that manufacturer guidance be followed for volume of hand hygiene product used and contact time of product.
The minimum time required by manufacturers is generally 15–20 seconds, with the volume required changing on the basis of the size of the hands to meet the time requirement. Recent studies suggest that 15 seconds is insufficient for meeting standards for high-quality hand disinfection (EN 1500) and that physical coverage of hands with hand hygiene product in clinical settings is often substandard.
In 2009, the WHO published guidance on a standardized multistep technique to promote coverage of all surfaces of the hands with hand hygiene product, estimating 20–30 seconds for hand rubbing and 40–60 seconds for hand washing with soap and water.
Recent studies have shown that training HCP on proper technique can increase coverage and decrease bacterial counts on the hands of HCP. Some studies have indicated that rigid adherence to standardized step-by-step technique may not be as critical by demonstrating that sufficient pathogen reductions could be achieved by instructing HCP simply to cover their hands with hand hygiene product (ie, the “reasonable application” approach) regardless of technique used. However, the studies finding reasonable application equivalent to a standardized technique had protocols using 3 mL of product, and it is unclear how often this volume is used in clinical practice (due to longer drying times associated with use of higher volumes).
The standard dispenser actuation for based hand rubs is 1.1 mL, although a recent study showed variability from 0.6 to 1.3 mL of product dispensed with each actuation. Two studies published in 2013 report conflicting findings on whether 1.1 mL is sufficient to meet the US Food and Drug Administration (FDA) requirement for log reductions.(Macinga DR, Infect Control Hosp Epidemiol 2013;34:299–301. and Kampf G BMC Infect Dis 2013;13: 472.)”
For the best result use 3 mL hand rub for 30 seconds, perform WHO 6-steps and check the result with an objective hand hygiene technique evaluation system.