Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses

Am J Infect Control. 2005 Mar;33(2):67-77. doi: 10.1016/j.ajic.2004.08.005.


Background: Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers.

Methods: We studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method.

Results: The highest log 10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2.

Conclusions: Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Benzethonium / administration & dosage
  • Benzethonium / pharmacology
  • Chlorhexidine / administration & dosage
  • Chlorhexidine / analogs & derivatives*
  • Chlorhexidine / pharmacology
  • Cross Infection / prevention & control*
  • Disinfectants / administration & dosage
  • Disinfectants / pharmacology*
  • Hand Disinfection*
  • Humans
  • Infection Control / methods
  • Levivirus / drug effects
  • Microbial Sensitivity Tests
  • Serratia marcescens / drug effects
  • Surface-Active Agents / administration & dosage
  • Surface-Active Agents / pharmacology*
  • Triclosan / administration & dosage
  • Triclosan / pharmacology


  • Disinfectants
  • Surface-Active Agents
  • Benzethonium
  • Triclosan
  • chlorhexidine gluconate
  • Chlorhexidine