Influence of rings on the efficacy of hand sanitization and residual bacterial contamination

Infect Control Hosp Epidemiol. 2007 Mar;28(3):351-3. doi: 10.1086/510790. Epub 2007 Feb 13.


Background: Previous studies, conducted before widespread use of scrubless, alcohol-based hand sanitizers, demonstrated increased residual bacterial counts after hand hygiene on hands with jewelry.

Objective: To compare the impact of finger rings on the effectiveness of scrubless and water-aided alcohol-based hand sanitization methods with that of povidone-iodine scrub.

Design: Randomized, controlled study.Setting. University hospital.Participants. Sixty volunteer subjects from a pool of perioperative staff and medical students.

Intervention: After recruitment, participants wore a ring on one hand and no ring on the other hand. They were randomly assigned to perform hand hygiene with a povidone-iodine scrub, an alcohol wash, or a waterless alcohol-chlorhexidine lotion (n=20 subjects per method). After subjects completed hand hygiene, gloves were placed on their hands by means of sterile methods, and a "glove juice" technique was used to obtain samples for culture. The number of colony-forming units in each culture was counted, and the data were compared.

Results: There was no significant difference in the number of bacteria between hands with and hands without rings for the groups that used alcohol wash or alcohol-chlorhexidine lotion. However, for the povidone-iodine group, the number of bacteria on hands with rings was greater than the number on hands without rings (P<.05). The hands of participants who used waterless alcohol-chlorhexidine had the lowest bacterial count, regardless of the presence of rings (P<.01).

Conclusions: The presence of rings does not negatively impact the effectiveness of alcohol-based hand sanitizers. Use of waterless alcohol-chlorhexidine lotion resulted in the lowest bacterial count.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Alcohols / administration & dosage*
  • Anti-Infective Agents, Local / administration & dosage*
  • Chlorhexidine / administration & dosage*
  • Colony Count, Microbial
  • Disinfection / methods
  • Drug Combinations
  • Fingers
  • Hand / microbiology*
  • Hand Disinfection / methods*
  • Humans
  • Povidone-Iodine / administration & dosage*
  • Surgical Procedures, Operative / standards
  • Treatment Outcome


  • Alcohols
  • Anti-Infective Agents, Local
  • Drug Combinations
  • Povidone-Iodine
  • Chlorhexidine