Beyond Handrubs: QAC Wipes as a Water-Sparing Alternative for Protein-Contaminated Hand Hygiene with Persistent Dorsum Challenges.

Background: This study compared the effectiveness of quaternary ammonium compound (QAC) wipes, handwashing, and hydrogen peroxide-enhanced alcohol-based hand rubs (ABHRs) in removing microorganisms from hands contaminated with proteinaceous organic matter.

Methods: A self-controlled crossover trial recruited 15 volunteers who received standardized hand hygiene training. Participants underwent three intervention methods: (1) handwashing with non-antimicrobial soap and running water for 60 seconds; (2) hand rubbing with 70% ethanol + 0.2% hydrogen peroxide for 30 seconds; and (3) hand wiping with QAC wipes for 60 seconds. Both hands were contaminated with Staphylococcus aureus (1.0-9.0 × 10⁶ CFU/mL) and supplemented with 3% bovine serum albumin (BSA). The microbial reduction was quantified using log₁₀ CFU/hand for three regions (fingers, palm, and dorsum).

Results: The efficacy of QAC wipes in bacterial removal from all three hand regions was non-inferior to soap, whereas its performance was significantly superior to that of handrub. Wipes and soap showed lower efficacy on the dorsum compared to the fingers (P < 0.001). The efficacy ranking across hand regions was: fingers > palm > dorsum, and the overall intervention efficacy ranking was: soap = wipes > handrub.

Conclusion: When QAC wipes are used under conditions of organic contamination with a 60-second procedural wiping protocol, the efficacy is not inferior to handwashing with soap, offering a feasible alternative in water-scarce environments. Handrubs show significantly lower efficacy in protein-rich environments. The poor bacterial removal efficiency on the dorsum of the hand highlights an anatomical oversight in hygiene practices, necessitating technical improvements.