Fragrance.

Products with a strong fragrance may lead to discomfort and respiratory symptoms in some HCWs allergic to perfume or fragrances. Many patients complain about perfumed products, especially in oncology. Therefore, consideration should be given to selecting a product with mild or no added fragrances.

Texture.

Handrubs are available as gels, solutions or foams. Dermal tolerance and efficacy are not affected by consistency.

Although more expensive than solutions, gels have recently become the most popular type of alcohol-based handrub preparation in many countries.

Due to their formulations, some gels may produce a feeling of humectant “build-up”, or the hands may feel slippery or oily with repeated use.

This difference in consistency has not been associated with better objective tolerance or higher compliance with hand cleansing in a controlled study. A prospective intervention study and a comparison study have shown that the use of a gel formulation was associated with better skin condition, superior acceptance, and a trend towards improved compliance. The antibacterial efficacy of alcohol-based gels may depend mainly on concentration and type of alcohol in the formulation.

Solutions dry more quickly than gels or foams (a potential advantage) and may be less likely to produce a feeling of humectant “build-up”.

They are more likely to drip from the hands onto to the floor during use, and it has been reported that these drips have created spots on the floor under the dispensers in some hospitals. Solutions often have a stronger smell of alcohol than do gels. Foams are used less frequently and are more expensive. Similar to gels, they are less likely to drip from the hands onto the floor during application, but may produce stronger “build-up” feeling with repeated use and may take longer to dry.