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Background The World Health Organization has called for the development of improved methodologies to evaluate alcohol-based handrub (ABHR) efficacy, including evaluation at “short application times and volumes that reflect actual use in healthcare facilities”. The objective of this study was to investigate variables influencing ABHR efficacy, under test conditions reflective of clinical use. Methods The test product (60% V/V 2-propanol) was evaluated according to a modified EN 1500 methodology, where application volumes of 1 mL, 2 mL, and 3 mL were rubbed until dry. Statistical analyses were performed to investigate the relative influences of product volume, hand size, and product dry-time on efficacy, and hand size and hand contamination on product dry-time. Results Mean log10 reduction factors (SD) were 1.99 (0.66), 2.96 (0.84) and 3.28 (0.96); and mean dry-times (SD) were 24 s (7 s), 50 s (14 s), and 67 s (20 s) at application volumes of 1 mL, 2 mL, and 3 mL, respectively (p ≤ 0.030). When data were examined at the individual volunteer level, there was a statistically significant correlation between dry-time and log reduction factor (p

Recent hand hygiene (HH) research has focused largely on adherence to defined HH indications specified in global and national guidelines. Research focused on quality of HH events has been limited. A critical variable impacting the quality of hand disinfection is the volume of alcohol-based hand rub (ABHR) applied during a single HH event (i.e. application volume or AV). It may be assumed that healthcare workers (HCWs) use AVs recommended by manufacturers; however, HCWs typically are able to control AV. Manufacturer recommendations for AV of ABHR vary based on local requirements with typical recommendations varying from 1 mL to 5 mL. To date, little data exists on actual ABHR AVs used in clinical practice.