Background: Healthcare workers often experience skin dryness and irritation from performing hand hygiene frequently. Tolerability and acceptability are barriers to hand hygiene compliance, but there is little in the literature about exactly which types of alcohol-based hand rubs (ABHRs) have a higher dermal tolerance.

Aim: To compare the tolerability and acceptability of three different ABHR gel formulations in a population of adult volunteers.

Methods: Thirty-eight participants were randomized to three different sequences, testing three hand-rub gel formulations: isopropanol-based (Hopigel®); ethanol-based (World Health Organization (WHO) gel formulation); and ethanol-based containing superfatting agents (Saniswiss Sanitizer Hands H1). Participants tested each of the formulations over a series of three five-day interventions, followed by a nine-day washout period. At the end of each intervention, skin condition was assessed and feedback was collected.

Findings: Whereas no statistically significant difference was observed regarding tolerability between the three ABHR gel formulations tested, there were differences in acceptability. Participants preferred the smell of the H1 and WHO gel formulations (P = 0.003 and P = 0.040, respectively); H1 had a better texture than the WHO gel formulation (P < 0.001); and H1 was considered more pleasant overall than Hopigel (P = 0.037). Overall preference varied, but H1 was rated the favourite most often among participants, and the least favourite least often.

Conclusion: A high variability was observed in the participants' reactions to the different formulations tested. These results highlight the importance of giving healthcare workers a choice between different high-quality hand rubs to ensure maximum acceptability.