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The Great Alcofoam Paradox

Is dry time more important that consumer preferences?

The rapidly growing popularity of foaming hand sanitizers complicates the question for whether healthcare facilities should replace their existing program with these new products. 

The relevance of alcohol content and application time.

A study published in January 2019 by Nina A. Gold and Ush Avaa suggests that regardless of the type of alcohol – based hand rub (ABHR) , it is imperative that 2.4 – 3ml is rubbed into the hands for a period between 25 – 30 seconds. The study goes on to highlight, that whether liquid, gel or foam, ABHRs must have an alcohol concentration between 60 % – 85 % to be most effective, with higher concentrations in that range being generally more effective.

There are several alcofoams that meet these concentration guidelines. However, the Nina A. Gold study  points out that alcofoams do tend to show dry times that exceed 30 seconds at the recommended dosages. This increased dry time causes many users to use less than the recommended minimum dosages.

Alcofoam could therefore theoretically decrease what we call quality of hand hygiene by causing users to use less product during each hand hygiene event. Though this has not been directly proven out, this could theoretically result in increased infections.

What makes the foam experience different?

In contrast, an October 2018 study focusing on the qualitative aspects of liquid, gel and foam determined that foam was the most desirable medium used by healthcare workers. The factors users favoured most were fast absorption, moisturizing effects, non-sticky feeling, clean feeling, and low smell. The study concluded that alcofoam could increase compliance rates because it combined the benefits of both gel and liquid, leading to the most positive user experience.

Taking this one step further, a 2007 study led by Traore and Coauthor  attempted to compare compliance rates of gel and liquid hand sanitizers. The study showed that the introduction of gel at a healthcare facility led to increased compliance, due to gel being perceived as the more skin friendly product.

The takeaway.

Since alcofoam was rated to be even more user friendly, we could expect the results shown by Traore and Coauthors to be more striking in an alcofoam study.

The user – friendly nature of this product, is likely at the core of its fast market adoption. However, in order to properly assess the choice between alcofoam, gel, and liquid ABHRs, more studies are needed. These studies should focus in particular on the counteracting effects of decreased quality of hand hygiene and increased compliance rates.


  1. Gold, Nina A & Avva, Usha Alcohol Sanitizer NCIB Bookshelf, National Institute of Health.
  2. Greenaway R, Ormandy K, Fellows C, Hollowood T, Impact of hand sanitizer format (gel/foam/liquid) and dose amount on the sensory properties and acceptability towards improving hand hygiene compliance as perceived by health care professionals, Journal of Hospital Infection (2018), doi: 10.1016/j.jhin.2018.07.011.
  3. Traore O, Hugonnet S, Lubbe J, Griffiths W, Pittet D: Liquid versus gel handrub formulation: a prospective intervention study. Crit Care 2007.


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