Effectiveness of Alcohol Gel-Based Antiseptics Against Multidrug-Resistant Bacteria: An in vitro Experimental Study
PDF
Supplementary File

Keywords

Antiseptics
Hand hygiene preparations
Hand hygiene
Standard bacterial strains
Healthcare-related infections

How to Cite

1.
Silva SK e, de Deus LB, Bittencourt L da S. Effectiveness of Alcohol Gel-Based Antiseptics Against Multidrug-Resistant Bacteria: An in vitro Experimental Study. ASIDE Health Sci. 2025;2(2):1-8. doi:10.71079/ASIDE.HS.121925210

Abstract

Background: Since the 19th century, asepsis has revolutionized public health, and hand hygiene remains a cornerstone of infection control, particularly in healthcare settings with high exposure to resistant microorganisms. This study aimed to evaluate the antimicrobial efficacy of four commercial alcohol-gel brands (A, B, C, and D) against standard ATCC strains of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis, which are prevalent in clinical environments.

Methods: The disk-diffusion method was employed on Müeller-Hinton agar, using sterile disks impregnated with each gel sample. Following a 24-hour incubation at 35°C, the resulting halo zones were measured.

Results: Significant variability was observed among the brands. Brand C exhibited the highest antimicrobial activity, particularly against P. aeruginosa (11.10 mm), with an overall mean inhibitory activity of 9.8 mm. Brand B demonstrated broad efficacy (mean 9.2 mm), while Brand A showed moderate activity with higher variability (mean 7.9 mm). Brand D demonstrated minimal to no inhibitory activity in the disk-diffusion assay compared to the other tested products (mean 4.3 mm). These differences were statistically significant across all tested bacteria.

Conclusions: These findings indicate that alcohol concentration is not the sole determinant of antimicrobial performance. Formulation factors—such as humectants, polymers, and viscosity—substantially impact efficacy. The composition of an alcohol-based hand sanitizer directly governs its antimicrobial power. The study reinforces the importance of selecting validated products, adhering to hygiene protocols, and conducting microbiological surveillance to prevent healthcare-associated infections.

PDF
Supplementary File

References

1. L R. Dictionary of Medical and Health Technical Terms. 2003.

2. Fontana RT. [Hospital infection and the historical evolution of infection]. Rev Bras Enferm. 2006: 703 [PMID: 17340720, https://doi.org/10.1590/s0034-71672006000500021]

3. Moura ME, Campelo SM, de Brito FC, Batista OM, de Araujo TM, Oliveira AD. [Nosocomial infection: study of prevalence at a public teaching hospital]. Rev Bras Enferm. 2007: 416 [PMID: 18041525, https://doi.org/10.1590/s0034-71672007000400011]

4. Portal de Boas Práticas em Saúde da Mulher dCedA. Hand hygiene as a strategy for preventing healthcare-associated infections (HAIs) and emergence of multidrug-resistant bacteria 2018 [updated 2018]. Available from: https://www.arca.fiocruz.br/handle/icict/3s0268.

5. Na G, others. Alcohol Sanitizer 2023 [updated 2023]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513254/.

6. Cruz AFD, Abreu AO, Souza PA, Deveza B, Medeiros CT, Sousa VS, Sabagh BP, Villas Boas MHS. Adaptation and validation of a method for evaluating the bactericidal activity of ethyl alcohol in gel format 70% (w/w). J Microbiol Methods. 2022: 106402 [PMID: 34973997, https://doi.org/10.1016/j.mimet.2021.106402]

7. Rocha VFD, da Silva EN, Azevedo J, Ribeiro MT, Reis MG, Barros TF, Reis JN. The impact of COVID-19 on microbiological profile and antibiotic consumption in ICU: a retrospective study in an infectious disease hospital in Brazil. Braz J Infect Dis. 2024: 103705 [PMID: 38065221, https://doi.org/10.1016/j.bjid.2023.103705]

8. Berardi A, Perinelli DR, Merchant HA, Bisharat L, Basheti IA, Bonacucina G, Cespi M, Palmieri GF. Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand. Int J Pharm. 2020: 119431 [PMID: 32461194, https://doi.org/10.1016/j.ijpharm.2020.119431]

9. Wichaidit W, Naknual S, Kleangkert N, Liabsuetrakul T. Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: A hospital-based quasi-experimental study. J Public Health Res. 2020: 1863 [PMID: 33150146, https://doi.org/10.4081/jphr.2020.1863]

10. Kalingamudali YT, Jalini P, Jayamaha A, Jayaratne DL. Knowledge, attitudes, and practices on the usage of antiseptics prior to invasive medical procedures: Evidence from Sri Lankan Healthcare Professionals. SAGE Open Med. 2023: 20503121231199654 [PMID: 37750100, https://doi.org/10.1177/20503121231199654]

11. Leslie RA, Zhou SS, Macinga DR. Inactivation of SARS-CoV-2 by commercially available alcohol-based hand sanitizers. Am J Infect Control. 2021: 401 [PMID: 32818578, https://doi.org/10.1016/j.ajic.2020.08.020]

12. Eslami H, Das S, Zhou T, Müller-Plathe F. How Alcoholic Disinfectants Affect Coronavirus Model Membranes: Membrane Fluidity, Permeability, and Disintegration. J Phys Chem B. 2020: 10374 [PMID: 33172260, https://doi.org/10.1021/acs.jpcb.0c08296]

13. Gf N. Bacterial resistance in hospital settings: a review 2010. Available from: http://dspace.bc.uepb.edu.br/jspui/handle/123456789/4136.

14. Organization WH. E. coli 2016 [updated 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs125/es/.

15. FoodSafetyBrazil.org. Escherichia coli O157:H7 - understand the outbreak in the US and actions taken 2024 [updated 2024].

16. FoodSafetyBrazil.org. Foodborne outbreaks in Brazil: data updated in December 2016 2017 [updated 2017]. Available from: http://foodsafetybrazil.org/surtos-alimentares-no-brasil-dados-atualizados-em-dezembro-de-2016.

17. Control CfD, Prevention. Pseudomonas aeruginosa in Healthcare Settings. 2014.

18. Garcia-Dominguez C, Martin P, Santos-Hurtado I, Blanco J, Blanco MT, Gomez-Garcia AC. Susceptibility of Pseudomonas aeruginosa to anti-pseudomonal antibiotics in a general hospital in Spain from 1989 to 1992. J Antimicrob Chemother. 1994: 1057 [PMID: 7993468, https://doi.org/10.1093/jac/33.5.1057]

19. Agency BNHS. Module 10: Clinical Microbiology Manual.

20. Laboratorial SBdPCM. Recomendações da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial: Boas práticas em Microbiologia Clínica. Barueri, SP, Brazil: Manole; 2015 2015.

21. Asta. Science ASSIST Standard Operating Procedure: Susceptibility testing of antiseptics and disinfectants. 2023.

22. Arbogast JW, Okeke B, Brill F, Bradley T, Fraise A, Wilkinson M, Macinga D. Advancement of the standard in vivo hand rub test methods: a critical comparison of the health care personnel handwash (ASTM E1174) and the hygiene handrub (EN1500). BMC Proceedings. 2011: https://doi.org/10.1186/1753-6561-5-s6-p269]

23. Golin AP, Choi D, Ghahary A. Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses. Am J Infect Control. 2020: 1062 [PMID: 32565272, https://doi.org/10.1016/j.ajic.2020.06.182]

24. Bloomfield SF, Aiello AE, Cookson B, O'Boyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. American Journal of Infection Control. 2007: S27 https://doi.org/10.1016/j.ajic.2007.07.001]

25. Jy K. Higiene das mãos: comparação da eficácia antimicrobiana do álcool – formulação gel e líquida – nas mãos com matéria orgânica 2004 [updated 2004]. Available from: https://www.teses.usp.br/teses/disponiveis/7/7139/tde-17112006-095710/pt-br.php.

26. Suchomel M, Weinlich M, Kundi M. Influence of glycerol and an alternative humectant on the immediate and 3-hours bactericidal efficacies of two isopropanol-based antiseptics in laboratory experiments in vivo according to EN 12791. Antimicrob Resist Infect Control. 2017: 72 [PMID: 28670452, https://doi.org/10.1186/s13756-017-0229-5]

27. Menegueti MG, Laus AM, Ciol MA, Auxiliadora-Martins M, Basile-Filho A, Gir E, Pires D, Pittet D, Bellissimo-Rodrigues F. Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy. Antimicrob Resist Infect Control. 2019: 109 [PMID: 31285821, https://doi.org/10.1186/s13756-019-0553-z]

28. d'Angelo I, Provenzano R, Florio E, Pagliuca C, Mantova G, Scaglione E, Vitiello M, Colicchio R, Salvatore P, Ungaro F, Quaglia F, Miro A. Alcohol-Based Hand Sanitizers: Does Gelling Agent Really Matter? Gels. 2022: [PMID: 35200468, https://doi.org/10.3390/gels8020087]

29. Zhou Y, Yan H, Zhou Q, Feng R, Zhai B. Impact of COVID-19 control measures on Legionella pneumophila infections in children in Henan, China. J Infect. 2023: 85 [PMID: 37116618, https://doi.org/10.1016/j.jinf.2023.04.020]

30. Thaddeus N, Francis E, Jane O, Obumneme A, Okechukwu E. Effects of some common additives on the antimicrobial activities of alcohol-based hand sanitizers. Asian Pacific Journal of Tropical Medicine. 2018: https://doi.org/10.4103/1995-7645.228437]

31. Agency BNHS. Patient Safety in Health Services: Hand Hygiene. 2009.

32. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox MH. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007: S1 [PMID: 17307562, https://doi.org/10.1016/S0195-6701(07)60002-4]

33. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, Health UKDo. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014: S1 [PMID: 24330862, https://doi.org/10.1016/S0195-6701(13)60012-2]

34. Chopin-Doroteo M, Krotzsch E. Soap or alcohol-based products? The effect of hand hygiene on skin characteristics during the COVID-19 pandemic. J Cosmet Dermatol. 2023: 347 [PMID: 36409429, https://doi.org/10.1111/jocd.15523]

35. Health BNHSAMo. Resolution no. 485, August 21, 2008 2008. Available from: http://www.cff.org.br/userfiles/file/resolucoes/res485_2008.pdf.

36. Andrade D, Beraldo CC, Watanabe E, Oliveira BA, Ito IY. Atividade Antimicrobiana in Vitro Do Álcool Gel a 70% Frente Às BactÉrias Hospitalares E Da Comunidade. Medicina (Ribeirão Preto). 2007: 250 https://doi.org/10.11606/issn.2176-7262.v40i2p250-254]

37. Alhalwani A, Husain A, Saemaldahar A, Makhdoum F, Alhakami M, Ashi R, Wali R, Alsharif S, Khan MA, Jastaniah N, Fasfous I. The impact of alcohol hand sanitizer use on skin health between healthcare worker: Cross-sectional study. Skin Res Technol. 2024: e13527 [PMID: 38186055, https://doi.org/10.1111/srt.13527]

38. Lopez-Gigosos RM, Mariscal-Lopez E, Gutierrez-Bedmar M, Mariscal A. Effect of Long-Term Use of Alcohol-Containing Handwashing Gels on the Biofilm-Forming Capacity of Staphylococcus epidermidis. Int J Environ Res Public Health. 2023: [PMID: 36981945, https://doi.org/10.3390/ijerph20065037]

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2025 ASIDE Health Sciences