Beyond handrubs: Why QAC wipes could be the future of hand hygiene in challenging environments

Hand hygiene remains one of the most powerful tools in preventing the spread of infections. Yet, not all methods perform equally well under the real-world conditions faced daily in healthcare, food handling and community settings. A newly published study¹ in the Journal of Hospital Infection by Yuan and colleagues sheds light on how different approaches, including soap and water, alcohol-based hand rubs (ABHRs) and quaternary ammonium compound (QAC) wipes, compare when hands are contaminated with protein-rich organic matter—a situation commonly encountered in clinical practice.

The finding that QAC wipes have equivalent performance to hand washing, and are superior to ABHR, has important implications for healthcare professionals, particularly in environments where water is scarce and quick, reliable alternatives are needed.

The challenge of organic contamination

Most national and international guidelines, including the World Health Organization (WHO)², Centers for Disease Control and Prevention (CDC)³ and the National Infection Prevention and Control Manuals in UK^4,5 , recommend ABHR for unsoiled hands or soap and water for soiled hands. But both ABHR and hand washing using soap and water have their limitations. Soap and water requires time (at least 60 s), compliance with technique and a steady supply of running water, something not always available in resource-limited or high-pressure environments. ABHRs, while convenient, lose much of their effectiveness in the presence of organic material, like blood, mucus or protein-rich fluids, and have a limited range of activity compared with soap and water washing, especially for gastrointestinal pathogens such as C. difficile and norovirus.

This is where QAC wipes (such as Clinell Antimicrobial Hand Wipes) come into play. They combine the chemical action of disinfectants with the mechanical action of wiping, raising the question: can they be as effective as soap and water when hands are visibly, or heavily, soiled?

Inside the study

The Chinese research team conducted a self-controlled crossover trial with 15 trained volunteers. Each participant’s hands were deliberately contaminated with Staphylococcus aureus mixed with bovine serum albumin (BSA)—a protein designed to mimic real-world soiling conditions.

Three interventions were then tested:

1. Handwashing with plain soap and water (60 seconds)
2. Alcohol-based hand rub (70% ethanol with 0.2% hydrogen peroxide, 30 seconds)
3. QAC wipes (Clinell, UK; 60 seconds of wiping)

The researchers measured how effectively each method was in the removal or inactivation of bacteria from three hand regions—fingers, palms and the often-overlooked dorsum (back of the hand).

Key findings

• QAC wipes are non-inferior to soap and water
  When used for a full 60 seconds, QAC wipes achieved bacterial reductions comparable to soap and water, even in the presence of organic contamination
• Both wipes and soap and water outperform alcohol-based hand rubs
  Across fingers, palms and dorsum, wipes and soap and water removed significantly more bacteria than ABHRs. The difference was especially pronounced when organic matter was present, confirming ABHRs limitations in such contexts
• The dorsum remains a weak spot
  All three methods were least effective on the back of the hand compared with fingers and palms. Anatomical features and gaps in coverage during standard techniques likely explain why the dorsum often harbours residual microbes. This overlooked area may represent a critical reservoir for transmission
• Ranking of methods under soiled conditions:
  Soap = QAC wipes > ABHRs

Why this matters for healthcare

The study reinforces that no single hand hygiene method is perfect across all contexts. ABHRs remain essential when hands are visibly clean and rapid decontamination is needed. But in situations where organic contamination is suspected, common in wards, emergency care and food preparation, ABHRs do not provide adequate protection. Whilst soap and water is a trusted alternative to ABHR when hands are soiled, it relies on the presence of running water and cannot be taken to the point of care.

QAC hand wipes bridge this gap. They offer portability, require no water and provide both chemical and physical removal of contaminants. In resource-constrained settings, during patient transfers, or when rapid hand decontamination is necessary, they represent an effective, water-sparing alternative.

A spotlight on the dorsum

Perhaps the most surprising finding is the consistent weakness across all methods on the dorsum of the hand. Previous studies have shown that healthcare workers often neglect this area during hand hygiene. The new evidence suggests the dorsum should not be overlooked, as it may contribute to residual contamination and onward transmission.

Future training, wipe design and protocols should place greater emphasis on thorough dorsum coverage—an area where wipes with larger surface area and structured wiping motions could make a meaningful difference.

Looking forward

This study challenges the traditional ‘soap vs. alcohol rub’ debate and introduces a more nuanced, context-specific hierarchy of hand hygiene methods. The data suggest a stratified approach:

• Use ABHRs when hands are visibly clean and speed is critical
• Use soap and water when heavy soiling or organic contamination is present or use QAC wipes as a practical, water-sparing alternative in soiled conditions when sinks are unavailable

Final thoughts

Hand hygiene remains one of our frontline defences against infection, but context matters. Yuan and colleagues remind us that effectiveness is shaped not just by the product, but by the environment, technique and even anatomy. By recognising the strengths and limitations of each method, healthcare providers can better protect patients and staff alike.

With mounting pressures on healthcare systems, and increasing awareness of sustainability and water use, QAC wipes stand out as a forward-thinking, evidence-backed tool in our infection prevention toolkit.

For GAMA Healthcare, the findings are particularly relevant. Clinell Antimicrobial Hand Wipes, when used for the recommended 60 seconds, have been shown to match soap in efficacy under challenging conditions. This positions them as a crucial adjunct in infection prevention, supporting healthcare workers to maintain high standards of hand hygiene, even in water-limited or high-demand environments.