John M. Boyce, Philip M. Polgreen, Mauricio Monsalve, David R. Macinga, James W. Arbogast

BACKGROUND Recently, the US Food and Drug Administration requested that a "maximal use" trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers. OBJECTIVE To establish how frequently volunteers should be exposed to ABHR during a maximal use trial. DESIGN Retrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems. METHODS We reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour. RESULTS Of 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour. CONCLUSIONS Hand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial. Infect Control Hosp Epidemiol 2016;1-7.