The Impact of Accelerated Drying on Alcohol-Based Antiseptic Efficacy: A Scoping Review

Document Type : Review Article

Authors

University of British Columbia, Vancouver, Canada

10.30491/hpr.2025.535440.1500
Abstract
Background: Alcohol-based antiseptics are widely used in clinical settings for skin disinfection prior to procedures, with efficacy dependent on both concentration and adequate wet contact time. Despite recommendations to allow antiseptics to air dry naturally, practices such as fanning or blowing are commonly used to hasten drying. The impact of such practices on antiseptic efficacy and safety remains unclear.
Objectives: To systematically map the existing literature on the effects of accelerated drying, particularly through fanning, blowing, or forced evaporation, on the antimicrobial efficacy of alcohol-based antiseptics used for skin disinfection.
Methods: A scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR guidelines. Five databases (PubMed, Embase, Scopus, CINAHL, and Web of Science) and grey literature sources were searched from inception to July 2025. Eligible studies examined alcohol-based antiseptics and assessed drying methods or contact time in relation to antimicrobial efficacy. Data were synthesized thematically.
Results: Eighteen publications met inclusion criteria, comprising experimental studies, clinical guidelines, technical protocols, and reviews. Four key themes emerged: (1) Sufficient wet contact time is essential for antimicrobial efficacy; (2) Fanning or accelerated evaporation reduces microbial kill rates, particularly for Staphylococcus aureus; (3) Surgical and clinical guidelines emphasize complete natural drying due to infection and fire risk; and (4) There is a lack of clinical trials evaluating infection outcomes or real-world adherence to drying recommendations.
Conclusion: Accelerating the drying of alcohol-based antiseptics can compromise antimicrobial efficacy by shortening contact time and has no support in current guidelines. Despite its widespread use, fanning remains unvalidated and potentially harmful. There is a need for clinical research on the impact of drying practices and adherence to protocols in real-world settings.

Keywords


1.       Boyce JM. Alcohols as Surface Disinfectants in Healthcare Settings. Infect Control Hosp Epidemiol. 2018;39(3):323-8. doi:10.1017/ice.2017.301
2.       Kampf G. Efficacy of ethanol against viruses in hand disinfection. J Hosp Infect. 2018;98(4):331-8. doi:10.1016/j.jhin.2017.08.025
3.       Kampf G, Kramer A. Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs. Clin Microbiol Rev. 2004;17(4):863-93. doi:10.1128/cmr.17.4.863-893. 2004
4.       Reichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for Skin Antisepsis at Clinically Relevant Skin Sites. Antimicrob Agents Chemother. 2009;53(11):4778-82. doi:10.1128/aac.00582-09
5.       Suchomel M, Eggers M, Maier S, Kramer A, Dancer SJ, Pittet D. Evaluation of World Health Organization–Recommended Hand Hygiene Formulations. Emerg Infect Dis. 2020;26(9):2064-8. doi:10.3201/eid2609. 201761
6.       Lim K, Li WY, Dinata A, Ho ET. Comparing the antibacterial efficacy and functionality of different commercial alcohol-based sanitizers. Al-Judaibi AA, editor. Plos One. 2023;18(3):e0282005. doi:10.13 71/journal.pone.0282005
7.       Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. doi:10.1017/ice.20 23.67
8.       Widmer AF, Atkinson A, Kuster SP, Wolfensberger A, Klimke S, Sommerstein R, et al. Povidone iodine vs chlorhexidine gluconate in alcohol for preoperative skin antisepsis: a randomized clinical trial. JAMA. 2024;332(7):541-9. doi:10.1001/jama.2024.8531
9.       Seidelman JL, Mantyh CR, Anderson DJ. Surgical Site Infection Prevention: A Review. JAMA. 2023;329(3): 244-52. doi:10.1001/jama.2022.24075
10.     Best EL, Parnell P, Wilcox MH. Microbiological comparison of hand-drying methods: the potential for contamination of the environment, user, and bystander. J Hosp Infect. 2014;88(4):199-206. doi:10.1016/j.jhin.2014.08.002
11.     Best EL, Redway K. Comparison of different hand-drying methods: the potential for airborne microbe dispersal and contamination. J Hosp Infect. 2015; 89(3):215-7. doi:10.1016/j.jhin.2014.11.007
12.     Taunk P, Shimpi R, Singh R, Collins J, Muthusamy VR, Day LW. GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies. Gastrointest Endosc. 2022;95(6):1048-1059.e2. doi:10.1016/j.gie. 2021.09.024
13.     Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/13645570320001196 16
14.     Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010 ;5(1):69. doi:10.1186/1748-5908-5-69
15.     Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73. doi:10.73 26/M18-0850
16.     Kampf G, Pitten FA, Heeg P, Christiansen B. Efficacy of two ethanol-based skin antiseptics on the forehead at shorter application times. BMC Microbiol. 2007;7(1):85. doi:10.1186/1471-2180-7-85
17.     Macinga DR, Shumaker DJ, Werner HP, Edmonds SL, Leslie RA, Parker AE, et al. The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs. BMC Infect Dis. 2014;14(1):511. doi:10.1186/1471-2334-14-511
18.     Monstrey SJ, Lepelletier D, Simon A, Touati G, Vogt S, Favalli F. Evaluation of the antiseptic activity of 5% alcoholic povidone-iodine solution using four different modes of application: a randomized open-label study. J Hosp Infect. 2022;123:67-73. doi:10.1016/j.jhin.2022.02.020
19.     Omidbakhsh N. Theoretical and experimental aspects of microbicidal activities of hard surface disinfectants: are their label claims based on testing under field conditions? J AOAC Int. 2010;93(6):1944-51. doi:10.1093/jaoac/93.6.1944
20.     Gibbons S, Dexter F, Loftus RW, Brown JR, Wanta BT, Charnin JE. The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination. J Hosp Infect. 2024; 145:142-7. doi:10.1016/j.jhin.2024.01.006
21.     Apfelbaum JL, Caplan RA, Barker SJ, Connis RT, Cowles C, Ehrenwerth J, et al. Practice advisory for the prevention and management of operating room fires: an updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology. 2013;118(2):271-90. doi:10.10 97/aln.0b013e31827773d2  
22.     Berr os-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91. doi:10.1001/jamasurg.2017.0904
23.     Keenan C, Danis H, Fraley J, Roets J, Spitzer H, Grasso S. The dreaded 3-minute wait: does it really prevent operating room fires? The IGNITE trial. Mil Med. 2024;189(11-12):e2468-74. doi:10.1093/ milmed/usae300
24.     Ryan SP, Adams SB, Allen N, Lazarides AL, Wellman SS, Gage MJ. Intraoperative Fire Risk: Evaluating the 3-Minute Wait After Chlorhexidine-Alcohol Antiseptic Scrub. J Orthop Trauma. 2021;35(1):e31-3. doi:10.1097/BOT.0000000000001885
25.     O’Grady NP. Prevention of Central Line–Associated Bloodstream Infections. Taichman DB, editor. N Engl J Med. 2023;389(12):1121-31. doi:10.1056/nejmra 2213296
26.     Wilkinson MAC, Ormandy K, Bradley CR, Hines J. Comparison of the efficacy and drying times of liquid, gel and foam formats of alcohol-based hand rubs. J Hosp Infect. 2018;98(4):359-64. doi:10.1016/j. jhin.2017.09.024
27.  Klarczyk BR, Ruffert L, Ulatowski A, Mogrovejo DC, Steinmann E, Steinmann J, et al. Evaluation of temperature, drying time and other determinants for the recovery of Gram-negative bacterial pathogens in disinfectant efficacy testing. J Hosp Infect. 2023;141: 17-24. doi:10.1016/j.jhin.2023.08.006