Quality and efficacy of alcohol-based hand rubs used in healthcare facilities of Addis Ababa, Ethiopia

BACKGROUND: Hand hygiene is critical for infection prevention and quality of care. Alcohol-based hand rubs (ABHRs) are widely recommended for their broad antimicrobial activity and ease of use; however, concerns remain regarding product quality and efficacy. This study evaluated the physicochemical properties and antimicrobial performance of ABHRs used in healthcare facilities in Addis Ababa. METHODS: reduction factor as the primary outcome. Non-parametric tests (Wilcoxon signed-rank, Kruskal-Wallis, and Mann-Whitney U) were applied. RESULTS: reductions of 2.63-4.63; 50% achieved the EN 1500 benchmark of ≥ 4 log reduction, 26.7% demonstrated moderate efficacy (3-<4 log reduction), and 23.3% fell below 3 log reduction. Imported formulations (73-86% v/v; median 79% v/v) consistently achieved ≥ 4 log reductions, significantly outperforming hospital-produced (p = 0.009) and locally manufactured products (p = 0.047). CONCLUSION: One-fourth of ABHRs and half of the tested products failed to meet the WHO concentration and EN 1500 efficacy benchmarks. Policymakers, hospital administrators, and the Ethiopian Food and Drug Authority must urgently establish mandatory quality audit systems and enforce strict adherence to international guidelines to safeguard healthcare workers, patients, and infection prevention efforts in Ethiopia.