# Changes in Alcohol-Based Handrub Usage Among Hospital Staff Four Years After the COVID-19 Pandemic: A Single-Centre Observational Time-Series Study

## TL;DR

Hospital staff reduced alcohol-based handrub use in a surgical department after the pandemic, suggesting a decline in hand hygiene compliance despite ongoing resources.

## Contribution

This study provides longitudinal evidence on the sustainability of pandemic-era hand hygiene practices using ABHR consumption trends.

## Key findings

- Surgical department ABHR consumption dropped 27.5% from 2022 to 2024, returning to pre-pandemic levels.
- Hospital-wide ABHR consumption increased by 36% but did not reach statistical significance.
- 2024 surgical department rates remained far below the 2020 pandemic peak.

## Abstract

Background/Objectives: Alcohol-based handrub (ABHR) consumption is commonly used as an indirect proxy for hand hygiene practices. Hand hygiene compliance increased significantly during COVID-19, but sustainability remains uncertain. This study assessed ABHR consumption trends from 2022 to 2024 and compared them with pre-pandemic and pandemic-era rates. Methods: We conducted a follow-up observational study tracking quarterly ABHR consumption in a surgical department and hospital-wide (2022–2024). Consumption was normalized as mL per patient-day and compared with 2019–2020 data. Time-series regression with Newey–West standard errors assessed temporal trends. Results: Surgical department consumption declined 27.5% (55.9 to 40.5 mL/patient-day), returning to 2019 pre-pandemic levels. Hospital-wide consumption increased 36% (36.4 to 49.6 mL/patient-day). Neither trend reached statistical significance (p > 0.05). The 2024 surgical rate remained substantially below the 2020 pandemic peak (320 mL/patient-day). Conclusions: Pandemic-era ABHR consumption gains were not sustained in the surgical department despite maintained educational infrastructure, accessible dispensers, and consistent staffing. The critical missing element was systematic monitoring and feedback. Institutions relying solely on passive education may experience erosion of hand hygiene compliance post-crisis, highlighting the need for active surveillance programs to maintain behavioral gains.