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Suchomel M, Kampf G, Gebel J, Droop F, Christiansen B, Roesch KM. How reliable are test results from 17 laboratories on the basis of EN 1500 for a hand rub based on 80% (w/w)? J Hosp Infect 2024; 147:188-196. [PMID: 38373530 DOI: 10.1016/j.jhin.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/13/2024] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION A ring trial organized by the Association of Applied Hygiene (VAH) on the bactericidal efficacy of an ethanol-based hand rub was carried out in 17 laboratories according to EN 1500 with the aim of describing the variability of test results and fulfilment of the methodological acceptance criteria. METHOD As a test product, a hand rub based on 80% ethanol (w/w) was tested in comparison with the reference alcohol (60% iso-propanol, v/v) in a crossover design. After pre-washing and contamination following the norm, hands were treated either with the reference alcohol (2 × 3 mL for 2 × 30 s) or the test product (3 mL in 30 s). Post-decontamination values were determined immediately after the rub-in period. Validated neutralizers were used. The arithmetic means of all individual log10 pre-values, post-values and reduction values were calculated per laboratory. Non-inferiority was assumed when the Hodges-Lehmann 97.5% confidence limit was <0.6 in comparison with the reference. A z-score was calculated to determine the laboratory performance. RESULTS Two laboratories did not meet the acceptance criteria and were excluded from the analysis. The bactericidal efficacy of the test product was non-inferior to the reference product in four laboratories and not non-inferior in 11 laboratories. The z-score for the Hodges-Lehmann 97.5% confidence limit indicated a satisfactory performance in all laboratories. CONCLUSION We consider the EN 1500 test method to be robust in terms of the variability of test results. For products of borderline efficacy, the evaluation should be based on more than one test.
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Affiliation(s)
- M Suchomel
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria.
| | - G Kampf
- University Medicine Greifswald, Greifswald, Germany
| | - J Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - F Droop
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - B Christiansen
- Association for Applied Hygiene, c/o Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - K-M Roesch
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Suwanchai C, Udompataikul M, Kamanamool N, Kanokrungsee S. A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial. Contact Dermatitis 2024; 90:394-401. [PMID: 38086328 DOI: 10.1111/cod.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations. METHOD This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21. RESULTS Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46). CONCLUSION Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.
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Affiliation(s)
- Chananya Suwanchai
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Montree Udompataikul
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Nanticha Kamanamool
- Department of Preventive and Social Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Alhalwani A, Husain A, Saemaldahar A, Makhdoum F, Alhakami M, Ashi R, Wali R, Alsharif S, Khan MA, Jastaniah N, Fasfous I. The impact of alcohol hand sanitizer use on skin health between healthcare worker: Cross-sectional study. Skin Res Technol 2024; 30:e13527. [PMID: 38186055 PMCID: PMC10772474 DOI: 10.1111/srt.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND 2020 Coronavirus disease 2019 (COVID-19) has become a global health crisis, so hand alcohol-based sanitizers have become essential to preventive measures. Previous studies reported that hand sanitizers could kill bacteria and viruses; however, using them excessively can lead to health problems if misused. In light of sanitizer overuse, the availability of various products and qualities in the market, and the absence of data on skin problems, we conducted a survey study about the impact of commonly used sanitizers on skin health, particularly on hands. The study aimed to determine the prevalence and the correlation between hand sanitizer and skin health during the COVID-19 pandemic at the National Guard Institute- Jeddah, Saudi Arabia. METHODS A cross-sectional study was conducted using a self-administered online questionnaire by sending an invitation link to students and employees of the National Guard Institute- Jeddah, Saudi Arabia, in 2021. A chi-squared test was used to obtain differences concerning awareness of hand sanitizer use/type and hand skin health. RESULTS In the total 216 participants, there were considerably more skin conditions reported by women (62.5%) and respondents ages 31-40 (36.6%). For the types of hand sanitizers, 89.8%, 40.9%, 30.2%, 4.7%, and 6% were recorded: gel, spray, wipes, foam, and others, respectively, and the survey applicants were filled by 60.6% of non-medical workers. According to the survey, 32.9% of participants experienced a hand crack, which was the most common hand side effect. The handwashing frequency was reported between 3 to 7 times per day during the COVID-19 pandemic, and 9.3% of participants used hand sanitizers more than 10 times daily. CONCLUSION It was found that during the pandemic, skin changes were common among the NGHA population and healthcare workers. Consequently, the adverse health effects of these hand sanitizers on human health may result in multiple infections and toxicity. The present study provides appropriate knowledge on the types and ingredients of hand sanitizers as essential factors for skin health, preventing health risks during this pandemic.
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Affiliation(s)
- Amani Alhalwani
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah bin International Medical Research CenterJeddahSaudi Arabia
| | - Amal Husain
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Amjad Saemaldahar
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Faizah Makhdoum
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Montaha Alhakami
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Rana Ashi
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Razaz Wali
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Sarah Alsharif
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
| | - Muhammad Anwar Khan
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah bin International Medical Research CenterJeddahSaudi Arabia
| | | | - Ismail Fasfous
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah bin International Medical Research CenterJeddahSaudi Arabia
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Alajlan AA, Mukhtar LE, Almussallam AS, Alnuqaydan AM, Albakiri NS, Almutari TF, Bin Shehail KM, Aldawsari FS, Alajel SM. Assessment of disinfectant efficacy in reducing microbial growth. PLoS One 2022; 17:e0269850. [PMID: 35759454 PMCID: PMC9236243 DOI: 10.1371/journal.pone.0269850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence of hospital- and community-acquired infections has been dramatically increased worldwide. Accordingly, hands hygiene and the use of disinfectants have been increased leading to the expansion in hand sanitizers production to meet public demand. This study was conducted to assess the efficiency of common disinfectants in the market of Riyadh, Saudi Arabia in inhibiting the microbial growth during the time of Coronavirus disease 2019 (COVID-19) pandemic. Five bacterial strains of commonly hospital-acquired infections (Pseudomonas aeruginosa, Escherichia coli, Salmonella enteritidis, Staphylococcus aureus, and Enterococcus faecalis) (ATCC reference strains and clinical isolates) were examined for their susceptibility against 18 disinfectants collected from the Saudi market. The tested 18 disinfectants were broadly clustered into different groups based on their active chemical composition as following: 12 products contained alcohol, 2 products had chlorhexidine, 3 products contained mixed concentration of alcohol/chlorhexidine and 1 product had a mixture of chlorhexidine/Hexamidine/Chlorocresol. By measuring the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), our results revealed that all the 18 disinfectants have reduced the microbial growth of all the tested strains. Generally, the MICs and the MBCs for the clinical strains are higher than those of the reference strains. Taken together, our findings showed that all tested products have high disinfectants’ killing rate against microbes of different origins, which suggest the high quality of these disinfectants and the good surveillance practice by the local authorities in Saudi Arabia.
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Affiliation(s)
- Abdullah A. Alajlan
- Microbial Identification Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Lenah E. Mukhtar
- Antimicrobial Resistance Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Adnan S. Almussallam
- Drug and Cosmetic Reference Laboratory, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Abdullah M. Alnuqaydan
- Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Nasser S. Albakiri
- Drug and Cosmetic Control Laboratory, Executive Department of Laboratory, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Turki F. Almutari
- Drug and Cosmetic Control Laboratory, Executive Department of Laboratory, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Khalid M. Bin Shehail
- Drug and Cosmetic Control Laboratory, Executive Department of Laboratory, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Fahad S. Aldawsari
- Drug and Cosmetic Reference Laboratory, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Sulaiman M. Alajel
- Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
- * E-mail:
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Nzekwe IT, Agwuka OI, Okezie MU, Fasheun DO, Nnamani PO, Agubata CO. Designing an ideal alcohol-based hand sanitizer: in vitro antibacterial responses of ethanol and isopropyl alcohol solutions to changing composition. AAPS OPEN 2021; 7:5. [PMID: 34841045 PMCID: PMC8606244 DOI: 10.1186/s41120-021-00038-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
This study aimed to achieve an in vitro quantification of the effects of composition and formulation factors on the killing rates of alcohol-based hand sanitizers. The killing rates of 85% ethyl alcohol (ET) and isopropyl alcohol (IPA) were studied under different conditions such as pH, electrolyte concentration, or inclusion of herbal extracts (cucumber, carrot, and aloe vera), a quaternary ammonium compound, or thickener over different time intervals. Changes in the activities were retested after 3 months as an indication of stability. From two-way ANOVA, both the time of exposure and the sanitizer type affected the activity against Staphylococcus aureus (P = 0.001 for both alcohols), whereas for Escherichia coli, time of exposure was significant (P = 0.027), while sanitizer type was less significant (P = 0.063). Extreme pHs, the presence of ions, and the inclusion of additives such as benzalkonium chloride (BAC), plant extracts, or carbomer impacted the 3-month activity of the samples differently. Important differences existing in the activities of ET and IPA, as a function of formulation factors or use conditions have been quantified using in vitro methods. Formulations should best be tailored for particular purposes and the all-purpose hand sanitizer may not exist. ![]()
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Affiliation(s)
- Ifeanyi T Nzekwe
- Department of Pharmaceutics & Pharmaceutical Technology, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Onyedika I Agwuka
- Department of Pharmaceutics & Pharmaceutical Technology, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Moses U Okezie
- Department of Pharmaceutical Microbiology & Biotechnology, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Daniel O Fasheun
- Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Petra O Nnamani
- Department of Pharmaceutics, University of Nigeria, Nsukka, Enugu Nigeria
| | - Chukwuma O Agubata
- Department of Pharmaceutical Technology and Industrial Pharmacy, University of Nigeria, Nsukka, Enugu State Nigeria
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Filipe HAL, Fiuza SM, Henriques CA, Antunes FE. Antiviral and antibacterial activity of hand sanitizer and surface disinfectant formulations. Int J Pharm 2021; 609:121139. [PMID: 34592397 DOI: 10.1016/j.ijpharm.2021.121139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 01/04/2023]
Abstract
Emergent diseases caused by viral and bacterial infections have proven to be a current and future challenge. The occurrence of these diseases is usually accompanied by the lack of vaccines and dedicated therapies leaving prevention as the best strategy to adopt. In that context, and apart from confinement and physical distancing measures, an increase in hygiene actions, namely hand and surface cleaning and disinfection can reduce the infection spread originated from our day-to-day routines. However, during crisis situations the high disinfectants demand can very likely lead to having them running out of stock. This impels many individuals and companies to produce their own disinfectants. Here, we explore the main components of a disinfection formulation, both for hand-rub and surface cleaning. Alcohol and non-alcohol based formulations are described, including the possibility to fine tune the properties of the final product in order to increase public acceptance while maintaining product efficacy. The action mechanisms of the main active principles are also described conjugating information from experimental and theoretical data. Overall, the main aspects to develop a disinfectant formulation are addressed, as well as their function, helping formulation developers to better understand the impact of their choices.
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Affiliation(s)
- Hugo A L Filipe
- Coimbra Chemistry Centre, Dept. of Chemistry, University of Coimbra, Rua Larga, 3004-535, Coimbra, Portugal; CPIRN-IPG-Center of Potential and Innovation of Natural Resources, Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal.
| | - Sónia M Fiuza
- Science351, IPN (Edifício C) Rua Pedro Nunes, 3030-199 Coimbra, Portugal
| | - César A Henriques
- EcoXperience, HIESE, Quinta Vale do Espinhal, 3230-343 Penela, Portugal
| | - Filipe E Antunes
- Coimbra Chemistry Centre, Dept. of Chemistry, University of Coimbra, Rua Larga, 3004-535, Coimbra, Portugal
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Gülşen M, Aydıngülü N, Arslan S, Doğan SD, Alptekin D, Nazik E. Surgical handwashing practices of operating room staff: An observational study. Scand J Caring Sci 2021; 36:926-934. [PMID: 33876848 DOI: 10.1111/scs.12988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/14/2021] [Accepted: 03/26/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This descriptive and cross-sectional study aims to assess the surgical handwashing practices of operating room staff. DESIGN Single-blind study. METHODS The study was conducted with 66 staff (surgeons and operating room nurses) employed in the surgery department of a university hospital in Turkey. Data were collected using a Staff Information Form prepared in light of the literature to collect the participants' sociodemographic data and the Surgical Hand Washing Procedure Checklist developed according to the guidelines of the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and Association of Surgical Technologists (AST). The staff assigned to operating rooms were identified, and then, their surgical handwashing practices were observed by one of the researchers. FINDINGS Of the participants, 77.3% were dressed suitable to the operating room field, 56.1% appropriately wet both of their hands and forearms, and 72.7% used a sufficient amount of antiseptic solution (3-5 ml) in their palms. More than half of them (51.5%) inappropriately performed the procedure of surgical handwashing (applying an antiseptic solution to hands and arms with circular motions, starting from the fingertips up to 3-5 cm above their elbows for a minute), and 47% incorrectly performed the procedure of rinsing hands and arms while keeping the hands above the elbows under running water and passing arms through the water in one direction during this process. CONCLUSION In the study, it was determined that none of the team members completed the preparation, application and drying steps of the surgical handwashing procedure. Therefore, it is necessary to make arrangements that will facilitate the handwashing procedures of the personnel. Personnel-related problems, such as the duration of washing and drying methods, are possible to be avoided with periodic in-service training and with posters demonstrating the washing stages, which might lead to behavioural changes.
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Affiliation(s)
- Muaz Gülşen
- Surgical Nursing Department, Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Nursevim Aydıngülü
- Surgical Nursing Department, Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Sevban Arslan
- Surgical Nursing Department, Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Sevgi Deniz Doğan
- Surgical Nursing Department, Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Dudu Alptekin
- Elderly Care Services Department, Abdi Sütçü Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Evşen Nazik
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Çukurova University, Adana, Turkey
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Assessment of Alcohol-Based Hand Sanitizers for Long-Term Use, Formulated with Addition of Natural Ingredients in Comparison to WHO Formulation 1. Pharmaceutics 2021; 13:pharmaceutics13040571. [PMID: 33920509 PMCID: PMC8073725 DOI: 10.3390/pharmaceutics13040571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
During the spread of COVID-19, many laboratories used the "Formulation 1" proposed by the World Health Organization to prepare hand sanitizers. Taking into consideration its ingredients and the prolonged use of hand sanitizers, "Formulation 1" (P1) was compared with two gel formulations (P2 and P3) prepared with the addition of natural emollients and two different viscosity enhancers to define their chemical-physical stability, biocidal efficacy, and in vivo acceptability and tolerability. P1 resulted in the most efficient biocide but was poorly tolerated by the skin and not acceptable in volunteer hedonic evaluation, especially in terms of irritation and drying effect, with an expectable reduction in the compliance. Moreover, its liquid formulation is unpractical and can cause ethanol evaporation. P2 and P3 proved to be both good products regarding pH and alcohol strength values. However, in terms of viscosity, texture, ease of use, and application, P3 seemed to be a better gel product than P2. Moreover, they were well tolerated by the skin, increasing the hydration of the stratum corneum, due to the addition of Calendula officinalis and Aloe vera. Despite a lower ethanol concentration than P1, P2 and P3 also showed a good biocide efficiency, with better results in P2. In conclusion, these gel formulations proved to be more convenient for long-term use with a good balance between efficacy, safety, and compatibility with the skin.
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Villa C, Russo E. Hydrogels in Hand Sanitizers. MATERIALS (BASEL, SWITZERLAND) 2021; 14:1577. [PMID: 33804917 PMCID: PMC8037907 DOI: 10.3390/ma14071577] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/21/2022]
Abstract
Hand hygiene can be considered a strategic key useful in the containment of infections such as COVID-19 both at home and in communities because it can dramatically reduce the widespread outbreak of infections. In case of the unavailability of soap and water, "instant" hand sanitizers are recommended because their application can be considered easy, versatile, quick and often less aggressive for the skin. For these reasons, alcoholic and alcohol-free hand rub gels can be considered the best performing formulations on the market. Together with disinfectants and antiseptic agents, hydrogels play a fundamental role in obtaining stable formulations and are easy to disperse, with a pleasant skin feel and an overall good performance. Several compounds commonly used in the pharmaceutical, cosmetic and food industry are available for this purpose, in particular, cellulose derivatives and synthetic polymers derivatives. Each of them is available in several grades, presenting different thickening behavior, rheological properties and compatibility with other ingredients, alcohols in particular. For all these reasons, it is important to explore hydrogel properties and behaviors in different contexts (i.e., hydroalcoholic and aqueous media) in order to develop new and performing hand rub gels, always taking into account the different international legal frameworks regarding disinfectant and sanitizing formulations.
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Affiliation(s)
- Carla Villa
- Section of Medicinal and Cosmetic Chemistry, Department of Pharmacy, University of Genova, Viale Benedetto XV, 3-16132 Genova, Italy
| | - Eleonora Russo
- Section of Medicinal and Cosmetic Chemistry, Department of Pharmacy, University of Genova, Viale Benedetto XV, 3-16132 Genova, Italy
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Abuga K, Nyamweya N. Alcohol-Based Hand Sanitizers in COVID-19 Prevention: A Multidimensional Perspective. PHARMACY 2021; 9:64. [PMID: 33808754 PMCID: PMC8006002 DOI: 10.3390/pharmacy9010064] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
The global use of alcohol-based hand sanitizers (ABHS) as an important means of controlling the transmission of infectious disease has increased significantly as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. This paper discusses the interplay between ABHS input (formulation) factors and output (product performance) factors in the context of a multidimensional perspective using a novel representative paradigm. In the model, represented in the form of a three-dimensional tetrahedron, each of the faces represents inputs in the manufacturing of the ABHS product, which are the type and amount of alcohol, the inactive ingredients, the formulation and the manufacturing practices. The four corners of the tetrahedron represent the product performance factors which include product efficacy, sensory characteristics, usage and compliance and product safety. The multidimensional approach to the formulation and evaluation of ABHS shows that several factors contribute to the effectiveness and utility of these products. The paradigm provides a useful framework for manufacturers of ABHS and related healthcare products.
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Affiliation(s)
- Kennedy Abuga
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Nasser Nyamweya
- Pharma Manufacturing Solutions, Nairobi P.O. Box 21297-00505, Kenya;
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Addressing the global challenge of access to supplies during COVID-19. ENVIRONMENTAL AND HEALTH MANAGEMENT OF NOVEL CORONAVIRUS DISEASE (COVID-19 ) 2021. [PMCID: PMC8237694 DOI: 10.1016/b978-0-323-85780-2.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current COVID-19 pandemic has presented unprecedented challenges for health care facilities worldwide. Global production and shipping routes were disrupted, and health care institutions, even in high resource areas, found themselves lacking the basic supplies for effective infection prevention and control. One major hurdle was the global access to supplies, particularly N95/FFP2 masks and alcohol-based hand rub (ABHR) for performing hand hygiene. This chapter explores how the lack of masks and ABHR were addressed through local production and the disinfection and reuse of disposable N95 masks. Although the global situation is no longer dire, the pandemic is currently still underway, and access to sufficient and high-quality supplies still is an important challenge faced by health care institutions. Previously, local production was mainly promoted by the World Health Organization (WHO) as a social business venture for helping developing countries. Disposable mask reuse was barely studied until this pandemic, because there was never really a need to. Thus the literature in these fields are mostly quite new. This chapter reviews the introduction and state of the art of the field, the evidence for hand hygiene and masking in the literature, the global situation since the pandemic and strategies that countries have taken to adapt. It then concentrates further on the specifics of local production, both for ABHR and for masks, and on the issues surrounding mask reuse. The chapter concludes with putting these technologies in the larger context of the pandemic, and how learning how the world tried to implement solutions can teach us lessons for future emergencies.
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12
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Suchomel M, Steinmann J, Kampf G. Efficacies of the original and modified World Health Organization-recommended hand-rub formulations. J Hosp Infect 2020; 106:264-270. [PMID: 32800826 PMCID: PMC7423627 DOI: 10.1016/j.jhin.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022]
Abstract
The World Health Organization (WHO) hand-rub formulations have been in use around the world for at least the past 10 years. The advent of coronavirus disease 2019 (COVID-19) has further enhanced their use. We reviewed published efficacy data for the original and modified formulations. Only efficacy data according to the European Norms (EN) were found. The bactericidal efficacy of the original formulations was, under practical conditions, partly insufficient (EN 1500, only effective in 60 s; EN 12791, efficacy too low in 5 min). The first modification with higher alcohol concentrations improves their efficacy as hygienic hand rub (effective in 30 s). The second (0.725% glycerol) and third (0.5% glycerol) modification improves their efficacy for surgical hand preparation (effective in 5 and 3 min). The original and second modified formulations were tested and demonstrate activity against enveloped viruses including severe acute resiratory syndrome coronavirus 2 (SARS-CoV-2) in 30 s. The ethanol-based formulation is also active against some non-enveloped test viruses in 60 s (suspension tests, EN 14476). In-vivo data on the formulations would provide a more reliable result on the virucidal efficacy on contaminated hands but are currently not available. Nevertheless, the most recent modifications should be adopted for use in healthcare.
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Affiliation(s)
- M Suchomel
- Institute of Hygiene and Applied Immunology, Medical University, Vienna, Austria
| | - J Steinmann
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Bremen, Germany
| | - G Kampf
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany.
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Singh D, Joshi K, Samuel A, Patra J, Mahindroo N. Alcohol-based hand sanitisers as first line of defence against SARS-CoV-2: a review of biology, chemistry and formulations. Epidemiol Infect 2020; 148:e229. [PMID: 32988431 PMCID: PMC7550876 DOI: 10.1017/s0950268820002319] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
The pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged as a serious global public health issue. Since the start of the outbreak, the importance of hand-hygiene and respiratory protection to prevent the spread of the virus has been the prime focus for infection control. Health regulatory organisations have produced guidelines for the formulation of hand sanitisers to the manufacturing industries. This review summarises the studies on alcohol-based hand sanitisers and their disinfectant activity against SARS-CoV-2 and related viruses. The literature shows that the type and concentration of alcohol, formulation and nature of product, presence of excipients, applied volume, contact time and viral contamination load are critical factors that determine the effectiveness of hand sanitisers.
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Affiliation(s)
- D. Singh
- School of Health Sciences, University of Petroleum and Energy Studies, Energy Acres, Bidholi, Via Premnagar, Dehradun248007, Uttarakhand, India
| | - K. Joshi
- Department of Biotechnology, BJM School of Biosciences, Indian Institute of Technology Madras, Chennai, 600036, India
| | - A. Samuel
- Department of Morphology, Surgery and Experimental Medicine, Universita'Degli Studi di Ferrara, Via Savonarola, 9, 44121Ferrara, FE, Italy
| | - J. Patra
- School of Health Sciences, University of Petroleum and Energy Studies, Energy Acres, Bidholi, Via Premnagar, Dehradun248007, Uttarakhand, India
| | - N. Mahindroo
- School of Health Sciences, University of Petroleum and Energy Studies, Energy Acres, Bidholi, Via Premnagar, Dehradun248007, Uttarakhand, India
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Berardi A, Perinelli DR, Merchant HA, Bisharat L, Basheti IA, Bonacucina G, Cespi M, Palmieri GF. Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand. Int J Pharm 2020; 584:119431. [PMID: 32461194 PMCID: PMC7229736 DOI: 10.1016/j.ijpharm.2020.119431] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023]
Abstract
The world is facing a medical crisis amid the CoViD-19 pandemic and the role of adequate hygiene and hand sanitisers is inevitable in controlling the spread of infection in public places and healthcare institutions. There has been a great surge in demand for hand sanitisation products leading to shortages in their supply. A consequent increase of substandard products in the market has raised safety concerns. This article, therefore, presents a critical review of hand sanitation approaches and products available on the market in light of the scientific evidence available to date. This review also provides a range of hand sanitisation product formulations, and manufacturing instructions to allow for extemporaneous preparations at the community and hospital pharmacies during this urgent crisis. In addition, this emergent situation is expected to continue, hence hand sanitisers will be in demand for an extended time, and the availability and purchase of substandard products on the market create an ongoing safety concern. Therefore, this article shall also provide various commercial organisations, interested in stepping forward the production and marketing of hand sanitisers, with a guide on the development of products of standardised ingredients and formulations.
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Affiliation(s)
- Alberto Berardi
- Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Diego R Perinelli
- School of Pharmacy, University of Camerino, 62032 Camerino, MC, Italy
| | - Hamid A Merchant
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom
| | - Lorina Bisharat
- School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Iman A Basheti
- Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Giulia Bonacucina
- School of Pharmacy, University of Camerino, 62032 Camerino, MC, Italy
| | - Marco Cespi
- School of Pharmacy, University of Camerino, 62032 Camerino, MC, Italy.
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Abstract
BACKGROUND The use of disinfectants is crucial to preventing the spread of nosocomial infections in health care workers. As many as 25 applications of hand disinfectants is a realistic default value during a working day. However, alcohol-based hand disinfectants may weaken skin barrier function and induce dryness and eczema, which decrease their acceptance. OBJECTIVE To evaluate the effect of ethanol-containing disinfectants with 5% urea on skin barrier function and on sensitivity to an irritant soap (sodium lauryl sulfate [SLS]). METHODS Twenty healthy volunteers treated one of their forearms twice daily for 17 days with an ethanol-containing gel with 5% urea. Two types of gels with urea were tested. Treatment was randomized to left or right forearm, and the contralateral forearm served as untreated control. Transepidermal water loss, skin capacitance (dryness), and sensitivity to SLS were evaluated. RESULTS Twice-daily application of the urea-containing ethanol gels lowered transepidermal water loss, prevented dryness, and reduced sensitivity to SLS compared with the untreated control skin. CONCLUSIONS Improved barrier function using this ethanol gel with urea may have relevance in daily disinfectant procedures.
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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; 26:2064-2068. [PMID: 32459621 PMCID: PMC7454073 DOI: 10.3201/eid2609.201761] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.
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Khairnar MR, G A, Dalvi TM, Kalghatgi S, Datar UV, Wadgave U, Shah S, Preet L. Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial. Indian J Crit Care Med 2020; 24:336-339. [PMID: 32728325 PMCID: PMC7358852 DOI: 10.5005/jp-journals-10071-23420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hands are the most common medium for initiation and spread of infection in clinics. Hand hygiene is the simplest and most economic method for reducing the healthcare-associated infections (HCAIs). Aim The aim of the present study was to compare the efficacy of hand sanitizer, liquid soap, and their combination for reducing the microbial colonies on hands. Materials and methods The study was a single-blinded randomized controlled trial executed in a dental college on 90 participants, which were randomly assigned into three intervention groups of 30 each. The participants were instructed to contaminate their hands followed by a hand hygiene protocol for the liquid hand-wash group, the alcohol-based hand sanitizer (ABHS) group, and the combination group according to WHO guidelines. The swabs were collected pre- and post-intervention and mean colony-forming units were determined for each group. Results Median percentage reduction was highest for the combination group (100%), followed by the ABHS group (94.29%) and lowest for the liquid soap (92.31%). This difference in the amount of colony-forming units (CFU) among all the groups was nonsignificant (p = 0.114). Conclusion The results of the study show that there was no significant difference in hand disinfection potential among hand sanitizer, liquid soap, or their combination. All the three interventions were equally effective with the reduction of total bacterial contamination from participants' hands. How to cite this article Khairnar MR, Anitha G, Dalvi TM, Kalghatgi S, Datar UV, Wadgave U, et al. Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial. Indian J Crit Care Med 2020;24(5):336-339.
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Affiliation(s)
- Mahesh R Khairnar
- Department of Public Health Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
| | - Anitha G
- Department of Periodontology, ESIC Dental College, Gulbarga, Karnataka, India
| | - Tanushri M Dalvi
- Department of Public Health Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
| | - Shrivardhan Kalghatgi
- Department of Public Health Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
| | - Uma V Datar
- Department of Oral Pathology and Microbiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
| | - Umesh Wadgave
- Department of Public Health Dentistry, ESIC Dental College, Gulbarga, Karnataka, India
| | - Shrushti Shah
- Department of Public Health Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
| | - Lucky Preet
- Department of Public Health Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India
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Menegueti MG, Laus AM, Ciol MA, Auxiliadora-Martins M, Basile-Filho A, Gir E, Pires D, Pittet D, Bellissimo-Rodrigues F. Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy. Antimicrob Resist Infect Control 2019; 8:109. [PMID: 31285821 PMCID: PMC6591802 DOI: 10.1186/s13756-019-0553-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting. Methods We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations. Results According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used. Conclusion In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.
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Affiliation(s)
- Mayra Gonçalves Menegueti
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Campus Universitário, s/n, Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil
| | - Ana Maria Laus
- Ribeirão Preto Nursing School, University of São Paul, Ribeirão Preto, Brazil
| | | | - Maria Auxiliadora-Martins
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anibal Basile-Filho
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elucir Gir
- Ribeirão Preto Nursing School, University of São Paul, Ribeirão Preto, Brazil
| | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fernando Bellissimo-Rodrigues
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Abstract
BACKGROUND The alcohol rub has been proposed as an alternative to the traditional surgical scrub in preparing the hands for surgical procedures. Few reviews have examined critically the evidence that favors or discredits the use of the alcohol rub instead of the traditional scrub. METHODS A review of available published literature was undertaken to define the evidence for the best methods for hand preparation before surgical procedures. The focus of this literature review was to compare the bacteriologic and clinical outcomes of conventional surgical scrubbing of the hands compared with alcohol rubs. RESULTS The bacteriologic studies of the hands after the conventional scrub versus the alcohol rub demonstrated consistently comparable or superior reductions in bacterial presence on the hand with the alcohol rub. Only four clinical studies were identified that compared the scrub versus the rub in the frequency of surgical site infections. No difference in surgical site infections were identified. CONCLUSIONS The alcohol rub appears to have comparable results to the surgical scrub and is a reasonable alternative in preparation of the hands for surgical procedures.
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Affiliation(s)
- Donald E Fry
- 1 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,2 Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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20
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Vallejo RBDB, Fernandez DS, Cervera LA, Aragón LM, Iglesias MEL, Yurrita LRC, Lopez DL. Effectiveness of surgical hand antisepsis using chlorhexidine digluconate and parachlorometaxylenol hand scrub: Cross-over trial. Medicine (Baltimore) 2018; 97:e12831. [PMID: 30334981 PMCID: PMC6211836 DOI: 10.1097/md.0000000000012831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/20/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chlorhexidine and parachlorometaxylenol (PCMX) are antiseptics recommended for surgical hand antisepsis. To our knowledge, PCMX has not been evaluated for bactericidal efficacy "in vivo. METHODS We conducted a randomized, double-blind, controlled crossover trial to compare the bacterial loads on fingertips and fingernails under laboratory conditions after use of antiseptic test products, including chlorhexidine digluconate 4%, PCMX 3%, and a reference solution of propan-1-ol 60% (P-1). We assessed bacterial load after a prewash with soft soap, immediately after application of an antiseptic, and 3 hours after application and wearing of sterile, powder-free gloves. Our procedures followed those specified by European Norm (EN) 12791 for evaluating surgical hand antiseptics and using cotton swab for fingertips and fingernails. RESULTS Chlorhexidine digluconate 4% and PCMX 3% did not decrease bacterial load on the hands. The bactericidal performances of chlorhexidine digluconate 4% and PCMX 3% did not differ significantly. Chlorhexidine digluconate 4% and PCMX 3% increased bacterial load on the fingertips after participants had worn gloves for 3 hours. Fingernails had greater bacterial loads than skin on the fingertips. CONCLUSIONS Chlorhexidine digluconate 4% and PCMX 3% had similar bactericidal efficacy, but they failed to meet the EN 12791 efficacy standard. Fingernails should be a particular focus of antisepsis in preparation for surgery.The trial was registered at ClinicalTrials.gov (ID: NCT02500758).
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21
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Suchomel M, Weinlich M, Kundi M. Influence of glycerol and an alternative humectant on the immediate and 3-hours bactericidal efficacies of two isopropanol-based antiseptics in laboratory experiments in vivo according to EN 12791. Antimicrob Resist Infect Control 2017; 6:72. [PMID: 28670452 PMCID: PMC5488408 DOI: 10.1186/s13756-017-0229-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guidelines for hand hygiene recommend the use of alcohol-based hand rubs containing humectants in order to improve dermal tolerance. However, the bactericidal efficacy of pre-surgical hand rubs is negatively affected by the WHO-recommended humectant glycerol, especially the 3-h efficacy. The aim of this study was to investigate whether replacing glycerol as humectant increases the bactericidal efficacy of surgical hand rubs based on isopropanol (75%, wt/wt). MATERIAL AND METHODS The efficacy of 3 and 5 min applications of a modified WHO II-formulation (containing lower glycerol concentrations) and the TPH 5766 hand rub which contains a new humectant (containing ethylhexylglycerin, dexpanthenol and a fatty alcohol) were compared to the European Norm 12,791 reference (n-propanol, 60%, vol/vol) immediately following and 3 h after application. RESULTS Immediately after application both isopropanol-based surgical rubs approximated the performance of the reference. The 3-h effect of the modified WHO II-formulation was found to be less efficacious than the EN 12791, showing a 30% decrease in log10 reduction values. The 3-h post application effect for the TPH 5766 hand rub was found to not be different from EN 12791. CONCLUSION Based on our data, the bactericidal efficacy of isopropanol-based surgical hand rubs can best be obtained if glycerol is not used in the formulation. Unlike glycerol, a humectant comprised of ethylhexylglycerin, dexpanthenol and a fatty alcohol was found not to decrease hand rub effectiveness. Further investigation of the bactericidal efficacy of other humectants is necessary and may prove useful.
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Affiliation(s)
- Miranda Suchomel
- Institute of Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Martina Weinlich
- Institute of Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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Chou PY, Doyle AJ, Arai S, Burke PJ, Bailey TR. Antibacterial Efficacy of Several Surgical Hand Preparation Products Used by Veterinary Students. Vet Surg 2016; 45:515-22. [PMID: 27120271 DOI: 10.1111/vsu.12473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare the antibacterial efficacy of different surgical hand antisepsis protocols used by veterinary students. STUDY DESIGN Prospective, randomized, controlled study. STUDY POPULATION Third year veterinary students (n=45). METHODS The participants were randomly assigned to 4 of the following 12 hand preparation product/time combinations: nonabrasive hand scrub method with 4% chlorhexidine gluconate (CH); hand rub with a mixture of 30% 1-propanol and 45% 2-propanol solution (MPS), 70% 2-propanol solution (IPS), or 61% ethanol solution with 1% chlorhexidine gluconate (ES/CH), with a contact time of 1.5, 3, or 5 minutes. Antibacterial efficacy was assessed after surgical hand preparation and at the end of surgery. Log reductions of total bacterial colony forming unit (CFU)/mL and positive aerobic culture rates were compared using multivariable analysis of variance and multivariable logistic regression, respectively. RESULTS After surgical hand preparation, CH and ES/CH provided significantly higher log CFU reduction and lower positive culture rate for Gram-positive and spore-forming bacteria compared to MPS and IPS. Increase in contact time did not provide significant improvement in bacterial reduction. At the end of surgery, ES/CH provided significantly higher log CFU reduction compared to IPS and lower positive culture rate for Gram-positive bacteria compared to CH, MPS, and IPS. Increase in contact time significantly improved log CFU reduction in ES/CH and MPS groups. CONCLUSION In our population of veterinary students ES/CH hand rubs or CH scrubs were more effective in reducing bacterial CFU during surgical hand preparation than MPS or IPS.
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Affiliation(s)
- Po-Yen Chou
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Aimie J Doyle
- Departments of Health Management, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Shiori Arai
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Pierre J Burke
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Trina R Bailey
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
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Oriel BS, Itani KM. Surgical Hand Antisepsis and Surgical Site Infections. Surg Infect (Larchmt) 2016; 17:632-644. [DOI: 10.1089/sur.2016.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Brad S. Oriel
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Kamal M.F. Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Macinga DR, Edmonds SL, Campbell E, McCormack RR. Comparative Efficacy of Alcohol-Based Surgical Scrubs: The Importance of Formulation. AORN J 2014; 100:641-50. [DOI: 10.1016/j.aorn.2014.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 03/19/2014] [Accepted: 03/22/2014] [Indexed: 11/16/2022]
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Young HL, Reese S, Knepper B, Miller A, Mauffrey C, Price CS. The effect of preoperative skin preparation products on surgical site infection. Infect Control Hosp Epidemiol 2014; 35:1535-8. [PMID: 25419777 DOI: 10.1086/678601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Skin preparation products contribute to surgical site infection (SSI) prevention. In a case-control study, diabetes was associated with increased SSI (adjusted odds ratio [OR], 5.74 [95% confidence interval (CI), 1.22-27.0]), while the use of chlorhexidine gluconate (CHG) plus isopropyl alcohol versus CHG alone was found to be protective (adjusted OR, 2.64 [95% CI, 1.12-6.20]).
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Affiliation(s)
- Heather L Young
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver, Denver, Colorado
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Babeluk R, Jutz S, Mertlitz S, Matiasek J, Klaus C. Hand hygiene--evaluation of three disinfectant hand sanitizers in a community setting. PLoS One 2014; 9:e111969. [PMID: 25379773 PMCID: PMC4224390 DOI: 10.1371/journal.pone.0111969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/09/2014] [Indexed: 11/29/2022] Open
Abstract
Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group.
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Affiliation(s)
- Rita Babeluk
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sabrina Jutz
- Department of Biotechnology, University of Applied Science Campus Vienna, Vienna, Austria
| | - Sarah Mertlitz
- Department of Biotechnology, University of Applied Science Campus Vienna, Vienna, Austria
| | - Johannes Matiasek
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminen Hospital Vienna, Vienna, Austria
| | - Christoph Klaus
- International Scientific Affairs, Schülke & Mayr GmbH, Vienna, Austria
- * E-mail:
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Barbadoro P, Martini E, Savini S, Marigliano A, Ponzio E, Prospero E, D'Errico M. In vivo comparative efficacy of three surgical hand preparation agents in reducing bacterial count. J Hosp Infect 2014; 86:64-7. [DOI: 10.1016/j.jhin.2013.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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Steinmann J, Becker B, Bischoff B, Magulski T, Steinmann J, Steinmann E. Virucidal activity of Formulation I of the World Health Organization's alcohol-based handrubs: impact of changes in key ingredient levels and test parameters. Antimicrob Resist Infect Control 2013; 2:34. [PMID: 24330802 PMCID: PMC4029200 DOI: 10.1186/2047-2994-2-34] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recently modified World Health Organization (WHO) Formulation I was examined as 80% and 97% solutions against poliovirus type 1, adenovirus type 5 and murine norovirus according to the new European Norm prEN 14476:2011. In a previous study the unmodified WHO Formulation I had failed to demonstrate a sufficient activity against poliovirus type 1 according to the European Norm EN 14476-2007 whereas a sufficient activity was seen with adeno- and norovirus. FINDINGS The modified WHO Formulation I demonstrated a virucidal activity against all 3 test viruses of the European Norm prEN 14476:2011 under clean conditions. This was achieved as 80% solution against adeno- and norovirus within 30 seconds and as 97% solution against poliovirus within 60 seconds. Testing the unmodified WHO Formulation I against poliovirus type 1 in the 97% assay of the European Norm prEN 14476:2011 an identical activity could be demonstrated. When comparing the 80% and the 97% assay of the European Norm prEN 14476:2011 the modified WHO Formulation I as 80% solution was active against adenovirus type 5 within 30 seconds whereas the 97% solution failed within 2 minutes exposure time. CONCLUSIONS The technical possibility in the new European Norm prEN 14476:2011 allows testing a ready-to-use disinfectant as 97% solution and is responsible for the new virucidal claim of the modified WHO Formulation I. In contrast to the improvements with poliovirus type 1 the activity against adenovirus type 5 decreased when increasing the test concentration from 80% to 97%.
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