Alcohol-based hand sanitisers as first line of defence against SARS-CoV-2: a review of biology, chemistry and formulations

Sonochemical synthesis of bioinspired graphene oxide-zinc oxide hydrogel for antibacterial painting on biodegradable polylactide film

Graphene oxide nanosheet (GO) is a multifunctional platform for binding with nanoparticles and stacking with two dimensional substrates. In this study, GO nanosheets were sonochemically decorated with zinc oxide nanoparticles (ZnO) and self-assembled into a hydrogel of GO-ZnO nanocomposite. The GO-ZnO hydrogel structure is a bioinspired approach for preserving graphene-based nanosheets from van der Waals stacking. X-ray diffraction analysis (XRD) showed that the sonochemical synthesis led to the formation of ZnO crystals on GO platforms. High water content (97.2%) of GO-ZnO hydrogel provided good property of ultrasonic dispersibility in water. Ultraviolet-visible spectroscopic analysis (UV-vis) revealed that optical band gap energy of ZnO nanoparticles (∼3.2 eV) GO-ZnO nanosheets (∼2.83 eV). Agar well diffusion tests presented effective antibacterial activities of GO-ZnO hydrogel against gram-negative bacteria (E. coli) and gram-positive bacteria (S. aureus). Especially, GO-ZnO hydrogel was directly used for brush painting on biodegradable polylactide (PLA) thin films. Graphene-based nanosheets with large surface area are key to van der Waals stacking and adhesion of GO-ZnO coating to the PLA substrate. The GO-ZnO/PLA films were characterized using photography, light transmittance spectroscopy, coating stability, scanning electron microscopy (SEM), energy-dispersive x-ray spectroscopic mapping (EDS), antibacterial test and mechanical tensile measurement. Specifically, GO-ZnO coating on PLA substrate exhibited stability in aqueous food simulants for packaging application. GO-ZnO coating inhibited the infectious growth ofE. colibiofilm. GO-ZnO/PLA films had strong tensile strength and elastic modulus. As a result, the investigation of antibacterial GO-ZnO hydrogel and GO-ZnO coating on PLA film is fundamental for sustainable development of packaging and biomedical applications.

Updates and future directions regarding hand hygiene in the healthcare setting: insights from the 3rd ICPIC alcohol-based handrub (ABHR) task force

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose threats to global health. Effective hand hygiene is essential for preventing HAIs and the spread of AMR in healthcare. We aimed to highlight the recent progress and future directions in hand hygiene and alcohol-based handrub (ABHR) use in the healthcare setting. In September 2023, 42 experts in infection prevention and control (IPC) convened at the 3rd International Conference on Prevention and Infection Control (ICPIC) ABHR Taskforce in Geneva, Switzerland. The purpose of this meeting was to provide a synthesis of recent evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices: (1) ABHR formulations and hand rubbing techniques, (2) low-resource settings and local production of ABHR, (3) hand hygiene monitoring and technological innovations, and (4) hand hygiene standards and guidelines.

A systematic overview of metal nanoparticles as alternative disinfectants for emerging SARS-CoV-2 variants

Coronaviruses are a diverse family of viruses, and new strains can emerge. While the majority of coronavirus strains cause mild respiratory illnesses, a few are responsible for severe diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS-CoV-2, the virus responsible for COVID-19, is an example of a coronavirus that has led to a pandemic. Coronaviruses can mutate over time, potentially leading to the emergence of new variants. Some of these variants may have increased transmissibility or resistance to existing vaccines and treatments. The emergence of the COVID-19 pandemic in the recent past has sparked innovation in curbing virus spread, with sanitizers and disinfectants taking center stage. These essential tools hinder pathogen dissemination, especially for unvaccinated or rapidly mutating viruses. The World Health Organization supports the use of alcohol-based sanitizers and disinfectants globally against pandemics. However, there are ongoing concerns about their widespread usage and their potential impact on human health, animal well-being, and ecological equilibrium. In this ever-changing scenario, metal nanoparticles hold promise in combating a range of pathogens, including SARS-CoV-2, as well as other viruses such as norovirus, influenza, and HIV-1. This review explores their potential as non-alcoholic champions against SARS-CoV-2 and other pandemics of tomorrow. This extends beyond metal nanoparticles and advocates a balanced examination of pandemic control tools, exploring their strengths and weaknesses. The manuscript thus involves the evaluation of metal nanoparticle-based alternative approaches as hand sanitizers and disinfectants, providing a comprehensive perspective on this critical issue.

Plant-derived strategies to fight against severe acute respiratory syndrome coronavirus 2

The coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented crisis, which has been exacerbated because specific drugs and treatments have not yet been developed. In the post-pandemic era, humans and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will remain in equilibrium for a long time. Therefore, we still need to be vigilant against mutated SARS-CoV-2 variants and other emerging human viruses. Plant-derived products are increasingly important in the fight against the pandemic, but a comprehensive review is lacking. This review describes plant-based strategies centered on key biological processes, such as SARS-CoV-2 transmission, entry, replication, and immune interference. We highlight the mechanisms and effects of these plant-derived products and their feasibility and limitations for the treatment and prevention of COVID-19. The development of emerging technologies is driving plants to become production platforms for various antiviral products, improving their medicinal potential. We believe that plant-based strategies will be an important part of the solutions for future pandemics.

Assessment of quality of commercial hand sanitizers using Fourier transform infrared spectroscopy and gas chromatography

Since the beginning of the COVID-19 pandemic, the use and manufacture of alcohol-based hand sanitizers increased exponentially. Efficacy of hand sanitizers mainly depends on active ingredients like ethanol and isopropanol (IPA). Even though methanol is extremely hazardous to people, it is still illegally used in hand sanitizers in Bangladesh. Developing a quick and simple analytical method for detecting and quantifying ethanol/IPA/methanol is crucial. Here, Fourier transform infrared spectroscopy (FTIR) was used to identify and quantify alcohol content in commercially available hand sanitizers in a quick and easy way. Comparing the FTIR and GC data, provided quite similar results. Unlike previous studies by FTIR, C-H, CH₃-C-CH₃ stretching, and C-H bending vibrational modes were employed to construct analytical calibration curves to detect and quantify alcohol in hand sanitizers. According to FTIR and GC findings, ethanol and IPA content were found to be 43-82% and 40-69%, and 56-64% and 61-66%, respectively, whereas ethanol was labeled at 66-80% and IPA at 65-70%. FTIR and GC revealed methanol content ranging from 37 to 98 and 19 to 81%, respectively. Also, the FTIR was significantly faster than the GC. Therefore, FTIR can be used to commercially analyze the quality of hand sanitizers.•FTIR was used to identify and quantify alcohol content in commercially available hand sanitizers in a quick and easy way.•Comparing the FTIR and GC data, provided quite similar results.•Out of ten samples, five contained ethanol, three IPA, and two methanol.

Emerging infectious diseases, focus on infection prevention, environmental survival and germicide susceptibility: SARS-CoV-2, Mpox, and Candida auris

BACKGROUND

New and emerging infectious diseases continue to represent a public health threat. Emerging infectious disease threats include pathogens increasing in range (eg, Mpox), zoonotic microbes jumping species lines to cause sustained infections in humans via person-to-person transmission (SARS-CoV-2) and multidrug-resistant pathogens (eg, Candida auris).

MATERIALS AND METHODS

We searched the published English literature and reviewed the selected articles on SARS-CoV-2, Mpox, and Candida auris with a focus on environmental survival, contamination of the patient's hospital environment, susceptibility of the pathogen to antiseptics and disinfectants and infection prevention recommendations.

RESULTS

All three pathogens (ie, SARS-CoV-2, Mpox, and Candida auris) can survive on surfaces for minutes to hours and for Mpox and C auris for days. Currently available antiseptics (eg, 70%-90% alcohol hand hygiene products) are active against SARS-CoV-2, Mpox and C auris. The U.S Environmental Protection Agency provides separate lists of surface disinfectants active against SARS-CoV-2, Mpox, and C auris.

DISCUSSION

The risk of environment-to-patient transmission of SARS-CoV-2, Mpox and Candida auris, is very low, low-moderate and high, respectively. In the absence of appropriate patient isolation and use of personal protection equipment, the risk of patient-to-health care provider transmission of SARS-CoV-2, Mpox, and C auris is high, moderate and low, respectively.

CONCLUSIONS

Appropriate patient isolation, use of personal protective equipment by health care personnel, hand hygiene, and surface disinfection can protect patients and health care personnel from acquiring SARS-CoV-2, Mpox, and C auris from infected patients.

Highly Effective Salt-Activated Alcohol-Based Disinfectants with Enhanced Antimicrobial Activity

Surfaces contaminated with pathogens raise concerns about the increased risk of disease transmission and infection. To clean biocontaminated surfaces, alcohol-based disinfectants have been predominantly used for disinfecting high-touch areas in diverse settings. However, due to its limited antimicrobial activities and concern over the emergence of alcohol-tolerant strains, much effort has been made to develop highly efficient disinfectant formulations. In this study, we hypothesize that the addition of a physical pathogen inactivation mechanism by salt recrystallization (besides the existing chemical inactivation mechanism by alcohol in such formulations) can improve inactivation efficiency by preventing the emergence of alcohol tolerance. To this end, we employed the drying-induced salt recrystallization process to implement the concept of highly efficient alcohol-based disinfectant formulations. To identify the individual and combined effects of isopropyl alcohol (IPA) and NaCl, time-dependent morphological/structural changes of various IPA solutions containing NaCl have been characterized by optical microscopy/X-ray diffraction analysis. Their antimicrobial activities have been tested on surfaces (glass slide, polystyrene Petri dish, and stainless steel) contaminated with Gram-positive/negative bacteria (methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella enterica subsp. enterica Typhimurium) and viruses (A/PR8/34 H1N1 influenza virus and HCoV-OC43 human coronavirus). We found that additional salt crystallization during the drying of the alcohol solution facilitated stronger biocidal effects than IPA-only formulations, regardless of the types of solid surfaces and pathogens, including alcohol-tolerant strains adapted from wild-type Escherichia coli MG1655. Our findings can be useful in developing highly effective disinfectant formulations by minimizing the use of toxic antimicrobial substances to improve public health and safety.

Designing 3D-Printed Mesh-Covered Fluid Collecting Racks (MFCRs) to Prevent Moisture-Related COVID-19 Sampling Interruptions in Taiwan

Background: A sampling platform (or table) set at the patient's side in a zero-exposure screening center (booth) might be used for specimen collection during public health crises such as the COVID-19 pandemic. However, repeated sanitization causes moisture problems. Such moisture problems would not only be noted by patients but also interrupt the sampling process. In this study, we aimed to develop 3D-printed mesh-covered fluid collecting racks (MFCRs) to address surface moisture problems to determine whether MFCRs can shorten the sampling time. Methods: This was an observational, descriptive, and cross-sectional study. We observed the reasons for sampling interruptions related to surface moisture problems among patients who used MFCRs or did not (April 28-30, 2022). We used a 3D printer to make an MFCR, which measured 14.5 cm in width and length and 1.0 cm in height. The MFCR allows the ethanol to drain through the mesh into the fluid collection rack below to leave a relatively dry surface on the mesh. Finally, we calculated the median time to finish sampling between MFCRs and non-MFCRs. Results: A total of 400 patients were randomly observed (using MFCRs, n = 200; non-MFCRs, n = 200). Patients in the non-MFCR group were more likely to interrupt the sampling process (n = 39, 19.5%) by noting surface moisture problems than those in the MFCR group (n = 3, 1.5%). Two of the major interruptions, "asking questions about the moist surface" (from 12% to 1%) and "slowing down their actions" (from 4.5% to 0.5%), were obviously improved by using MFCRs. Overall, the median sampling time was significantly shorter (p < 0.001) in the group using MFCRs (0.6 min) than in the group using non-MFCRs (1.5 min). The MFCRs shortened the sampling time by 60%, which might be associated with decreasing interruptions caused by surface moisture problems. Conclusions: The 3D printed MFCRs are suitable for handling surface moisture problems caused by repeated sanitizations. More importantly, the MFCRs might be associated with decreasing interruptions caused by moisture problems.

Hand Sanitizer Gels: Classification, Challenges, and the Future of Multipurpose Hand Hygiene Products

Hand hygiene is a crucial measure in the prevention and control of infections, and there is a growing awareness among individuals who are making a conscious effort to maintain hand cleanliness. With the advent of the SARS-CoV-2 outbreak, the demand for hand hygiene products has also gradually shifted towards those with antimicrobial properties. Among these products, hand sanitizer gels (HSGs) have gained considerable popularity as an efficient method of hand cleaning, due to their rapid drying and sustained antimicrobial efficacy. Concurrently, there has been a growing interest in novel HSGs that offer additional functions such as skin whitening, moisturizing, and anti-inflammatory effects. These novel HSGs effectively address concerns associated with the ingestion of antimicrobial ingredients and demonstrate reduced skin irritation, thereby alleviating hand dermatological issues. This review provides an extensive overview of the application scenarios, classification, and challenges associated with HSGs while emphasizing the emergence of novel components with biological functions, aiming to contribute to the advancement of hand hygiene practices and offer novel insights for the development of novel HSGs with outstanding antimicrobial properties with other multiple biological functions and desirable biosafety profiles.

Determination of ethanol, isopropyl alcohol and methanol in alcohol-based hand sanitiser to ensure product quality, safety and efficacy

The Coronavirus Disease-2019 (COVID-19) outbreak is an unprecedented global pandemic, sparking grave public health emergencies. One of the measures to reduce COVID-19 transmissions recommended by the World Health Organization is hand hygiene, i.e., washing hands with soap and water or disinfecting them using an alcohol-based hand sanitiser (ABHS). Unfortunately, competing ABHSs with unknown quality, safety, and efficacy thrived, posing yet another risk to consumers. This study aims to develop, optimise, and validate a gas chromatography-mass spectrometry (GC-MS)-based analytical method to simultaneously identify and quantify ethanol or isopropyl alcohol as the active ingredient in ABHS, with simultaneous determination of methanol as an impurity. The GC-MS was operated in Electron Ionisation mode, and Selected Ion Monitoring was chosen as the data acquisition method for quantitation. The analytical method was validated for liquid and gel ABHSs, covering the specificity, linearity and range, accuracy, and precisions, including the limit of detection and the limit of quantitation. The specificity of each target analyte was established using the optimised chromatographic separation with unique quantifier and qualifier ions. The linearity was ascertained with a coefficient of determination (r2) of > 0.9994 over the corresponding specification range. Respectively, the accuracy and precisions were satisfactory within 98.99 to 101.09% and < 3.04% of the relative standard deviation. The method was successfully applied to 69 ABHS samples, where 14 contained insufficient amounts of the active ingredient. Alarmingly, four samples comprised a high amount of methanol ranging from 5.3 to 19.4% with respect to the active alcohol percentage, which may pose significant short- and long-term health issues, leading to life-threatening crises for consumers. The method established would benefit in protecting the public against the potential harm due to substandard or unsafe ABHS products, primarily due to the presence of hazardous impurities such as methanol.

Positive Correlation Between Heavy Alcoholic Drinking and SARS-Cov-2 Non-Infection Rate

Introduction During the SARS-CoV-2 pandemic, rumors claimed that alcohol drinking could someway be useful in contrasting the contagion and even the disease. It appears opportune to bring some robust data to determine whether heavy alcohol drinkers and non-drinkers experienced different infection rates. Methods A cross-sectional study through a simple survey based on the social media software Weixin and the mini survey program Wenjuanxing was carried out in China after the zero-Covid policy ended, namely from 15:00 January 1, 2023, to 12:35 January 3, 2023. The evaluation was conducted among subjects belonging to the first author's Weixin community, mostly residents in the higher populated China area. Study participants received a questionary and were asked about their virus infection status, and were classified into two groups: (a) infected, meaning he/she has been infected at least once (whether recovered or not); (b) remain uninfected, meaning the virus has not infected him/her. A total of 211 subjects adhered to the survey. Alcoholic drinking behavior about liquors with no less than 40% alcohol content in volume was retrieved from the participants. In China, such beverages are almost uniquely referred to as the Chinese Spirits or BaiJiu. The frequency of drinking quantified the drinking behavior, and it is classified into three groups: never drink or drink occasionally (group A); drink one or two times per week (group B); drink three times per week or more often (group C). The hypothesis of an existing relationship between infection status and drinking behavior was advanced before data collection. The numbers of the uninfected people in each of the three drinking groups were counted, and the rates of not-infection were calculated. The rates are compared with each other to conclude whether significant differences exist, considering the size of the samples. The conclusion is drawn from standard hypothesis testing. Results The male/female ratio was 108/103 (51.2% and 48.8%), the mean age was 38.8 years (range 21-68), and the median age of 37.4 years. The total 211 participants fell into three groups with different drinking frequencies, with counts (percentages in total 211 participants) 139 (65.9%) in group A, 28 (13.3%) in group B, and 44 (20.8%) in group C. The number (percentage within the group) of uninfected members in groups A, B, and C are 29 (20.9%), 7 (25.0%), and 17 (38.6%), respectively. The statistical analysis through the Cochran-Armitage trend test gave a significative result: p=0.0209. Conclusions Within the methodology's limitations, this study shows the significant relationship between alcohol drinking habits and the chances of avoiding SARS-CoV-2 infection. A possible hypothesis explaining these findings is advanced. However, the authors warn about misleading conclusions and advocate research that could properly guide ethanol use in the present and other possible pandemics. Limitations This study is based on self-reported data from a specific community in China. There could be recall bias and social desirability bias, and the generalizability of the findings to other populations could be limited. Other factors that could influence infection rates, such as age, occupation, and health status, are not controlled in the present study. There could be other explanations for the observed relationship between alcohol drinking habits and infection rates.

Knowledge, attitudes and practice regarding environmental friendly disinfectants for household use among residents of China in the post-pandemic period

Background

A sharp rise in household consumption of disinfectants triggered by COVID-19 pandemic has generated tremendous environmental burden and risks of disinfectant emissions in the post-pandemic period. To address this emerging challenge, replacing highly hazardous disinfectants with more environmental friendly alternatives has been accepted as an inherently effective solution to environment issues posed by disinfectant emerging contaminants. However, no study has yet been done to explore the potential customers' attitudes and the market prospect of environmental friendly disinfectants until now.

Methods

This cross-sectional questionnaire-based survey was conducted from January to March, 2022, among resident volunteers in China, to explore the practices, knowledge and attitudes of the public regarding environmental friendly disinfectants for household use.

Results

Among a total of 1,861 Chinese residents finally included in the analyses, 18% agreed or strongly agreed that they paid special attention to the environmental certification label on the product, and only bought the environmental certified disinfectant products; 16% and 10% were using environmental friendly disinfectants for hand sanitization and environmental disinfection, respectively. The mean self-assessed and actual knowledge scores were 2.42 ± 1.74 and 2.12 ± 1.97, respectively, out of a total of 5. Participants having good practices of consuming environmental friendly disinfectants achieved higher knowledge scores. Residents' overall attitudes toward the development, consumption and application of environmental friendly disinfectants were very positive. "Possible conflict between disinfection effectiveness and environmental factor of disinfectants in a context of severe COVID-19 pandemic" was considered as the most important barrier jeopardizing the participants' usage intention for environmental friendly disinfectants.

Conclusions

These data suggested most residents of China had a positive attitude, poor knowledge and practices toward environmental friendly disinfectants. More should be done to enhance the residents' environmental knowledge levels about disinfectants, and to further develop and promote disinfectant products with both excellent disinfection activity and environmentally friendly attributes.

Impact of an Alcohol-based hand sanitizer usage during COVID-19 pandemic on disulfiram treatment: A South Indian psychiatrist's practice experiences

Background: Alcohol-based hand sanitizer (ABHS) usage has become one of the COVID-19 pandemic-related adapted responses. Some disulfiram-ethanol reactions are reported in people who use alcohol-based hand rub/sanitizer and take Disulfiram as a treatment for their alcohol use disorders. Aim & Objective: To determine the practice experiences of psychiatrists on disulfiram prescription to alcohol use disorder victims. Methodology: A cross-sectional study on the psychiatrists to find the experiences of disulfiram prescription to their clients with alcohol use disorders during the COVID-19 pandemic. Results: Nearly 84 (51%) were reverted with a completed questionnaire. Among the respondents, 28 (33.3%) of the respondents decreased to prescribe Disulfiram, 48 (57.1%) reported that their patients stopped using ABHS due to fear of Disulfiram-Ethanol Reaction (DER), and 20 (23.8%) responders notified that their patients were expressed their worry on DER with Disulfiram and ABHS. Conclusion: Disulfiram prescribed for alcohol use disorders; treatment got peculiar experiences with the incidences of DER reported with Alcohol-based hand sanitizer. Many practitioners were scared to prescribe disulfiram due to DER with ABHS. The prevailing evidence that there is no possibility of cutaneous application of ABHS producing enough significant DER. Hence using ABHS is not a contraindication for disulfiram prescription.

Alcohol-based Hand Sanitizers amid COVID-19: Chemical Formulation, Analysis, Safety

Alcohol-based hand sanitizers (ABHSs) containing ethanol (EtOH) or isopropyl alcohol (IPA) to inactivate microorganisms help prevent the spread of respiratory diseases. These products have become very popular during the COVID-19 pandemic. Apart from vaccines or other preventative antiseptic measures, the majority of consumers have relied on different types of ABHSs to disinfect their hands. As a result, there has been a global rush in the demand for these ABHSs and other antiseptic hygiene products. This has resulted in the formation of many new commercial sanitizer producers. There are around fifty companies of varying sizes that have been marketing their ABHSs in Bangladesh, most of which have only been manufacturing their products for the first time since the COVID-19 pandemic. To monitor the quality and components of these products, the Bangladesh Council of Scientific and Industrial Research (BCSIR) analyzed approximately 200 different hand sanitizer samples using GC-FID method. All samples were alcohol-based except for 3 which were alcohol-free aqueous hand sanitizers. Of the supplied formulated ABHSs, 80 samples were found to contain only IPA and 54 contained only EtOH. However, 28 samples were found to be contaminated with methanol (MeOH), 7 samples contained only MeOH and 18 samples contained both EtOH and IPA. This is the first study to explore the analysis of alcohol content in formulated ABHSs and their marketing status in Bangladesh, but the findings could be of use in other jurisdictions as similar issues have been raised in many parts of the world.

Efficacy and Safety of Inhalation of Nebulized Ethanol in COVID-19 Treatment: A Randomized Clinical Trial

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. Many efforts have been made and are currently being made to prevent and treat this global disease.

OBJECTIVES

This study was designed to evaluate the efficacy and safety of nebulized ethanol (EtOH) in treating COVID-19.

METHODS

A randomized clinical trial (RCT) of 99 symptomatic and real-time polymerase chain reaction (RT-PCR)-positive patients admitted to a hospital receiving remdesivir-dexamethasone was conducted. They were randomly assigned to receive distilled water spray (control group (CG)) or 35% EtOH spray (intervention group (IG)). Both groups inhaled three puffs of spray (nebulizer) every six hours for a week. The primary outcome included Global Symptomatic Score (GSS) between the two groups at the first visit and on days three, seven, and 14. Secondary outcomes included the Clinical Status Scale (CSS; a seven-point ordinal scale ranging from death to complete recovery) and readmission rate.

RESULTS

A total of 44 and 55 patients were enrolled in the IG and CG, respectively. Although there was no difference at admission, the GSS and CSS improved significantly in the IG (p = 0.016 and p = 0.001, respectively). The IG readmission rate was considerably lower (0% vs. 10.9%; p = 0.02).

CONCLUSIONS

Inhaled-nebulized EtOH is effective in rapidly improving the clinical status and reducing further treatment. Due to its low cost, availability, and absent/tolerable adverse events, it could be recommended as an adjunctive treatment for moderate COVID-19. Further research on curative effects in more serious cases and in prevention is advisable.

Antiviral Properties of Pennisetum purpureum Extract against Coronaviruses and Enteroviruses

Many severe epidemics are caused by enteroviruses (EVs) and coronaviruses (CoVs), including feline coronavirus (FCoV) in cats, epidemic diarrhea disease virus (PEDV) in pigs, infectious bronchitis virus (IBV) in chickens, and EV71 in human. Vaccines and antiviral drugs are used to prevent and treat the infection of EVs and CoVs, but the effectiveness is affected due to rapidly changing RNA viruses. Many plant extracts have been proven to have antiviral properties despite the continuous mutations of viruses. Napier grass (Pennisetum purpureum) has high phenolic content and has been used as healthy food materials, livestock feed, biofuels, and more. This study tested the antiviral properties of P. purpureum extract against FCoV, PEDV, IBV, and EV71 by in vitro cytotoxicity assay, TCID₅₀ virus infection assay, and chicken embryo infection assay. The findings showed that P. purpureum extract has the potential of being disinfectant to limit the spread of CoVs and EVs because the extract can inhibit the infection of EV71, FCoV, and PEDV in cells, and significantly reduce the severity of symptoms caused by IBV in chicken embryos.

Understanding and combating COVID-19 using the biology and chemistry of SARS-CoV-2

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms of COVID-19 can range from asymptomatic to severe, which could lead to fatality. Like other pathogenic viruses, the infection of SARS-CoV-2 relies on binding its spike glycoprotein to the host receptor angiotensin-converting enzyme 2 (ACE 2). Molecular studies suggested that there is a high affinity between the spike glycoprotein and ACE 2 that might arise due to their hydrophobic interaction. This property is mainly responsible for making this virus highly infectious. Apart from this, the transmissibility of the virus, prolonged viability in certain circumstances, and rapid mutations also contributed to the current pandemic situation. Nanotechnology provides potential alternative solutions to combat COVID-19 with the development of i. nanomaterial-based COVID-19 detection technology, ii. nanomaterial-based disinfectants, iii. nanoparticle-based vaccines, and iv. nanoparticle-based drug delivery. Hence, this review provides diverse insight into understanding COVID-19.

Recycling of plastic wastes generated from COVID-19: A comprehensive illustration of type and properties of plastics with remedial options

Plastic has contributed enormously to the healthcare sector and towards public health safety during the COVID-19 pandemic. With the frequent usage of plastic-based personal protective equipment (PPEs) (including face masks, gloves, protective body suits, aprons, gowns, face shields, surgical masks, and goggles), by frontline health workers, there has been a tremendous increase in their manufacture and distribution. Different types of plastic polymers are used in the manufacture of this equipment, depending upon their usage. However, since a majority of these plastics are still single-use plastics (SUP), they are not at all eco-friendly and end up generating large quantities of plastic waste. The overview presents the various available and practiced methods in vogue for disposal cum treatment of these highly contaminated plastic wastes. Among the current methods of plastic waste disposal, incineration and land filling are the most common ones, but both these methods have their negative impacts on the environment. Alongside, numerous methods that can be used to sterilize them before any treatment have been discussed. There are several new sorting technologies, to help produce purer polymers that can be made to undergo thermal or chemical treatments. Microbial degradation is one such novel method that is under the spotlight currently and being studied extensively, because of its ecological advantages, cost-effectiveness, ease of use, and maintenance. In addition to the deliberations on the methods, strategies have been enumerated for combination of different methods, vis-à-vis studying the life cycle assessment towards a more circular economy in handling this menace to protect mankind.

Disinfectants against SARS-CoV-2: A Review

The pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged as a serious global public health issue. Besides the high transmission rate from individual to individual, indirect transmission from inanimate objects or surfaces poses a more significant threat. Since the start of the outbreak, the importance of respiratory protection, social distancing, and chemical disinfection to prevent the spread of the virus has been the prime focus for infection control. Health regulatory organizations have produced guidelines for the formulation and application of chemical disinfectants to manufacturing industries and the public. On the other hand, extensive literature on the virucidal efficacy testing of microbicides for SARS-CoV-2 has been published over the past year and a half. This review summarizes the studies on the most common chemical disinfectants and their virucidal efficacy against SARS-CoV-2, including the type and concentration of the chemical disinfectant, the formulation, the presence of excipients, the exposure time, and other critical factors that determine the effectiveness of chemical disinfectants. In this review, we also critically appraise these disinfectants and conduct a discussion on the role they can play in the COVID-19 pandemic.

A novel inactivated virus system (InViS) for a fast and inexpensive assessment of viral disintegration

The COVID-19 pandemic has caused considerable interest worldwide in antiviral surfaces, and there has been a dramatic increase in the research and development of innovative material systems to reduce virus transmission in the past few years. The International Organization for Standardization (ISO) norms 18,184 and 21,702 are two standard methods to characterize the antiviral properties of porous and non-porous surfaces. However, during the last years of the pandemic, a need for faster and inexpensive characterization of antiviral material was identified. Therefore, a complementary method based on an Inactivated Virus System (InViS) was developed to facilitate the early-stage development of antiviral technologies and quality surveillance of the production of antiviral materials safely and efficiently. The InViS is loaded with a self-quenched fluorescent dye that produces a measurable increase in fluorescence when the viral envelope disintegrates. In the present work, the sensitivity of InViS to viral disintegration by known antiviral agents is demonstrated and its potential to characterize novel materials and surfaces is explored. Finally, the InViS is used to determine the fate of viral particles within facemasks layers, rendering it an interesting tool to support the development of antiviral surface systems for technical and medical applications.

Application of a headspace GC-MS method to evaluate the product quality of alcohol-based wipe hand sanitizers (ABHS)

The investigation of marketed wipe hand sanitizers presented an analytical challenge due to the extraction from the solid matrix of the products. The present work describes the development of a new sample preparation method for the extraction of analytes from wipe hand sanitizer matrix into dimethyl sulfoxide for analysis by headspace GCMS. ABHS wipe products labeled to contain ethanol or isopropanol as active ingredients were tested, varying in the size and weight of the wipes. The spike recovery assay was confirmed using spiking solutions containing the impurities at concentrations equivalent to 50%, 100% and 200% of the interim concentration limits. All tested analytes showed recovery within the allowable limits (80%-120%). Six marketed ABHS wipe products were tested and no impurities above the FDA interim limits were observed. One product contained ethanol below the 60% v/v limit and another product was mislabeled for isopropanol and was found to contain ethanol instead. Four of the six ABHS products did not meet the label claim, which may affect the product quality. The analytical method and sample preparation procedures will provide the FDA and ABHS manufacturers with the capability to conduct quality assurance testing of wipe hand sanitizers for active ingredient content and impurities.

Potential Use of Tea Tree Oil as a Disinfectant Agent against Coronaviruses: A Combined Experimental and Simulation Study

The COVID-19 pandemic has highlighted the relevance of proper disinfection procedures and renewed interest in developing novel disinfectant materials as a preventive strategy to limit SARS-CoV-2 contamination. Given its widely known antibacterial, antifungal, and antiviral properties, Melaleuca alternifolia essential oil, also named Tea tree oil (TTO), is recognized as a potential effective and safe natural disinfectant agent. In particular, the proposed antiviral activity of TTO involves the inhibition of viral entry and fusion, interfering with the structural dynamics of the membrane and with the protein envelope components. In this study, for the first time, we demonstrated the virucidal effects of TTO against the feline coronavirus (FCoVII) and the human coronavirus OC43 (HCoV-OC43), both used as surrogate models for SARS-CoV-2. Then, to atomistically uncover the possible effects exerted by TTO compounds on the outer surface of the SARS-CoV-2 virion, we performed Gaussian accelerated Molecular Dynamics simulations of a SARS-CoV-2 envelope portion, including a complete model of the Spike glycoprotein in the absence or presence of the three main TTO compounds (terpinen-4-ol, γ-terpinene, and 1,8-cineole). The obtained results allowed us to hypothesize the mechanism of action of TTO and its possible use as an anti-coronavirus disinfectant agent.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

Background

Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures.

Aim

To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I² statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed.

Findings

Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%).

Conclusions

During the COVID-19 pandemic, the compliance of health care providers’ HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for “before contact with patients” should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Neonatal acute ethanol intoxication during the epidemic of COVID-19: a case report

Background

After the outbreak of COVID-19, many families equip with 75% ethanol to inactivate the SARS-CoV-2, which increases the risk of exposure to ethanol.

Case presentation

We reported a 25-day-old newborn who was diagnosed with neonatal acute ethanol intoxication with a presenting complaint of accidental consumption about 15 ml formula milk containing 75% ethanol. His main clinical manifestations were irritability, flushed skin, tachycardia, tachypnea, and toxicology analysis detected ethanol. After timely gastric lavage and intravenous fluid replacement, he was cured and discharged.

Conclusions

During the COVID-19 epidemic, high concentration ethanol used for inactivating SARS-COV-2 should be placed reasonably and neonatal feeding safety should be emphasized. Timely diagnosis and symptomatic treatment are essential for the prevention and management of acute ethanol intoxication in newborns.

Development and validation of a headspace GC-MS method to evaluate the interconversion of impurities and the product quality of liquid hand sanitizers

The COVID-19 pandemic has led to increased usage of hand sanitizer products by the public to prevent the spread of COVID-19 and decrease the likelihood of acquiring the disease. The increase in demand has also led to an increase in the number of manufacturers. This work describes the FDA's Center for Drug Evaluation and Research (CDER) laboratories efforts to develop tests to assess the quality of hand sanitizer products containing ethanol or isopropanol as the primary active ingredient. The products were evaluated for the active ingredient content and determination of the 12 impurities listed in the FDA Hand Sanitizer Temporary Guidance, followed by a spike recovery assay performed to verify the test results. Extensive method development was conducted including an investigation into the stability of ethanol, isopropanol, and the 12 impurities. Stability and kinetic studies confirmed the instability of acetal in acidic liquid hand sanitizer products during spike recovery assay testing. The headspace GC-MS method was validated according to ICH Q2 (R1) guidelines and the spike recovery assay was validated using three concentrations of standards for the drug product. During method application, six liquid hand sanitizer products were tested and all were determined to have ethanol or isopropanol above 70% v/v. Two liquid hand sanitizer products were determined to contain acetaldehyde as an impurity above the FDA recommended safety levels.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s41120-021-00049-8.

Sensitivity of SARS-CoV-2 towards Alcohols: Potential for Alcohol-Related Toxicity in Humans

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative organism that is highly contagious and has been responsible for more than 240 million cases and 5 million deaths worldwide. Using masks, soap-based hand washing, and maintaining social distancing are some of the common methods to prevent the spread of the virus. In the absence of any preventive medications, from the outset of pandemic, alcohol-based hand sanitizers (ABHS) have been one of the first-line measures to control transmission of Coronavirus Disease 2019 (COVID-19). The purpose of this narrative review is to evaluate the sensitivity of SARS-CoV-2 towards ABHS and understand their potential adverse effects on humans. Ethanol and isopropanol have been the most commonly used alcohols in ABHS (e.g., gel, solution, spray, wipes, or foam) with alcohol in the range of 70–85% v/v in World Health Organization or Food and Drug Administration-approved ABHS. The denaturation of proteins around the envelope of SARS-CoV-2 positive sense single-stranded RNA virus is the major mechanism of action of ABHS. Due to frequent use of high-percentage alcohol-containing ABHS over an extended period of time, the oral, dermal, or pulmonary absorption is a possibility. In addition to the systemic toxicity, topical adverse effects such as contact dermatitis and atopic dermatitis are plausible and have been reported during COVID-19. ABHS appear to be effective in controlling the transmission of SARS-CoV-2 with the concern of oral, dermal, or pulmonary absorption.

A new method for sampling African swine fever virus genome and its inactivation in environmental samples

African swine fever (ASF) is currently the most dangerous disease for the global pig industry, causing huge economic losses, due to the lack of effective vaccine or treatment. Only the early detection of ASF virus (ASFV) and proper biosecurity measures are effective to reduce the viral expansion. One of the most widely recognized risks as regards the introduction ASFV into a country is infected animals and contaminated livestock vehicles. In order to improve ASF surveillance, we have assessed the capacity for the detection and inactivation of ASFV genome by using Dry-Sponges (3 M) pre-hydrated with a new surfactant liquid. We sampled different surfaces in ASFV-contaminated facilities, including animal skins, and the results were compared to those obtained using a traditional sampling method. The surfactant liquid successfully inactivated the virus, while ASFV DNA was well preserved for the detection. This is an effective method to systematically recover ASFV DNA from different surfaces and skin, which has a key applied relevance in surveillance of vehicles transporting live animals and greatly improves animal welfare. This method provides an important basis for the detection of ASFV genome that can be assessed without the biosafety requirements of a BSL-3 laboratory at least in ASF-affected countries, which may substantially speed up the early detection of the pathogen.

Natural vaccines accumulated in facemasks during COVID-19: Underappreciated role of facial masking

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a causal agent behind coronavirus disease 2019 (COVID-19). Despite promising developments in therapeutic and preventive avenues, the importance of facial masking is a key factor for the protective measures among exposed human populations. Preclinical and clinical data on the importance of facial masking concerning asymptomatic over symptomatic COVID-19 cases is limited. The recent introduction of the concept of SARS-CoV-2 associated molecular particle patterns (SAMPPs) as a natural vaccine has opened new avenues for the comprehensive development of immunity. To take this further, the scope of natural vaccines accumulated in facemasks during facial masking needs to be highlighted that may directly or indirectly contribute to building adaptive immunity among human populations. This paper attempts to discuss the underappreciated contributions of facial masking in the management of COVID-19 at the global level.

Quantifying ethanol in ethanol-based hand sanitizers by headspace gas chromatography with flame ionization detector (HS-GC/FID)

BACKGROUND

The COVID-19 pandemic sharply increased the demand for ethanol-based gel hand sanitizers, leading to a shortage of these products. Consequently, regulatory health agencies worldwide have altered their regulatory guidelines, on ethanol quality, to meet this high demand, raising concern about the products quality.

OBJECTIVE

The aim of this study was to quantify ethanol content and to qualitatively assess common impurities in ethanol-based gel hand sanitizers by headspace gas chromatography with flame ionization detector (HS-GC/FID).

METHODS

To quantify the ethanol content, 0.10 g of the sample was weighed in a 20 mL headspace vial and 5 mL of deionized water was added. Regarding the qualitative approach, 0.25 g of the sample was weighed and 4 mL of deionized water and was added. The samples were incubated, and then 400 µL of the headspace was injected into the GC/FID. Forty-eight products purchased in Brazil were analyzed.

RESULTS

Thirteen products presented at least one nonconformity regarding the ethanol quantity. Two samples presented an average ethanol concentration below the lower limit considered effective. Twelve samples presented acetaldehyde or ethyl acetate.

CONCLUSION

The huge demand for ethanol-based gel hand sanitizers may have impacted their quality. Because concern with proper hand hygiene tends to remain an issue for a long period, more studies about quality control of hand sanitizers will be needed.

HIGHLIGHTS

A simple and fast HS-GC/FID method to quantify ethanol in ethanol-based gel hand sanitizers was developed, validated and applied to commercial samples in Brazil. The regulatory authorities must be more vigilant to ensure that the commercially available products meet the recommended specifications.

Antiviral effect of multipurpose contact lens disinfecting solutions against coronavirus

Purpose

To evaluate the antiviral potential of five multipurpose disinfecting solutions against coronavirus (mouse hepatitis virus, a surrogate for SARS-CoV-2 human corona virus).

Methods

Test solutions (Biotrue, renu Advanced [Bausch and Lomb], ACUVUE RevitaLens [Johnson and Johnson Vision], cleadew [Ophtecs corp.] or AOSept Plus [Alcon]) were mixed with the coronavirus mouse hepatitis virus at 10⁴ plaque forming units (PFU)/mL as the final concentration and incubated at room temperature for the specified disinfection time. Surviving virus from each sample was then quantified by standard plaque forming unit assay and the reduction of PFU for each disinfectant was compared to the phosphate buffer saline (PBS) treated negative control. A regimen test was also conducted using Biotrue.

Results

The three multipurpose disinfecting solutions Biotrue (containing PHMB and polyquaternium-1), renu Advanced (PHMB, polyquaternium-1 and alexidine) and ACUVUE RevitaLens (polyquaternium-1 and alexidine) did not kill the coronavirus at the manufacturers recommended disinfection time in the stand alone test. After treatment, the virus’s titer (3.8 ± 0.2 log₁₀ for Biotrue, 3.7 ± 0.1 log₁₀ for renu and 3.7 ± 0.2 log₁₀ for RevitaLens) was similar to the negative control (3.7 ± 0.1 log₁₀; p ≥ 0.996). AOSept Plus (hydrogen peroxide) and cleadew (povidone iodine) significantly (p < 0.001) reduced the numbers of coronaviruses to below the detection limit (i.e. killed 3.7 ± 0.1 log₁₀ viruses compared to control). However, there was a significant reduction (p = 0.028) in numbers of coronaviruses attached to lenses when using the regimen test with Biotrue.

Conclusions

This study shows that oxidative contact lens disinfecting solutions (i.e. those containing povidone-iodine or hydrogen peroxide) provide superior antiviral activity against a coronavirus surrogate of SARS-CoV-2, unless the full regimen test (rub, rinse, disinfect) is used.

Aspectos biofísicos de la transmisión del SARS-CoV-2 y medidas para contrarrestar la COVID-19: una revisión integral

La pandemia por COVID-19 ha tenido al mundo en vilo desde su inicio en diciembre de 2019 al sur de China. Su alcance global obedece a que el SARS-CoV-2, su agente etiológico, ha mostrado una alta facilidad para transmitirse entre humanos. Desde entonces, Gobiernos de todas las naciones han desplegado una batería de medidas para disminuir sus consecuencias. De acuerdo con el crecimiento del contagio, se emplean medidas de contención, mitigación o supresión. La base científica de las medidas se deriva del conocimiento de las características biológicas del virus y de sus vías de transmisión. Por tanto, en este trabajo se revisarán la biología del coronavirus, la física de su transmisión y el concepto de dosis de infección que permiten comprender las intervenciones sanitarias empleadas para disminuir los casos y fallecimientos por la enfermedad, especialmente en el contexto latinoamericano.

Will we ever wash our hands of lubrication theory?

Lubrication theory is used to investigate how weakly bound particles can be transported away from the vicinity of the wall when two spatially periodic rough surfaces are sheared relative to one another at constant velocity U while immersed in fluid. The aim is to model what could be an important process during decontamination of hands by washing and is motivated by Mittal et al. ["The flow physics of COVID-19," J. Fluid Mech. 894, F2 (2020)] who remark "Amazingly, despite the 170+ year history of hand washing in medical hygiene, we were unable to find a single published research article on the flow physics of hand washing." Under the assumption that the roughness wavelength 2 π / k is large compared with the spacing of the surfaces, a, the lubrication approximation permits closed-form expressions to be found for the time-varying velocity components. These are used to track the motion of a particle that is initially trapped in a potential well close to one of the surfaces, and experiences a drag force proportional to the difference between its velocity and that of the surrounding fluid. Complications such as particle-wall hydrodynamic interactions, finite size effects, and Brownian motion are ignored for now. Unsurprisingly, particles remain trapped unless the flow driven by the wall motion is strong compared to the depth of the trapping potential well. Perhaps less obvious is that for many starting positions the process of escape to large distances from the wall takes place over a large number of periods 2 π / k U , essentially because the no-slip boundary condition means that fluid velocities relative to the wall are small close to the wall, and thus the velocities of particles along or away from the wall are also small. With reasonable estimates for the various dimensional parameters, the escape times in these cases are found to be comparable in magnitude to the washing times recommended in hand washing guidelines.

Amuchina Gel Xgerm hand rub in vitro virucidal activity against SARS-CoV-2

Aim: Ethanol is highly effective at inactivating enveloped viruses, including SARS-CoV-2. The aim of this study is to evaluate the virucidal activity of Amuchina Gel Xgerm (74% ethanol) against SARS-CoV-2, according to the European Standard EN14476:2013+A2:2019. Materials & methods: Virucidal activity of the study product was evaluated against SARS-CoV-2 strain USAWA1/2020 in suspension, in the presence of 0.3 g/l of bovine serum albumin. Results: The log₁₀ reduction of SARS-CoV-2 in the presence of bovine serum albumin was ≥4.11 ± 0.12 after 30 s of exposure to the study product (80% dilution). Cytotoxicity was observed in the 10⁰ dilution, affecting the detection limit by 1 log₁₀. Conclusion: Virucidal activity against SARS-CoV-2 supports the effectiveness of this alcohol-based formulation as a prevention measure for COVID-19 illness.

Toxicology Practice During COVID-19 Pandemic: Experience of the Dammam Poison Control Center-Eastern Province, Saudi Arabia

BACKGROUND

The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems.

OBJECTIVE

To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics.

METHODS

Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019.

RESULTS

Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086).

CONCLUSION

The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.

Alcohol-Based Hand Sanitizers in COVID-19 Prevention: A Multidimensional Perspective

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.

Topical Oral and Intranasal Antiviral Agents for Coronavirus Disease 2019 (COVID-19)

With the largest viral loads in both symptomatic and asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) present in the oral and nasal cavities, agents that act on these two areas have the potential for large therapeutic and prophylactic benefit. A literature review was conducted to elucidate the possible agents useful in treatment of SARS-CoV-2. These agents were evaluated for their current applications, adverse reactions, their current state of study, and any future considerations in their management of coronavirus disease 2019 (COVID-2019). Our review has found that, while there are many promising agents with proven efficacy in their in-vitro efficacy against SARS-CoV-2, more clinical trials and in-vivo studies, as well as safety trials, must be conducted before these agents can be effectively implemented.