Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study

BACKGROUND

Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers.

METHODS

A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3-5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures.

RESULTS

Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml).

CONCLUSION

The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

A critical evaluation of contents, labeling, and cost of hand sanitizers marketed in India during COVID-19 pandemic

Background

Antiseptics were introduced a long time ago, but their significance was noteworthy during the COVID-19 pandemic. Hand sanitizer plays a pivotal role as a preventive measure. Multiple national authorities have advocated for the application of Alcohol-Based Hand Sanitizers (ABHS). During the pandemic, a surge in demand and limited supply prompted numerous manufacturers to ramp up production. Consequently, it is imperative to scrutinize the composition, labeling, and price of hand sanitizers.

Aims and Objective

To assess the contents, labeling, and price of hand sanitizers available in the Indian market.

Methodology

Hand sanitizers, both online and offline, marketed in India between May 2019 and May 2022 were included. Hand sanitizers by local manufacturers without labeling were excluded. Contents and labeling of hand sanitizers were evaluated as per World Health Organization (WHO) recommendations. Price was assessed as a percentage cost variation.

Result

Out of 79, the majority (98.73%) were ABHS, and 28.20% of them met the recommended criteria for "Adequate" alcohol concentration. Ethyl alcohol emerged as the most prevalent (69.23%), often accompanied by emollients, humectants, fragrances, and color additives. Notably, 69.62% of the hand sanitizers featured comprehensive labeling, while incomplete labels lacked essential details under "Warning and Cautions." The average price of hand sanitizers was Rs 505.11 ± 255.36.

Conclusion

Choosing ABHS with appropriate alcohol concentrations in line with recommendations is crucial. To ensure the proper and safe use of hand sanitizers, individuals should follow the instructions provided on the product labels; both manufacturers and regulators are responsible for adhering to standards for hand sanitizers made available to the public.

Purification and use of crude green glycerol from the transesterification of triglycerides in the formulation of an alcohol gel hand sanitizer

The aim of this study was to produce an alcohol gel hand sanitizer containing green glycerol. Crude glycerol was purified using chemical and physical treatments. The sanitizer was prepared using 71.100 g of 99.3° GL ethanol, 28.0 g H2O, 0.5 g of Carboxypolymethylene [Carbopol 940® or Carbomer], 5 drops of triethanolamine (pH 5-7), and glycerol (1.5% w/w). The thermal behavior of the ethanol, carbopol, triethanolamine, glycerol, and alcohol gels were evaluated using Thermogravimetry and Differential Thermal Analysis. The apparent viscosity was obtained using a rotary viscometer. The determination of in vitro spreadability was achieved by an adaptation of the Knorst method. The ethanol content was measured by headspace gas chromatography using a flame ionization detector. The thermal behavior of the gels was influenced by the presence of glycerol, which confirms the possible network interactions formed. The relative densities of the samples were between 0.887 and 0.890 g/cm3. No alteration of the pH of the formulation resulted from the incorporation of glycerol. The apparent viscosities of the alcohol gels were greater than 20,000 cP. No alteration in the in vitro spreadability of the gel alcohol (530.6 mm2) resulted from the addition of glycerol. Hand sanitizer was produced using glycerol from a transesterification reaction. It represents an alternative use for the glycerol being produced in biodiesel processes. The product satisfied the requirements of WHO that preconize a formulation containing 1.45% glycerol as an humectant to protect skin against dryness and dermatitis.

Prevention of skin damages related to personal protective equipment among healthcare workers: Summary of best-evidence practiced strategies

AIM

To conduct a quality evaluation of the literature for the prevention of skin damage caused by personal protective equipment among healthcare workers and to summarise the best-evidence practice strategies to prevent it.

DESIGN

Review.

METHODS

Two researchers retrieved the literature from Web of Science, Public Medicine, etc., from the establishment of the database until 24 June 2022. Appraisal of Guidelines, Research and Evaluation II was used to assess the methodological quality of the guidelines. Expert consensus was assessed by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. By tracking the original study, the quality of practice recommendations and best-practice evidence information sheets were evaluated by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pre-grading and recommending level system.

RESULTS

A total of 5476 studies were retrieved after duplications were eliminated. After the quality evaluation, 10 qualified studies were finally included. All consisted of two guidelines, one best practice information sheet, five practice recommendations, and one expert consensus. The evaluation results of the guidelines were both B-level recommendations. The consistency strength of expert consensus was moderate (Cohen's kappa coefficient = .571). Thirty best-evidence practised strategies were compiled for four elements, including cleaning, moisturising, prophylactic dressings and others.

CONCLUSION

Our study evaluated the quality of the included studies and summarised the preventive measures of PPE-related skin lesions according to the recommendation level. The main preventive measures were divided into 4 parts and 30 items. However, the associated literature was rare, and the quality was slightly low. More high-quality research is needed to focus on healthcare workers' health and not just skin in the future.

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.

Assessment of Anti-Bacterial Effectiveness of Hand Sanitizers Commonly Used in South Africa

Hand sanitizers are used as an alternative to hand washing to reduce the number of viable microorganisms when soap and water are not readily available. This study aimed to investigate the anti-bacterial effectiveness of commercially available hand sanitizers and those commonly used in healthcare and community settings. A mapping exercise was done to select and procure different hand sanitizers (n = 18) from retailers. Five microorganisms implicated in hospital-acquired infections were selected and tested against each hand sanitizer: Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Twenty-one volunteers were recruited to do a handprint before and after applying the hand sanitizer. Only four out of eighteen hand sanitizers (22%) were effective against all tested bacterial species, and an equal number (22%) were completely ineffective. Seven hand sanitizers with a label claim of 99.99% were only effective against E. coli. Only five hand sanitizers (27%) effectively reduced bacteria on participants’ hands. This study showed that only a fifth of hand sanitizers were effective against selected microorganisms. The findings raise a concern about the effectiveness of hand sanitizers and their role in infection, prevention, and control if not well regulated.

Assessment of disinfectant efficacy in reducing microbial growth

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.

Designing an ideal alcohol-based hand sanitizer: in vitro antibacterial responses of ethanol and isopropyl alcohol solutions to changing composition

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.

Antiviral and antibacterial activity of hand sanitizer and surface disinfectant formulations

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.

Skin barrier response to active chlorine hand disinfectant-An experimental study comparing skin barrier response to active chlorine hand disinfectant and alcohol-based hand rub on healthy skin and eczematous skin

BACKGROUND

Alcohol-based hand rub (ABHR) is widely used for hand disinfection in the health care sector. ABHR is, however, known to cause discomfort when applied on damaged skin emphasizing the unmet need for alternative and better tolerated types of disinfectants. Active chlorine hand disinfectants (ACHDs) are potential new candidates; however, the effect on the skin barrier function compared to ABHR remains to be assessed.

MATERIALS AND METHODS

In Study A, the forearm skin of healthy adults was repeatedly exposed to ACHD and ABHR. Skin barrier function was assessed by measurement of transepidermal water loss, electrical conductance, pH, and erythema at baseline and at follow-up after 2 days, and subjective discomfort was likewise assessed. Study B was performed in the same way; however, in order to induce an experimental irritant contact dermatitis, sodium lauryl sulfate patch tests were applied to forearms before exposure to ACHD and ABHR.

RESULTS

In both studies, the skin barrier function was unaffected after repetitive exposure to ACHD and ABHR, and with no significant differences between the products. Subjective discomfort was reported as sporadic or very mild in relation to both products.

CONCLUSION

Our results illustrate that use of ACHD does not affect the skin barrier function negatively, neither in intact skin nor in skin with experimentally induced contact dermatitis. Future studies should include real-life evaluation of skin barrier function and subjective discomfort following ACHD use in individuals with and without hand eczema.

Hand hygiene in health care: 20 years of ongoing advances and perspectives

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.

Assessment of Alcohol-Based Hand Sanitizers for Long-Term Use, Formulated with Addition of Natural Ingredients in Comparison to WHO Formulation 1

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.

Hydrogels in Hand Sanitizers

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.

COVID-19 and dermatological personal protective equipment considerations

Cutaneous injury and irritation among health care workers has substantially risen during the COVID-19 pandemic. In a field already laden with skin-induced injury and irritation due to high levels of handwashing and glove wearing, increases have been reported in handwashing-induced xerosis, irritant dermatitis, and contact dermatitis from N95 respirators and other surgical masks. Masks, goggles, face shields, and gloves all potentially create abrasions from long hours of use, leading to itching, pain, and aggravation of underlying skin conditions. Personal protective equipment (PPE)-related skin injury can be serious, and the American Academy of Dermatology has released recommendations on preventing and treating occupationally induced dermatologic conditions during the COVID-19 pandemic. These are reviewed and discussed in conjunction with overarching guidelines for mitigating the spread of the virus.

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.

How irritant are n-propanol and isopropanol? - A systematic review

BACKGROUND

The use of alcoholic-based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID-19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection.

METHODS

This systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol-based disinfectants restricted to n-propanol (1-propanol) and its structural isomer isopropanol (isopropyl alcohol, 2-propanol).

RESULTS

The majority of the included studies show a low irritation potential of n-propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n-propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n-propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone.

CONCLUSION

While recent studies indicate a higher risk of skin irritation for n-propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID-19 infections.

In vivo evaluation of the toxicity, genotoxicity, histopathological, and anti-inflammatory effects of the purified bioglycerol byproduct in biodiesel industry

BACKGROUND

Biodiesel has gained an increased popularity as a good alternative for fossil fuel because of its unusual qualities as a biodegradable, nontoxic, and renewable diesel fuel. Hence, the economic utilization of the accumulated bioglycerol byproduct became critically important for the sustainability of biodiesel industry. The purified bioglycerol might be used as a valuable industrial stock in cosmetic, medical, and food industries. However, if the purified product is going to be used in food, drug, or any industry that involves its ingestion or skin contact by human or animals, the product should be thoroughly tested on animal models.

RESULTS

The present study investigated the acute toxicity, anti-inflammatory, histopathological, and genotoxic effects of zeolite-purified biogylcerol on different animal models. All the previous tests proved the ability of the purification process to improve the qualities of the crude bioglycerol to a degree comparable to the pharmaceutical grade glycerol.

CONCLUSION

In other words, it could be concluded that zeolite-purified bioglycerol can be used in different industries that involves products consumed by human or animals.

Efficacies of the original and modified World Health Organization-recommended hand-rub formulations

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.

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

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.

Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand

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.

Evaluation of World Health Organization-Recommended Hand Hygiene Formulations

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.