Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water

Infection prevention and control studies for care of patients with suspected or confirmed filovirus disease in healthcare settings, with focus on Ebola and Marburg: an integrative review

Objective

To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses.

Design

Integrative review.

Data sources

PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature.

Study selection

Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives.

Methods

Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations.

Results

Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.

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.

Disinfection of Phi6, MS2, and Escherichia coli by Natural Sunlight on Healthcare Critical Surfaces

Ultraviolet (UV) radiation systems, commonly used to disinfect surfaces, drinking water, and air, stem from historical practice to use sunlight to disinfect household items after contagious illness. Currently, it is still recommended in viral outbreak contexts such as COVID-19, Ebola, and Marburg to expose soft surfaces to sunlight after washing with detergent or disinfecting with chlorine. However, sunlight that reaches the Earth's surface is in the UVA/UVB wavelengths, whereas UV disinfection systems typically rely on biocidal UVC. Our goal was to fill the evidence gap on the efficacy of sunlight disinfection on surface materials common in low-resource healthcare settings by seeding four surfaces (stainless steel, nitrile, tarp, cloth) with three microorganisms (viral surrogate bacteriophages Phi6 and MS2 and Escherichia coli bacteria), with and without soil load, and exposing to three sunlight conditions (full sun, partial sun, cloudy). We conducted 144 tests in triplicate and found: solar radiation averaged 737 W/m2 (SD = 333), 519 W/m2 (SD = 65), and 149 W/m2 (SD = 24) for full sun, partial sun, and cloudy conditions; significantly more surfaces averaged ≥ 4 log10 reduction value (LRV) for Phi6 than MS2 and E. coli (P < 0.001) after full sun exposure, and no samples achieved ≥ 4 LRV for partial sun or cloudy conditions. On the basis of our results, we recommend no change to current protocols of disinfecting materials first with a 0.5% chlorine solution then moving to sunlight to dry. Additional field-based research is recommended to understand sunlight disinfection efficacy against pathogenic organisms on healthcare relevant surfaces during actual outbreak contexts.

Failure of sodium hypochlorite to meet the EN 1500 efficacy requirement for hygienic hand disinfection

This study evaluated the bactericidal efficacy of two alternative hand antiseptics, based on sodium hypochlorite or sodium hypochlorite and hypochlorous acid, compared with isopropanol on the hands of volunteers artificially contaminated with Escherichia coli using EN 1500. The reference alcohol was applied according to the norm, and the study formulations were used as in common practice (3 mL for 30 s). The products showed mean log₁₀ reductions of 1.63 and 1.89, both of which were inferior to the reference treatment (4.78). Due to the failure to achieve sufficient bactericidal efficacy within 30 s, sodium hypochlorite (0.05-0.06%) should not be considered for hand disinfection.

Anderson C, B. Boehm A, Wolfe MK. Quantifying the Viral Reduction Achieved Using Ash and Sand as Handwashing Agents

The WHO recommends handwashing with soap and water for 20-40 seconds. In settings where soap is not available, ash or sand is used for handwashing, yet their efficacy as handwashing materials is underresearched. The purpose of this study was to quantify the removal of viruses using ash and sand as handwashing agents, and compare their efficacy to commonly recommended handwashing methods. We performed a volunteer study to estimate the log reduction value (LRV) of model viruses Phi6 and MS2 on hands after six handwashing conditions: two handwashing agents (ash and water, and sand and water) with two time points (5 and 20 seconds), and two handwashing agents (soap and water, and water only) with one time point (20 seconds). Plaque assays were used to measure infectious virus reduction. Handwashing with any of the handwashing agents for 20 seconds resulted in a greater LRV than the 2-log reduction U.S. Food and Drug Administration criteria for both viruses. Soap and water resulted in a significantly greater LRV (2.7-4.8) than washing with ash and water (2.0-2.8) or sand and water (1.8-2.7) for 5 seconds for both viruses, and water only resulted in a significantly higher LRV (2.8) than all ash (2.0-2.6) and sand (1.8-2.4) conditions for MS2 only. These results suggest that using ash or sand as handwashing agents can be efficacious in reducing viruses but may be less efficacious than soap, especially when used for shorter durations. Further research should investigate the use of ash and sand as handwashing agents in real-world settings.

Safe use of PHI6 IN the experimental studies

Surrogate viruses theoretically provide an opportunity to study the viral spread in an indoor environment, a highly needed understanding during the pandemic, in a safe manner to humans and the environment. However, the safety of surrogate viruses for humans as an aerosol at high concentrations has not been established. In this study, Phi6 surrogate was aerosolized at high concentration (Particulate matter_2.5: ∼1018 μg m^-3) in the studied indoor space. Participants were closely followed for any symptoms. We measured the bacterial endotoxin concentration of the virus solution used for aerosolization as well as the concentration in the room air containing the aerosolized viruses. In addition, we measured how the bacterial endotoxin concentration of the sample was affected by different traditional virus purification procedures. Despite the purification, bacterial endotoxin concentration of the Phi6 was high (350 EU/ml in solution used for aerosols) with both (two) purification protocols. Bacterial endotoxins were also detected in aerosolized form, but below the occupational exposure limit of 90 EU/m³. Despite these concerns, no symptoms were observed in exposed humans when they were using personal protective equipment. In the future, purification protocols should be developed to reduce associated bacterial endotoxin levels in enveloped bacterial virus specimens to ensure even safer research use of surrogate viruses.

Physiological characteristics, geochemical properties and hydrological variables influencing pathogen migration in subsurface system: What we know or not?

The global outbreak of coronavirus infectious disease-2019 (COVID-19) draws attentions in the transport and spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in aerosols, wastewater, surface water and solid wastes. As pathogens eventually enter the subsurface system, e.g., soils in the vadose zone and groundwater in the aquifers, they might survive for a prolonged period of time owing to the uniqueness of subsurface environment. In addition, pathogens can transport in groundwater and contaminate surrounding drinking water sources, possessing long-term and concealed risks to human society. This work critically reviews the influential factors of pathogen migration, unravelling the impacts of pathogenic characteristics, vadose zone physiochemical properties and hydrological variables on the migration of typical pathogens in subsurface system. An assessment algorithm and two rating/weighting schemes are proposed to evaluate the migration abilities and risks of pathogens in subsurface environment. As there is still no evidence about the presence and distribution of SARS-CoV-2 in the vadose zones and aquifers, this study also discusses the migration potential and behavior of SARS-CoV-2 viruses in subsurface environment, offering prospective clues and suggestions for its potential risks in drinking water and effective prevention and control from hydrogeological points of view.

Chlorine efficacy against bacteriophage Phi6, a surrogate for enveloped human viruses, on porous and non-porous surfaces at varying temperatures and humidity

While efficacy of chlorine against Phi6, a widely-used surrogate for pathogenic enveloped viruses, is well-documented, surfaces common to low-resource contexts are under-researched. We evaluated seven surfaces (stainless steel, plastic, nitrile, tarp, cloth, concrete, wood) and three environmental conditions-temperature (4, 25, 40 °C), relative humidity (RH) (23, 85%), and soiling-to determine Phi6 recoverability and the efficacy of disinfection with 0.5% NaOCl. Overall, Phi6 recovery was >4 log₁₀ PFU/mL on most surfaces after drying 1 hour at all temperature/humidity conditions. After disinfection, all non-porous test conditions (48/48) achieved ≥4 LRV at 1 and 5 minutes of exposure; significantly more non-porous surfaces met ≥4 LRV than porous (p < 0.001). Comparing porous surfaces, significantly fewer wood samples met ≥4 LRV than cloth (p < 0.001); no differences were observed between concrete and either wood (p = 0.083) or cloth (p = 0.087). Lastly, no differences were observed between soil and no-soil conditions for all surfaces (p = 0.712). This study highlights infectious Phi6 is recoverable across a range of surfaces and environmental conditions, and confirms the efficacy of chlorine disinfection. We recommend treating all surfaces with suspect contamination as potentially infectious, and disinfecting with 0.5% NaOCl for the minimum contact time required for the target enveloped virus (e.g. Ebola, SARS-CoV-2).

Hand hygiene and face mask wearing practices for COVID-19 prevention: a non-intrusive observation of patrons of community convenience shops in Accra, Ghana

INTRODUCTION

in the absence of a vaccine and definitive treatment, non-pharmacological measures of physical distancing, regular hand hygiene and wearing of face covering remain the mainstays of mitigating coronavirus disease 2019 (COVID-19). In Ghana, these measures are mandatory in public places and underpin COVID-19 infection prevention and control (IPC). We assessed adherence and appropriate performance of these measures among patrons of community convenience shops in selected hotspots.

METHODS

we conducted a non-intrusive observation of patrons of convenience shops in COVID-19 burden hotspots. We observed patrons as they entered and exited the shops and collected data on their gender, adherence and appropriate use of face covering and hand hygiene facilities. Data were analyzed descriptively and inferentially to determine factors associated with adherence to IPC guidelines.

RESULTS

of 800 patrons observed from eight community shops, 481 (60.1%) were males. Of these, 653 (81.6%) wore face covering and 98 (12.3%) performed hand hygiene; with 92 (11.5%) adhering to both measures. Patrons who wore face mask appropriately were 578; comprising 299 (92.3%) of patrons who wore face mask before entering the shops. Of 89 patrons who washed their hands, appropriate handwashing was recorded among nine (10.1%). Compared to inappropriate handwashing, appropriate handwashing was negatively associated with adherence to IPC guidelines [aOR=0.1 (95% CI=0.01-0.59)].

CONCLUSION

adherence to and appropriate performance of IPC measures of handwashing and use of face covering in the selected shops was low. There is the need to complement availability of IPC measures with intensification of risk communication messaging targeted at ensuring their appropriate use.

Phi 6 recovery from inoculated fingerpads based on elution buffer and methodology

Phi 6 (Φ6) bacteriophage is a proposed surrogate to study pathogenic enveloped viruses including SARS-CoV-2-the causative agent of COVID-19-based on structural similarities, BSL-1 status, and ease of use. To determine the role of virus-contaminated hands in disease transmission, an enhanced understanding of buffer and method performance for Φ6 recovery needs to be determined. Four buffer types and three methodologies were investigated for the recovery of Φ6 from human fingerpads over a 30 min duration. Phosphate buffered saline (PBS), PBS + 0.1 % Tween, 0.1 M glycine + 3% beef extract, and viral transport medium were evaluated as buffers for recovery of Φ6 via a dish, modified glove juice, and vigorous swabbing method. Φ6 concentrations on fingerpads were determined at 0-, 5-, 10-, and 30-min post-inoculation. While there were observed differences in virus recovery across buffer and method types depending on the time point, log PFU recovery based on buffer type or methodology was not significantly different at any time point (P > 0.05). The results presented in this study will allow for future work on Φ6 persistence, transfer between hands and surfaces, and efficacy of hand hygiene methods to be performed using a well-characterized and validated recovery method.

Effects of Hand Hygiene Using 4% Chlorhexidine Gluconate or Natural Soap During Hand Rubbing Followed by Alcohol-Based 1% Chlorhexidine Gluconate Sanitizer Lotion in the Operating Room

Objective: Hand hygiene using either 4% chlorhexidine gluconate (CHG) or natural soap during hand rubbing, followed by alcohol-based 1% CHG sanitizer lotion in the operating room was compared to assess bacterial reduction, skin moisture, skin texture, and hand hygiene using qualitative questionnaires. Approach: A crossover study with 36 professional scrub nurses at two medical centers was performed to compare 4% CHG followed by alcohol-based 1% CHG sanitizer lotion, the Two-stage method with handwashing using natural soap followed by alcohol-based 1% CHG sanitizer lotion, and the Waterless method, after a period of 10 days of use. The study completely followed CONSORT, www.consort-statement.org. Results: There was no significant difference in bacterial reduction based on the bacterial colony-forming units between the two methods. The skin moisture and skin roughness scores were not significantly different between the two methods. The Waterless method was significantly better than the Two-stage method regarding "foaming," "quality," "longevity" (p < 0.0001, p < 0.0001, and p < 0.0001, respectively), but "disappearance" was significantly better by the Two-stage method (p = 0.0095) during washing and rubbing. Immediately after washing and rubbing, the Waterless method was significantly better regarding "tightness" and "moisture," whereas the Two-stage method was significantly better regarding "stickiness" (p = 0.0114, p = <0.0001, and 0.0059, respectively) Innovation: The Waterless method using natural soap during handwashing followed by alcohol-based 1% CHG sanitizer lotion was as effective as the Two-stage method of 4% CHG followed by alcohol-based 1% CHG sanitizer lotion. Conclusion: Handwashing using natural soap is simple and superior to hand scrubbing in several aspects.

Assessment of water, sanitation and hygiene practices for prevention and control of COVID-19 in Kenya

Background

Safely managed water, sanitation and hygiene (WASH) services are an essential part of preventing and protecting human health during infectious disease outbreaks, including the current coronavirus disease 2019 (COVID-19) pandemic. Additionally, adherence to COVID-19 measures, including washing hands using soap and proper waste disposal, no doubt can improve containment of the virus.

Methods

A cross-sectional survey was conducted in Kilifi and Mombasa Counties in Kenya. A total of 612 quantitative data were collected using a mobile data collection tool Open Data Kit. Parametric and non-parametric tests were used to examine factors associated with WASH practices and control of COVID-19 in Kenya.

Results

More than half of the respondents were from Kilifi, 431 (70.4%) were female and the mean age was 38.2±14.8 y. Households in Kilifi were most likely not to have enough water, while Mombasa households were more likely to pay for water. Sanitation coverage was 47.6%, with more than half sharing sanitation facilities. Sharing of latrines was significantly associated with county and income level. Accessing soap was worse compared with the month prior to the survey, only 3.9% had their garbage collected by formal service providers and only 17% reported wearing any protective gear while handling waste at home.

Conclusions

Water is disproportionately available in the two counties, with low sanitation coverage. There is low knowledge on hand washing and inadequate waste disposal services.

Comparative analysis of peracetic acid (PAA) and permaleic acid (PMA) in disinfection processes

The growing demand to reduce chlorine usage and control disinfection byproducts increased the development of new strategies in wastewater treatments. Organic peracids are increasingly attracting interest in disinfection activities as a promising alternative to chlorine and chlorine-based agents. In this study, we assessed the antimicrobial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) of a new organic peracid, permaleic acid (PMA) compared with the reference peracetic acid (PAA). Disinfectant properties were evaluated by i) disk diffusion agar, ii) broth microdilution, iii) antibiofilm properties. PMA demonstrated a 10- and 5-fold decrease in the microbial inhibitory concentration (MIC) value against E. coli and S. aureus respectively, compared to PAA. Results showed greater efficacy of PMA regarding wastewater (WW) and treated wastewater (TWW) disinfection at low concentrations. Furthermore, the biofilm degradation ability was only observed following PMA treatment, for both strains. Bacterial regrowth from biofilm matrix after PAA and PMA disinfection, in the absence and presence of organic matter, was evaluated. PMA was more efficient than PAA to prevent the regrowth of planktonic cells of S. aureus and E. coli. After PAA and PMA treatment, in the presence of organic matter, the bacterial regrowth inhibition was maintained up to 10 and 5 g/L, respectively. Based on these results, PMA could be used as a valid alternative to the currently used disinfection methods.

Transfer Rate of Enveloped and Nonenveloped Viruses between Fingerpads and Surfaces

Fomites can represent a reservoir for pathogens, which may be subsequently transferred from surfaces to skin. In this study, we aim to understand how different factors (including virus type, surface type, time since last hand wash, and direction of transfer) affect virus transfer rates, defined as the fraction of virus transferred, between fingerpads and fomites. To determine this, 360 transfer events were performed with 20 volunteers using Phi6 (a surrogate for enveloped viruses), MS2 (a surrogate for nonenveloped viruses), and three clean surfaces (stainless steel, painted wood, and plastic). Considering all transfer events (all surfaces and both transfer directions combined), the mean transfer rates of Phi6 and MS2 were 0.17 and 0.26, respectively. Transfer of MS2 was significantly higher than that of Phi6 (P < 0.05). Surface type was a significant factor that affected the transfer rate of Phi6: Phi6 is more easily transferred to and from stainless steel and plastic than to and from painted wood. Direction of transfer was a significant factor affecting MS2 transfer rates: MS2 is more easily transferred from surfaces to fingerpads than from fingerpads to surfaces. Data from these virus transfer events, and subsequent transfer rate distributions, provide information that can be used to refine quantitative microbial risk assessments. This study provides a large-scale data set of transfer events with a surrogate for enveloped viruses, which extends the reach of the study to the role of fomites in the transmission of human enveloped viruses like influenza and SARS-CoV-2. IMPORTANCE This study created a large-scale data set for the transfer of enveloped viruses between skin and surfaces. The data set produced by this study provides information on modeling the distribution of enveloped and nonenveloped virus transfer rates, which can aid in the implementation of risk assessment models in the future. Additionally, enveloped and nonenveloped viruses were applied to experimental surfaces in an equivalent matrix to avoid matrix effects, so results between different viral species can be directly compared without confounding effects of different matrices. Our results indicating how virus type, surface type, time since last hand wash, and direction of transfer affect virus transfer rates can be used in decision-making processes to lower the risk of viral infection from transmission through fomites.

Soap, water, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): an ancient handwashing strategy for preventing dissemination of a novel virus

Public Health Agencies worldwide (World Health Organization, United States Centers for Disease Prevention & Control, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control, etc.) are recommending hand washing with soap and water for preventing the dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. In this review, we have discussed the mechanisms of decontamination by soap and water (involving both removal and inactivation), described the contribution of the various components of formulated soaps to performance as cleansers and to pathogen inactivation, explained why adherence to recommended contact times is critical, evaluated the possible contribution of water temperature to inactivation, discussed the advantages of antimicrobial soaps vs. basic soaps, discussed the differences between use of soap and water vs. alcohol-based hand sanitizers for hand decontamination, and evaluated the limitations and advantages of different methods of drying hands following washing. While the paper emphasizes data applicable to SARS-CoV-2, the topics discussed are germane to most emerging and re-emerging enveloped and non-enveloped viruses and many other pathogen types.

Potential application of novel technology developed for instant decontamination of personal protective equipment before the doffing step

The use of personal protective equipment (PPE) has been considered the most effective way to avoid the contamination of healthcare workers by different microorganisms, including SARS-CoV-2. A spray disinfection technology (chamber) was developed, and its efficacy in instant decontamination of previously contaminated surfaces was evaluated in two exposure times. Seven test microorganisms were prepared and inoculated on the surface of seven types of PPE (respirator mask, face shield, shoe, glove, cap, safety glasses and lab coat). The tests were performed on previously contaminated PPE using a manikin with a motion device for exposure to the chamber with biocidal agent (sodium hypochlorite) for 10 and 30s. In 96.93% of the experimental conditions analyzed, the percentage reduction was >99% (the number of viable cells found on the surface ranged from 4.3x106 to <10 CFU/mL). The samples of E. faecalis collected from the glove showed the lowest percentages reduction, with 86.000 and 86.500% for exposure times of 10 and 30 s, respectively. The log10 reduction values varied between 0.85 log10 (E. faecalis at 30 s in glove surface) and 9.69 log10 (E. coli at 10 and 30 s in lab coat surface). In general, E. coli, S. aureus, C. freundii, P. mirabilis, C. albicans and C. parapsilosis showed susceptibility to the biocidal agent under the tested conditions, with >99% reduction after 10 and 30s, while E. faecalis and P. aeruginosa showed a lower susceptibility. The 30s exposure time was more effective for the inactivation of the tested microorganisms. The results show that the spray disinfection technology has the potential for instant decontamination of PPE, which can contribute to an additional barrier for infection control of healthcare workers in the hospital environment.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

ABSTRACT

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

HIGHLIGHTS

Evaluation of the Efficacy of Alcohol-Based Hand Sanitizers Sold in Southwest Ethiopia

Background

Regarding the protection of community and health professionals suffering from a COVID-19 outbreak, currently different alcohol-based hand sanitizers have been distributed. Even though for effective protection effective alcohol-based hand sanitizers are mandatory. Their efficacy was not evaluated. This is the reason why this research was designed to assess the antimicrobial efficacy of hand sanitizers that have been sold in southern parts of Ethiopia.

Methods

Six test organisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella typhimurium and Shigella boydii) were selected from different clinical specimens. Then seven locally made products of alcohol-based hand sanitizers (MTU, Folium Fine, Epharm, Harego, Taflen and Sheba) were purchased and the disc diffusion, minimum inhibition concentration and minimum bactericidal concentration test were done against selected test organisms. Quality control measures throughout the whole process of the laboratory work were implemented and descriptive parameters were analyzed.

Results

The zones of inhibition of the hand sanitizers at their claim concentration were ranged from noninhibition zone (Folium) to 27mm (Sheba). The minimum inhibitory concentration against all selected test organisms was observed at 45%, 55%, 65% and Taflen on undiluted form. The growth of test organisms was decreased across increasing the concentration gradient of different hand sanitizers. MTU except against E. coli, Fine, Hargo, Ephra and Sheba hand sanitizers were showed growth below 60% concentrations for all test micro-organisms. But a Folium product against all selected test micro-organisms and MTU product against E. coli were not bactericidal.

Conclusion

Fine, Hargo, Ephra, Sheba and Taflen sanitizers were the products that were effective in inhibiting the growth of all the selected test organisms, and they were having effective bactericidal activity in vitro at their claim concentration. But MTU product against E. coli and Folium product against all test microorganisms were not having an effective bactericidal activity. So, regulatory authorities and manufacturers should implement strict quality control measures and regular observations throughout the production to ensure the efficacy of hand sanitizers.

Evaluating the Efficacy of the Supertowel™ as a Handwashing Product: A Simulation of Real-World Use Conditions

The Supertowel is a fabric treated with a permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The Supertowel has been shown to be as efficacious as handwashing with soap and water when tested under controlled laboratory conditions. It has also been shown to be a practical, acceptable, and desirable product among crisis-affected populations. The aim of this study was to test whether the Supertowel remains as efficacious when used under conditions which mimic real-world hand cleaning in challenging settings. Two rounds of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of the Supertowel when used for a shorter duration, when less wet, when used with contaminated water, when visibly dirty, and when dry. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the Supertowel and the reference condition (normally handwashing with soap), using a crossover design. The Supertowel was marginally less efficacious than handwashing with soap when used for 15 seconds (P = 0.04) but as efficacious at 30 and 60 seconds durations. All the other Supertowel conditions were as efficient as their reference comparisons meaning that the Supertowel can effectively remove pathogens from hands when it is wet, damp, or completely dry, when it is used with contaminated water, when visibly dirty with mud and/or oil.

Hand hygiene: virucidal efficacy of a liquid hand wash product against Ebola virus

Background

Hand washing is an important targeted hygiene intervention for limiting the spread of infectious agents, including the Ebola virus, which continues to re-emerge. We have assessed the virucidal efficacy of a commercially available liquid hand wash product (LHW) for inactivating Ebola virus.

Methods

The ASTM E1052-11 Standard was used to evaluate the efficacy of an LHW containing the microbicidal active salicylic acid for inactivating Ebola virus - Makona variant suspended in an organic load. Three concentrations (12.5%, 25%, 50%) of three lots of LHW prepared in 440 ppm hard water were evaluated at room temperature for 20, 30, and 60 s contact time.

Results

A 25% solution of the LHW caused 4.5 log₁₀ and 4.8 log₁₀ reduction in Ebola virus titer within 20 and 30 s, respectively. The efficacy of a 12.5% LHW solution was lower (1.9 and 2.0 log₁₀ reduction in titer within 20 and 30 s, respectively). The efficacy of the 50% LHW solution could not be measured, due to inability to sufficiently neutralize the LHW at the end of exposure.

Conclusion

These results suggest the potential utility of an appropriately formulated liquid hand wash agent during Ebola virus disease outbreaks for use within healthcare, community, and home settings. Such an LHW should also be effective against other enveloped viruses, such as the pandemic coronavirus SARS-CoV-2.

COVID-19: urgent actions, critical reflections and future relevance of 'WaSH': lessons for the current and future pandemics

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

COVID-19: una revisión de la evidencia en el ámbito pediátrico

En el contexto de la pandemia por COVID-19, es importante la selección y el uso adecuado de los conocimientos nuevos y de aquellos adquiridos en situaciones históricas similares, para garantizar una correcta toma de decisiones en cuanto a la prevención, manejo y tratamiento de esta enfermedad en la población pediátrica. Desde inicios del 2020, la atención se ha focalizado en el control de la pandemia y en el manejo de los pacientes con esta enfermedad, cuya mayoría se encuentra en la población adulta. Sin embargo, recientemente se han observado cursos más severos de la enfermedad en pacientes pediátricos y lo que inicialmente se consideraba como una patología inofensiva ha generado mayores alertas en esta población por la presencia de complicaciones severas. Por lo anterior, la presente revisión busca determinar las últimas estrategias de prevención, diagnóstico y tratamiento avaladas y soportadas por la evidencia científica, de manera que se aporten las herramientas necesaria para garantizar un manejo adecuado y disminuir, en la medida de lo posible, los desenlaces fatales en la población pediátrica. 

In Vivo Comparison of Chlorine-Based Antiseptics versus Alcohol Antiseptic for Surgical Hand Antisepsis

Despite being commonly used as effective preparation for surgical hand antisepsis, alcohol solutions have major drawbacks, such as drying effect, emergence of hand eczema, and other diseases. This study aimed to demonstrate the effectiveness of sodium hypochlorite (NaOCl) and hydrogen peroxide (H₂O₂) as antiseptic in comparison to single sodium hypochlorite and 70% ethanol. In 5-day tests, the effects of 3 antiseptics were established according to standard test methods. The antiseptics were applied to the hands of 82 volunteers, and samples of bacteria were collected on days 1 and 5, immediately after drying and 6 hours later after antiseptic application. Student's t test and ANOVA were applied in a statistical study. The NaOCl with H₂O₂ composition demonstrated noninferiority to both sodium hypochlorite only and alcohol products and superiority to these antiseptics on day 5 (P < 0.05 at a significance level of 5% for each comparative trial in this day) at equivalence margin of 20%. The effectiveness of the NaOCl plus H₂O₂ composition as an antiseptic was explained by the formation of singlet oxygen in the system. Together, these data suggest that NaOCl and H₂O₂ may be an effective hand antisepsis that avoids the drawbacks seen with alcohol solutions.

Handwashing in averting infectious diseases: Relevance to COVID-19

After officially declared as a pandemic by the World Health Organization (WHO), drastic measures to restrict human movements to contain the COVID-19 infection are employed by most of the countries. Maintaining high personal hygiene by frequent handwashing and be vigilant of clinical signs are widely recommended to reduce the disease burden. The national and international health agencies, including the Centers for Disease Control and Prevention (CDC) and the WHO, have provided guidelines for prevention and treatment suggestions. Here, in this brief article, based on available clinical information, the author discusses why handwashing could be protective of COVID-19 infections. Although a detailed and in-depth discussion of various preventive and protective measures is beyond the scope of this article, this review will focus on the utility of frequent handwashing in minimizing the risk of spreading COVID-19 infection.

Hypochlorous Acid: A Review

The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.

Developing chlorine-based antiseptic by electrolysis

The use of Alcohol-based antiseptics is efficient and approved, however it has some limitations. This paper examined the possibility of using hypochlorite water as a chlorine-based antiseptic for handwashing in public buildings and healthcare facilities. The electrolysis method was used, which produces Hypochlorous acid (HOCl) from mixing drinking water with small amounts of sodium hydroxide. Hypochlorous acid is usually produced by blood cells to surround pathogens when the skin is cut and exposed to pathogens. The methods used were based on hydrolysing drinking water at a different salt concentration (from 0 up to saline water 0.9% NaCl) under the different power supply. The results showed that 0.005-0.01% hydrochloride water can be a perfect antiseptic that can kill most bacteria and pathogenies within 12 s. In one prototype set up one litter of the prepared solution needed the only 2 g of NaCl, 12 V and 3 amps' power. However, the pH value should be maintained to be around 5-6. The results also showed that the most efficient way was to produce the solution on-site. However, if stored properly it can be used for 7-10 days after production.

Evaluating the Environmental Persistence and Inactivation of MS2 Bacteriophage and the Presumed Ebola Virus Surrogate Phi6 Using Low Concentration Hydrogen Peroxide Vapor

Ebola virus (EBOV) disease outbreaks, as well as the ability of EBOV to persist in the environment under certain conditions, highlight the need to develop effective decontamination techniques against the virus. We evaluated the efficacy of hydrogen peroxide vapor (HPV) to inactivate MS2 and Phi6 bacteriophages, the latter a recommended surrogate for EBOV. The phages were inoculated onto six material types with and without the presence of whole human blood. The inoculated materials were then exposed to either a high or low concentration of HPV for various elapsed times. The phages were also recovered from positive controls at these same elapsed times, to assess environmental persistence and decontamination efficacy. Low concentration hydrogen peroxide vapor (LCHP; 25 ppm) was effective against both phages on all materials without the presence of blood at 2 h. LCHP was ineffective against the phages in the presence of blood, on all materials, even with a 3-day contact time. Higher concentrations of HPV (>400 ppm) with contact times of 24-32 h achieved approximately 2-6 log reduction of the phages in the presence of blood.

Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit

Background

Personal protective equipment (PPE) protects healthcare workers (HCWs) caring for patients with Ebola virus disease (EVD), and PPE doffing is a critical point for preventing viral self-contamination. We assessed contamination of skin, gloves, and scrubs after doffing Ebola-level PPE contaminated with surrogate viruses: bacteriophages MS2 and Φ6.

Methods

In a medical biocontainment unit, HCWs (n = 10) experienced in EVD care donned and doffed PPE following unit protocols that incorporate trained observer guidance and alcohol-based hand rub (ABHR). A mixture of Φ6 (enveloped), MS2 (nonenveloped), and fluorescent marker was applied to 4 PPE sites, approximating body fluid viral load (Φ6, 105; MS2, 106). They performed a patient care task, then doffed. Inner gloves, face, hands, and scrubs were sampled for virus, as were environmental sites with visible fluorescent marker.

Results

Among 10 HCWs there was no Φ6 transfer to inner gloves, hands, or face; 1 participant had Φ6 on scrubs at low levels (1.4 × 102). MS2 transfer (range, 101-106) was observed to scrubs (n = 2), hands (n = 1), and inner gloves (n = 7), where it was highest. Most (n = 8) had only 1 positive site. Environmental samples with visible fluorescent marker (n = 21) were negative.

Conclusions

Among experienced HCWs, structured, observed doffing using ABHR protected against hand contamination with enveloped virus. Nonenveloped virus was infrequent on hands and scrubs but common on inner gloves, suggesting that inner gloves, but not necessarily ABHR, protect against hand contamination. Optimizing doffing protocols to protect against all types of viruses may require reinforcing careful handling of scrubs and good glove/hand hygiene with effective agents.

Reactivity of Enveloped Virus Genome, Proteins, and Lipids with Free Chlorine and UV254

The survivability of viruses in natural and engineered systems impacts public health. Inactivation mechanisms in the environment have been described for nonenveloped viruses, but it remains unclear how the membrane layer of enveloped viruses influences inactivation. We applied molecular tools and high-resolution mass spectrometry to measure reactions in the genome, proteins, and lipids of enveloped Pseudomonas phage Phi6 during inactivation by free chlorine and UV₂₅₄. Free chlorine readily penetrated the lipid membrane to react with proteins in the nucleocapsid and polymerase complex. The most reactive Phi6 peptides were approximately 150 times more reactive with free chlorine than the most reactive peptides reported in nonenveloped coliphage MS2. The inactivation kinetics of Phi6 by UV₂₅₄ was comparable with those of nonenveloped adenovirus and coliphage MS2 and were driven by UV₂₅₄ reactions with viral genomes. Our research identifies molecular features of an enveloped virus that are susceptible to chemical oxidants or UV radiation. Finally, the framework developed in the manuscript for studying molecular reactivities of Phi6 can be adopted to investigate enveloped virus survivability under various environmental conditions.