Validation of a hand hygiene visual feedback system to improve compliance with drying time of alcohol-based hand rub in a neonatal intensive care unit: the Incubator Traffic Light system

BACKGROUND

Compliance with the recommended 30 s drying time of alcohol-based hand rub (ABHR) is often suboptimal. To increase hand hygiene compliance at a neonatal intensive care unit (NICU), we installed an Incubator Traffic Light (ITL) system which shows 'green light' to open incubator doors after the recommended drying time.

AIM

To measure the impact of this visual feedback system on NICU healthcare professionals' compliance with the recommended ABHR drying time.

METHODS

Ten traffic light systems were installed on incubators at a NICU, five of which provided visual feedback, and five, serving as a control group, did not provide visual feedback. During a two-month period, the systems measured drying time between the moment of dispensing ABHR and opening the incubator's doors. The drying times of the incubators were compared with and without feedback.

FINDINGS

Of the 6422 recorded hand hygiene events, 658 were valid for data analysis. Compliance with correct drying time reached 75% (N = 397/526) for incubators equipped with visual feedback versus 36% (N = 48/132; P < 0.0001) for incubators lacking this feature.

CONCLUSION

The ITL improves compliance with the recommended 30 s ABHR drying time in a NICU setting.

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.

Development and efficacy assessment of hand sanitizers and polylactic acid films incorporating caffeic acid and vanillin for enhanced antiviral properties against HCoV-229E

BACKGROUND

Although three years after the outbreak of SARS-CoV-2, the virus is still having a significant impact on human health and the global economy. Infection through respiratory droplets is the main transmission route, but the transmission of the virus by surface contact cannot be ignored. Hand sanitizers and antiviral films can be applied to control SARS-CoV-2, but sanitizers and films show drawbacks such as resistance of the virus against ethanol and environmental problems including the overuse of plastics. Therefore, this study suggested applying natural substrates to hand sanitizers and antiviral films made of biodegradable plastic (PLA). This approach is expected to provide advantages for the easy control of SARS-CoV-2 through the application of natural substances.

METHODS

Antiviral disinfectants and films were manufactured by adding caffeic acid and vanillin to ethanol, isopropyl alcohol, benzalkonium chloride, and PLA. Antiviral efficacies were evaluated with slightly modified international standard testing methods EN 14,476 and ISO 21,702.

RESULTS

In suspension, all the hand sanitizers evaluated in this study showed a reduction of more than 4 log within 2 min against HCoV-229E. After natural substances were added to the hand sanitizers, the time needed to reach the detection limit of the viral titer was shortened both in suspension and porcine skin. However, no difference in the time needed to reach the detection limit of the viral titer was observed in benzalkonium chloride. In the case of antiviral films, those made using both PLA and natural substances showed a 1 log reduction of HCoV-229E compared to the neat PLA film for all treatment groups. Furthermore, the influence of the organic load was evaluated according to the number of contacts of the antiviral products with porcine skin. Ten rubs on the skin resulted in slightly higher antiviral activity than 50 rubs.

CONCLUSION

This study revealed that caffeic acid and vanillin can be effectively used to control HCoV-229E for hand sanitizers and antiviral films. In addition, it is recommended to remove organic matter from the skin for maintaining the antiviral activity of hand sanitizer and antiviral film as the antiviral activity decreased as the organic load increased in this study.

Pediatric hand sanitizer exposures reported to United States poison centers, 2017-2021

INTRODUCTION

The COVID-19 pandemic increased demand for alcohol-based hand sanitizers. We aimed to describe the epidemiological trends in pediatric alcohol-based hand sanitizer cases reported to United States poison centers. We characterized clinically significant pediatric reports involving alcohol-based hand sanitizer products before and during the pandemic and methanol-containing hand sanitizers during the pandemic.

METHODS

We included all single-substance cases involving alcohol-based hand sanitizers reported to the National Poison Data System among children ≤ 19 years from 1 January 2017 to 31 December 2021, and methanol-containing hand sanitizers from 23 June 2020 to 31 December 2021. Multiple product exposures and non-human exposures were excluded. Clinically significant outcomes included moderate or major effects or death.

RESULTS

There were 95,718 alcohol-based hand sanitizer pediatric cases during the study period. Most (n = 89,521; 94%) were unintentional, occurred by ingestion (n = 89,879; 93.9%), occurred at home, and were managed at the exposure site (n = 89,774; 93.8%). Common symptoms were vomiting (n = 2,969; 3.1%), coughing (n = 1,102; 1.2%), ocular irritation (n = 1,244; 1.3%), and drowsiness (n = 981; 1.0%). Most children (n = 3,937; 66.2%) managed at a health care facility were treated and released; a minority were admitted (n = 527; 9.0%). Few children (n = 81; 1.4%) were admitted to the intensive care unit. The prevalence of clinically significant cases increased in 2020 and 2021, compared to 2017. Population-adjusted rates, by state, of alcohol-based hand sanitizer cases ranged from 280 to 2,700 per million children. Of the 540 reported cases involving methanol-containing hand sanitizers, the majority (n = 255) occurred in July 2020. Thirteen cases (2.4%) had clinically significant outcomes. The prevalence of clinically significant cases remained similar in 2020 and 2021 and exhibited lower prevalence compared to alcohol-based products. Population-adjusted rates, by state, ranged from fewer than 0.9 to 40 per million children.

CONCLUSIONS

Clinically significant pediatric cases involving alcohol-based hand sanitizers increased during the pandemic and remained elevated in 2021. Cases involving methanol-containing products were less frequent. Our findings may inform heightened product quality control and regulatory oversight.

Public awareness of preventive measures against COVID-19: an infodemiology study

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in global awareness of relevant public health preventive measures. This awareness can be explored using online search trends from major search engines, such as Google Trends. We investigated the relationship between public awareness of preventative measures and progression of the COVID-19 pandemic.

METHODS

Search data for five queries ('mask', 'hand washing', 'social distancing', 'hand sanitizer', and 'disinfectant') were extracted from Google Trends in the form of relative search volume (RSV). Global incidence data for COVID-19 were obtained from 1 January to 30 June 2020. These data were analysed and illustrated using a global temporal RSV trend diagram, a geographical RSV distribution chart, scatter plots comparing geographical RSV with average number of daily cases, and heat maps comparing temporal trends of RSV with average number of daily cases.

RESULTS

Global temporal trends revealed multiple increases in RSV, associated with specific COVID-19-related news events. The geographical distribution showed top regions of interest for various preventive measures. For the queries 'mask', 'hand washing', 'hand sanitizer', and 'disinfectant', heat maps demonstrated patterns of early RSV peaks in regions with lower average number of daily cases, when the temporal element was incorporated into the analysis.

CONCLUSION

Early public awareness of multiple preventive measures was observed in regions with lower average number of daily cases. Our findings indicate optimal public health communication regarding masks, hand washing, hand sanitiser, and disinfectant in the general population during early stages of the COVID-19 pandemic. Early public awareness may facilitate future disease control efforts by public health authorities.

Hidden threat lurking in extensive hand hygiene during the Covid-19 pandemic: investigation of sensitizing molecules in gel products by hyphenated chromatography techniques

During the Covid-19 pandemic, health agencies worldwide have recommended frequent handwashing and sanitizing. A variety of hand gel products were made available on the market, often with fragrances added to curtail the strong smell of alcohol. Commonly used Citrus fragrances contain volatile aroma constituents and non-volatile oxygen heterocyclic compounds (OHCs), consisting mostly of polymethoxyflavones, coumarins, and furocoumarins. The latter have long been investigated for their phototoxic properties, and their safety as cosmetic product ingredients has been debated recurrently. To this concern, twelve commercial Citrus-scented products were investigated in this study. An extraction method was optimized for thirty-seven OHC compounds, obtaining absolute mean recovery values in the 73.5-116% range with only few milliliters of solvent consumption. Analysis by ultra-high-pressure liquid chromatography with tandem mass spectrometry detection evidenced that three samples did not conform to the labeling requirements for fragrance allergens (coumarin) laid down by the European Union Regulation on Cosmetic Products. The total furocoumarin (FC) content of the samples investigated was in the 0.003-3.7ppm range, with some noteworthy exceptions. Specifically, in two samples, the total FCs were quantified as 89 and 219 ppm, thus exceeding the safe limits recommended up to a factor of 15. Finally, the consistency of the volatile fingerprint attained by gas chromatography allowed drawing conclusions on the authenticity of the Citrus fragrances labeled, and several products did not conform to the information reported on the label concerning the presence of essential oils. Besides the issue of product authenticity, analytical tools and regulatory actions for widespread testing of hand hygiene products are urgent, to protect consumers' health and safety.

Advanced sanitation products infused with silver nanoparticles for viral protection and their ecological and environmental consequences

The outbreak of coronavirus ailments (COVID-19) in 2019 resulted in public health crisis leading to global pandemonium. In response to the high prevalence of disease transmission, governments all around the globe implemented emergency measures in various routes (e.g., social distancing, personal hygiene, and disinfection of public/private places) to curb/contain COVID-19 infections. The social media infodemic, released as uncensored publishing and/or views/recommendations, also triggered large-scale behavior changes such as the overuse of advanced sanitation products (ASPs) containing nanomaterials. The majority of these ASPs contain silver nanoparticles (AgNPs) as an active ingredient to enhance their antimicrobial potential. Ecotoxicological concerns such as the transformation and degradation of these AgNP-infused products in terrestrial or aquatic environments are under the jurisdiction of the EPA. However, they are not considered in the FDA approval process. In light of excessive consumption of ASPs, it is time to consider their ecotoxicological screening prior to market approval jointly by the FDA and EPA, along with the implementation of post-market surveillance strategies. At the same time, efforts should be put into running awareness programs to prevent the overuse of ASPs.

Assessment of compliance to packaging and labeling regulatory requirements of locally manufactured alcohol-based hand sanitizers marketed in Addis Ababa, Ethiopia

Background

Following the emergence of the global Coronavirus Disease-2019 (COVID-19) pandemic, alcohol-based hand sanitizers (ABHS) have been extensively used as one of the effective methods of preventing its transmission. The products are dispensed over the counter and used by the general population. Growing concerns have been reported, however, regarding the quality, efficacy and compliance to regulatory requirements calling for objective evidence that can facilitate proactive regulatory measures.

Objectives

The study aimed at assessing the level of compliance to packaging and labeling regulatory requirements of selected locally manufactured ABHS products marketed in Addis Ababa, Ethiopia.

Methods

A cross-sectional study design was employed to randomly collect 25 locally manufactured ABHS products from retail outlets located in Addis Ababa. The manufacturers were grouped under four categories considering their experience in manufacturing, resources and technical capacities. The collected samples were evaluated for compliance to packaging and labeling information regulatory requirements and the results subjected to descriptive analysis.

Results

Majority of the products were found to meet most of the packaging, general product description and manufacturer-related information requirements. However, concerning gaps were observed in storage, precaution and warning-related labeling information requirements. The overall compliance of the selected products (to a total of 29 requirements under 5 categories) was 56.9%. The highest level of compliance was for general product information requirements (80.2%) followed by packaging and manufacturer-related requirements accounting for 76.8% and 75.0%, respectively. Low level of compliance was observed for storage condition and precautions (10.2% and 42.4%, respectively). Better overall compliance to packaging and labeling requirements (62.9%) were observed by large pharmaceutical and cosmetics manufacturers, while the lowest compliance level was recorded for medium level pharmaceuticals and cosmetics manufacturers.

Conclusions

Even though most of the selected products were able to comply with the majority of packaging, product description and manufacturer-related requirements, gaps were observed in essential labeling information requirements. Considering the extensive use of ABHS products among diverse population groups and the potential risks associated with inappropriate use of the products, improving regulatory law enforcement practices, strengthening continuing education of manufacturing personnel and raising public awareness is very timely.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00456-6.

Occurrence of and dermal exposure to benzene, toluene and styrene found in hand sanitizers from the United States

Human exposure to carcinogenic volatile organic compounds (VOCs), such as benzene, from hand sanitizers is a topic of current concern. In light of the heavy use of hand sanitizers during the COVID-19 pandemic, determination of exposure to toxicants present in these products deserves attention. The US Food and Drug Administration (FDA) had set an interim limit for benzene in alcohol-based hand sanitizers at 2000 parts-per-billion (ppb). We determined the concentrations of and exposure to three VOCs namely, benzene, toluene and styrene, in 200 hand sanitizers using high-resolution gas chromatography coupled with high-resolution mass spectrometry (HRGC-HRMS). Benzene, toluene and styrene were found in 31%, 25% and 32%, respectively, of the samples analyzed at mean concentrations of 395 (range: 0.181-22,300), 164 (range: 0.074-20,700) and 61.3 ng/g (range: 0.082-4200 ng/g), respectively. Benzene was found at concentrations > 2000 ng/g (above the FDA interim limit) in 5% of the samples, representing 9 brands. The mean potential dermal exposure doses (DEDs) to benzene (children/teenagers: 34.6; adults: 24.7 ng/kg-bw/d) were higher than those for toluene (children/teenagers: 14.4; adults: 10.3 ng/kg-bw/d) and styrene (children/teenagers: 5.37; adults: 3.83 ng/kg-bw/d) in the 200 hand sanitizers analyzed. The estimated cancer risk from exposure to benzene in children/teenagers and adults from hand sanitizer use (at an estimated usage rate of 5 g/day) was greater than the one-in-a-million risk benchmark (1.0 × 10^-6) for 10% and 9% of the samples, respectively. To the best of our knowledge, this is the first study to determine both the concentrations of and exposure risks to benzene, toluene and styrene present in hand sanitizers.

Significant variations of dangerous exposures during COVID-19 pandemic in Italy: a possible association with the containment measures implemented to reduce the virus transmission

BACKGROUND

In response to the COVID-19 health emergency, mass media widely spread guidelines to stop the virus transmission, leading to an excessive and unaware use of detergents and disinfectants. In Italy and in other countries this tendency caused a significant increase of exposures to these products in 2020. Evaluating data collected by the Italian Pavia Poison Centre (PPC), this study intends to examine the relationship between the COVID-19 lockdown and the variations of exposures to specific product categories possibly associated to the containment measures implemented. Simultaneously, this work shows the effectiveness of the European Product Categorisation System (EuPCS) in surveillance activities of dangerous chemicals.

METHODS

Exposure cases managed by the PPC during March-May 2020 (lockdown) and during the same months of 2017-2018-2019 were compared. Differences in categorical variables were tested with the Chi-square test. The level of significance was set at Alpha = .05. The study included all EuPCS groups but specifically focused on cleaners, detergents, biocides and cosmetics.

RESULTS

During the lockdown, calls from private citizens showed a highly significant increase (+ 11.5%, p < .001) and occupational exposures decreased (- 11.7%, p = .011). Among Cleaners, exposures to Bleaches slightly increased while Drain cleaning products went through a significant reduction (- 13.9%, p = .035). A highly significant increase of exposures to Disinfectants was observed (+ 7.7%, p = .007), particularly to those for surfaces (+ 6.8%, p = .039). Regarding Cosmetics, both handwashing soaps and gel products significantly increased (respectively: + 25.0, p = .016 and + 9.7%, p = .028). Among children 1-5 years, the statistical significance is reached with exposures to Dishwashing detergents (+ 13.1%, p = .032), handwashing soaps (+ 28.6%, p = .014) and handwashing gel products (+ 16.8%, p = .010). Contrarily, Liquid Laundry Detergent Capsules decreased in a highly significant manner (- 25%; p = .001). The general severity of exposures showed a highly significant decrease (Moderate: - 10.1%, p = .0002).

CONCLUSIONS

This study investigated the relationship between the COVID-19 lockdown and the variations of exposures to some product categories related to the containment measures. The results obtained support any action to be taken by Competent Authorities to implement measures for a safer use of cleaners/disinfectants. This paper shows the benefit in applying the EuPCS to categorize products according to their intended use, though an extension of this system to products not covered by CLP Regulation may be a further advantage.

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.

Rheological properties of cellulosic thickeners in hydro-alcoholic media: The science behind the formulation of hand sanitizer gels

Cellulosic-based thickeners are commonly used in the preparation of hydro-alcoholic hand sanitisers. Yet, little is known about the behaviour of these polymeric dispersions in hydro-alcoholic mixtures. Here, we studied the dispersion ability and rheology of hydroxyethyl cellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose and sodium carboxymethyl cellulose in water-ethanol mixtures. Hydroxypropyl cellulose formed transparent dispersions across the entire range of ethanol concentrations, while a critical ethanol concentration (CEC), above which dispersions became turbid, was found for all the other polymers. At and below the CEC, all the rheological parameters followed a bell-like shape profile as a function of ethanol concentration. Moreover, the molecular weight and degree of substitution of the polymers influenced the rheological properties. The CEC and rheological behaviour of the dispersions were both dependent on the ethanol/polymer and water/polymer interactions. As hand disinfectants should contain 60-95% ethanol, polymers of higher CEC, such as hydroxypropyl cellulose and hydroxypropyl methylcellulose, are recommended.

[Basic hygiene measures in the delivery room-also during a pandemic]

BACKGROUND

The German Infection Protection Act calls for effective measures to be implemented in clinics to avoid nosocomial infections. The corona pandemic once again demonstrates the importance of adequate hygiene measures in avoiding infections.

OBJECTIVES

Compilation of common basic hygiene measures for clinical obstetrics.

METHODS

Discussion of relevant German guidelines relating to the work in the delivery room. Development of recommendations for hygienically correct childbirth care.

RESULTS

Recommendations for surface disinfection refer to predefined risk-categories in the delivery unit. In cooperation with hospital hygiene, the frequency of cleaning and disinfection must be specified in the facility's internal hygiene plans. To avoid a selection of disinfectant-tolerant germs, it is essential to observe the spectrum of activity and exposure time of each disinfectant. Hand disinfection is the single most effective measure to prevent nosocomial infections. The challenge here is the consistent implementation of the generally known indications for hand disinfection in everyday life. For the hygienically correct management of water birth and maintenance of the bathtub, standards should be developed in every delivery room, the effectiveness of which must be regularly monitored. In a pandemic, there are additional hygiene rules, tailored to the particular pathogen.

CONCLUSIONS

Although there is no lack of knowledge in the form of guidelines and recommendations, the implementation of basic hygiene measures in everyday life in the delivery room requires perseverance and commitment.

COVID-19: Eco-friendly hand hygiene for human and environmental safety

The Coronavirus disease-2019 (COVID-19) outbreak is caused by a highly pathogenic novel coronavirus (SARS-CoV-2). To date, there is no prescribed medicine for COVID-19. Frequent handwashing with soap and the use of alcohol-based hand sanitizers is recommended by WHO for hand hygiene and to prevent the spread of COVID-19. However, there are safety concerns associated with the use of soaps and alcohol-based hand sanitizers. Therefore, the review aims to highlight the health and environmental concerns associated with the frequent use of soaps/detergents and alcohol-based hand sanitizers amid COVID-19. The potential of some of the natural detergents and sanitizing agents as eco-friendly alternatives to petrochemical-based soaps and alcohol-based hand rubs for hand hygiene are discussed. The market of soaps and hand sanitizers is expected to grow in the coming years and therefore, future research should be directed to develop eco-friendly soaps and hand sanitizers for human and environmental safety.

A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation

Background

Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID.

Methods

A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study.

Results

Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention.

Conclusions

ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-05895-1.

COVID-19 and frequent use of hand sanitizers; human health and environmental hazards by exposure pathways

Till date no medication or vaccine is available to cope with the COVID-19 infection and infection rate is increasing drastically across the globe. Only preventive measures and healthy life style with efficient immune system have been suggested by WHO to fight and stay safe from COVID-19. WHO recommended alcohol based hand sanitizers for frequent hand hygiene, which are mainly made up from ethanol, isopropyl alcohols, hydrogen peroxides in different combinations. These preparations may become toxic to human health and environment when misused. These chemicals have known toxic and hazardous impact on environment when released by evaporation. In early five months of 2020, American Association of Poison Control Center reported 9504 alcoholic hand sanitizer exposure cases in children under the age of 12 years and recognized that even a small amount of alcohol can cause alcohol poisoning in children that is responsible for confusion, vomiting and drowsiness, and in severe cases, respiratory arrest and death. Furthermore, frequent usage of said hand sanitizers has reported increased chance of antimicrobial resistance and chance of other viral diseases. Current review is designed with main objective to highlight the toxic and serious health risks to human health and environment by frequent using hand hygiene products with alcohols based formulations.

Antiviral efficacy of personal care formulations against Severe Acute Respiratory Syndrome Coronavirus 2

Background

Non-therapeutic interventions such as practicing good hand hygiene continue to be the mainstay of protection from SARS-CoV-2 and other emerging respiratory viruses.

Methods

We have evaluated a range of commercially available personal care products including soaps, handwash liquids and alcohol-based hand sanitizers for antiviral efficacy against a clinical isolate of SARS-CoV-2 using internationally accepted standardized protocols at user-relevant contact time-points and product dilutions.

Results

All the tested products resulted in 3 to 4 log reduction of SARS-CoV-2 titer.

Conclusion

Our data re-affirms recommendations by global public health authorities that proper hand hygiene can reduce SARS-CoV-2 viral load significantly which should likely limit spread of the contagion.

•

Personal care formulations from Unilever showed efficacy against SARS-CoV-2.

•

All tests were conducted at user relevant contact duration and product dilution.

•

Soap bars with varying TFM content resulted in ≥ 3 log reduction.

•

Liquid cleansers with varying surfactant levels resulted in ≥ 3 log reduction.

•

Sanitizers with variable % of alcohol resulted in ≥ 3 to 4 log reduction.

Pandemic products and volatile chemical emissions

The recent pandemic (COVID-19) has seen a sweeping and surging use of products intended to clean and disinfect, such as air sprays, hand sanitizers, and surface cleaners, many of which contain fragrance. However, exposure to fragranced cleaning products has been associated with adverse effects on human health. Products can emit a range of volatile chemicals, including some classified as hazardous, but relatively few ingredients are disclosed to the public. Thus, relatively little is known about the specific emissions from these products. This study investigates the volatile organic compounds (VOCs) emitted from "pandemic products" that are being used frequently and extensively in society. In addition, among these emissions, this study identifies potentially hazardous compounds, compares so-called green and regular versions of products, and examines whether ingredients are disclosed to the public. Using gas chromatography/mass spectrometry, 26 commonly used pandemic products, including 13 regular and 13 so-called green versions, were analyzed for their volatile emissions. Product types included hand sanitizers, air disinfectants, multipurpose cleaners, and handwashing soap. All products were fragranced. The analyses found the products collectively emitted 399 VOCs with 127 VOCs classified as potentially hazardous. All products emitted potentially hazardous compounds. Comparing regular products and green products, no significant difference was found in the emissions of the most prevalent compounds. Further, among the 399 compounds emitted, only 4% of all VOCs and 11% of potentially hazardous VOCs were disclosed on any product label or safety data sheet. This study reveals that pandemic products can generate volatile emissions that could pose risks to health, that could be unrecognized, and that could be reduced, such as by using fragrance-free versions of products.

Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial

Background

Hands are the most common medium for initiation and spread of infection in clinics. Hand hygiene is the simplest and most economic method for reducing the healthcare-associated infections (HCAIs).

Aim

The aim of the present study was to compare the efficacy of hand sanitizer, liquid soap, and their combination for reducing the microbial colonies on hands.

Materials and methods

The study was a single-blinded randomized controlled trial executed in a dental college on 90 participants, which were randomly assigned into three intervention groups of 30 each. The participants were instructed to contaminate their hands followed by a hand hygiene protocol for the liquid hand-wash group, the alcohol-based hand sanitizer (ABHS) group, and the combination group according to WHO guidelines. The swabs were collected pre- and post-intervention and mean colony-forming units were determined for each group.

Results

Median percentage reduction was highest for the combination group (100%), followed by the ABHS group (94.29%) and lowest for the liquid soap (92.31%). This difference in the amount of colony-forming units (CFU) among all the groups was nonsignificant (p = 0.114).

Conclusion

The results of the study show that there was no significant difference in hand disinfection potential among hand sanitizer, liquid soap, or their combination. All the three interventions were equally effective with the reduction of total bacterial contamination from participants' hands.

How to cite this article

Khairnar MR, Anitha G, Dalvi TM, Kalghatgi S, Datar UV, Wadgave U, et al. Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial. Indian J Crit Care Med 2020;24(5):336-339.

Why language matters: a tour through hand hygiene literature

Background

Hand hygiene has evolved over the last decades and many terminologies emerged. We aimed to analyse the evolution in the frequency of utilization of key hand hygiene terms in the literature along the years.

Methods

We identified keywords and Medical Subject Headings (MeSH) used in MEDLINE® indexation related to hand hygiene by searching international guidelines and the MeSH database. We performed a MEDLINE® search combining the selected keywords and MeSH and analysed the number of publications retrieved yearly.

Results

The literature search yielded 9019 publications when all hand hygiene related search terms were combined, between 1921 and November 2016. The total number of publications per year increased from a median of 4 (IQR 3, 6) in the 1950’s to 554 (IQR 478, 583) between 2011 and 2015. The most frequently used keywords are hand disinfection, hand hygiene, hand washing, handrub, hand sanitizer and alcohol-based hand rub (ABHR). Until the 1990s, hand disinfection and hand washing were the most frequently used terms. Whilst the last decade has seen a remarkable increase in publications mentioning hand disinfection and hand hygiene and for the first time handrub, hand sanitizers and ABHR were introduced in the literature. Hand disinfection, hand hygiene and hand sanitizers are the main MeSH used by MEDLINE®. Since 2013 hand hygiene is the most frequently used MeSH and keyword.

Conclusions

The change seen in literature in the last two decades, from hand washing and hand disinfection to hand hygiene, most probably reflect the paradigm shift favouring use of ABHR over soap and water promoted by international guidelines in the early 2000s.

Alcohol handrubbing and chlorhexidine handwashing are equally effective in removing methicillin-resistant Staphylococcus aureus from health care workers' hands: A randomized controlled trial

We conducted a randomized controlled trial in a tertiary-care hospital in a real-time setting to evaluate the effectiveness of 3 hand hygiene protocols in reducing hand carriage of methicillin-resistant and methicillin-sensitive Staphylococcus aureus among health care workers. Our study shows that use of alcohol handrub, either covering all hand surfaces in no particular order or using the 7-step technique, and chlorhexidine handwashing were equally effective in removing hand carriage of these pathogens.

Safety assessment for ethanol-based topical antiseptic use by health care workers: Evaluation of developmental toxicity potential

Ethanol-based topical antiseptic hand rubs, commonly referred to as alcohol-based hand sanitizers (ABHS), are routinely used as the standard of care to reduce the presence of viable bacteria on the skin and are an important element of infection control procedures in the healthcare industry. There are no reported indications of safety concerns associated with the use of these products in the workplace. However, the prevalence of such alcohol-based products in healthcare facilities and safety questions raised by the U.S. FDA led us to assess the potential for developmental toxicity under relevant product-use scenarios. Estimates from a physiologically based pharmacokinetic modeling approach suggest that occupational use of alcohol-based topical antiseptics in the healthcare industry can generate low, detectable concentrations of ethanol in blood. This unintended systemic dose probably reflects contributions from both dermal absorption and inhalation of volatilized product. The resulting internal dose is low, even under hypothetical, worst case intensive use assumptions. A significant margin of exposure (MOE) exists compared to demonstrated effect levels for developmental toxicity under worst case use scenarios, and the MOE is even more significant for typical anticipated occupational use patterns. The estimated internal doses of ethanol from topical application of alcohol-based hand sanitizers are also in the range of those associated with consumption of non-alcoholic beverages (i.e., non-alcoholic beer, flavored water, and orange juice), which are considered safe for consumers. Additionally, the estimated internal doses associated with expected exposure scenarios are below or in the range of the expected internal doses associated with the current occupational exposure limit for ethanol set by the Occupational Safety and Health Administration. These results support the conclusion that there is no significant risk of developmental or reproductive toxicity from repeated occupational exposures and high frequency use of ABHSs or surgical scrubs. Overall, the data support the conclusion that alcohol-based hand sanitizer products are safe for their intended use in hand hygiene as a critical infection prevention strategy in healthcare settings.