Abstract
IntroductionStandard in vitro and in vivo tests help demonstrate efficacy of hand hygiene products; however, there is no standard in vivo test method for viruses. We investigated the bactericidal and virucidal efficacy of povidone-iodine (PVP-I) 7.5% scalp and skin cleanser, chlorhexidine gluconate (CHG) 4% hand cleanser and the reference hand wash (soft soap) in 15 healthy volunteers following European Standard EN1499 (hygienic hand wash test method for bacteria), which was adapted for virucidal testing.MethodsSeparate test series were performed for bactericidal (Escherichia coli) and virucidal [murine norovirus (MNV)] testing. After pre-washing and artificial contamination of hands with test organisms, volunteers underwent testing with 3 and 5 mL of each product for contact times of 15, 30 and 60 s according to a Latin-square randomization. The number of test organisms released from fingertips into sampling fluids was assessed before and after hand washing and mean log10 reduction factor (RF) was calculated. RFs (test-reference) were compared using a Wilcoxon–Wilcox multiple comparisons test per EN1499; efficacy was concluded if p ≤ 0.01.ResultsPVP-I 7.5% and CHG 4% cleansers both passed EN1499 requirements against E. coli, with statistically significantly greater (p ≤ 0.01) mean log10 RFs compared with reference soft soap across all tests (PVP-I: 4.09–5.27; CHG: 4.12–5.22; soap: 2.75–3.11). The experimental design using EN1499 was applicable to testing with MNV as discriminatory and reproducible results were generated. Mean log10 RFs of MNV were statistically significantly greater for PVP-I (1.57–2.57) compared with soft soap (1.24–1.62), while mean log10 RFs with CHG (0.90–1.34) were lower than for soft soap across all tests.ConclusionPVP-I 7.5% cleanser showed superior efficacy against MNV compared to soft soap and CHG 4% cleanser, while both PVP-I and CHG were superior to soft soap against E. coli. The experimental set-up may be applicable to future testing for antiviral hand washes.FundingMundipharma Manufacturing Pte Ltd.Plain Language SummaryPlain language summary available for this article.
Highlights
Standard in vitro and in vivo tests help demonstrate efficacy of hand hygiene products; there is no standard in vivo test method for viruses
Hand hygiene tests were performed on the hands of healthy volunteers simulating practical use according to the methods described in European Standard EN1499:2013, which were adapted and used in an exploratory manner to assess the virucidal activity of the hand cleansers
The mean log10 reductions achieved with the test products PVPI and chlorhexidine gluconate (CHG) were statistically significantly greater (p B 0.01) than the reduction achieved with the reference soft soap for all product volumes and contact times (Table 1)
Summary
Standard in vitro and in vivo tests help demonstrate efficacy of hand hygiene products; there is no standard in vivo test method for viruses. Multiple hand hygiene agents are currently available including plain non-medicated soap, medicated hand washes with various active ingredients, and waterless or alcohol-based hand rubs. The use of alcohol-based hand rubs is convenient, the World Health Organization (WHO) recommends washing hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids [2]. In vitro suspension tests and human challenge trials help to demonstrate which hand hygiene agents are fit for purpose, but variations in methodology affect the measurement of efficacy [7]. Ensuring that hand rub and hand wash products pass standardized antimicrobial activity tests helps to better understand and interpret efficacy results [7]
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