Alcohol-based Hand Antiseptics Research Articles

Testing the Antibacterial Efficacy of Various Commercially Available Alcohol-based Hand Antiseptics and The World Health Organization Formulation II with the EN 1500 Standard

Testing the Antibacterial Efficacy of Various Commercially Available Alcohol-based Hand Antiseptics and The World Health Organization Formulation II with the EN 1500 Standard

ÁLCOOL EM GEL PARA ASSEPSIA DAS MÃOS – FORMULAÇÃO ADEQUADA E EFICIÊNCIA GARANTIDA EM MEIO À PANDEMIA DA COVID-19

ALCOHOL GEL FOR ASEPSY OF THE HANDS – PROPER FORMULATION AND GUARANTEED EFFICIENCY AMID THE PANDEMIC OF COVID-19. The use of hand antiseptics became widespread as a routine in the fight against COVID-19. In the market, the availability and purchase of substandard antiseptics create a permanent concern with safety, even after a pandemic. Therefore, the development of easy-to-deploy analytical methods for the quality control of alcohol-based hand antiseptics is needed. In this work, to determine the ethanol content in alcohol gel the use of refractometry and alcohol oxidation method by dichromate accompanied by UV-Vis spectroscopy were applied. The results indicated that 19 brands (out of the 70 evaluated) (27.1%) had levels of ethyl alcohol below the recommended level (68.25%), therefore, they are ineffective for hand asepsis. For the quality control of hand antiseptics, refractometry and the oxidation-reduction reaction are complementary analytical methodologies. As a quick, inexpensive screening method, refractometry provides a more suitable technique. However, the interference of emollients may affect the accuracy of the ethanol content determination. Therefore, applying the ethanol oxidation method coupled with electronic spectroscopy offers a simple and broadly accessible method to confirm the ethanol content in alcohol-based hand antiseptics. In addition to developing quality control protocols, is also described the 3.5-ton production of alcohol gel at the Federal University of Bahia.

Evaluation of antimicrobial persistent activity of alcohol-based hand antiseptics against bacterial contamination.

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.

ノンエンベロープウイルスに対する効果が改善されたアルコール手指消毒剤の手肌への影響

ノンエンベロープウイルスに対する効果が改善されたアルコール手指消毒剤の手肌への影響

Use of an Extended Controlled Application Technique Model to Evaluate Skin Compatibility of a New Alcohol Based Hand Rub

The use and acceptance of alcohol-based hand antiseptics in the U.S. has increased dramatically over the past decade. Foam products have been particularly well accepted, in large part due to the favorable perception of the aesthetics of foam by users. Although many currently marketed alcohol hand antiseptic foams represent an improvement in efficacy and protection of skin health versus traditional surfactant-based, rinse off cleansers, they are often not formulated with a view toward proactive improvement of skin barrier integrity.

Prospective, randomized in vivo comparison of a dual-active waterless antiseptic versus two alcohol-only waterless antiseptics for surgical hand antisepsis

This study aimed to demonstrate the value of adding an active level of a persistent antimicrobial agent, such as chlorhexidine gluconate (CHG), to an alcohol-based surgical hand antiseptic. The persistence of 3 waterless, brushless alcohol-based surgical hand antiseptics, including one product containing CHG, was compared. The test products were applied a total of 12 times over 5 days. Samples of aerobic bacteria were collected on days 1 and 5, on both days immediately after drying and 6 hours later, using the glove juice technique. Relative suppression of regrowth was compared using t tests. Using an equivalence margin of 20%, the alcohol plus CHG product showed noninferiority to the alcohol-only products at all sampling points and, based on significantly lower bacterial regrowth (P = .026), superior persistence to the alcohol-only products after 6 hours of glove wear. Given the primary objective of surgical hand antisepsis of reducing resident skin flora for the duration of the surgical procedure, using an alcohol-based hand antiseptic containing CHG appears to be the most appropriate choice for maintaining microbial levels as low as possible for as long as possible.

How effective are hand antiseptics for the postcontamination treatment of hands when used as recommended?

Alcohol-based hand antiseptics are often tested using 3 or 5 mL per application, but smaller volumes are likely to be applied in clinical practice. For that reason, we investigated the efficacy of 2 different volumes of 4 marketed hand rubs when applied to contaminated hands. Hands of 16 volunteers were contaminated with Serratia marcescens. Hand rub A (85% ethanol), hand rub B (60% ethanol), hand rub C (62% ethanol), and hand rub D (61% ethanol) were applied as blinded formulations, each in single applications of 2.4 or 3.6 mL. Hibiclens (4% chlorhexidine gluconate) served as the reference treatment. Each hand rub was rubbed into the hands until dry. Preintervention and postintervention bacterial populations were obtained by the glove juice method. Neutralization of residual activity was validated. A 2.4-mL aliquot of a hand rub product was sufficient to cover both hands in 96.9% of the subjects. Applied in that volume, hand rubs produced a log(10)-reduction in bacterial populations of 2.79 for hand rub A, 2.26 for hand rub C, 1.96 for hand rub D, and 1.90 for hand rub B. Application of 3.6 mL was significantly more effective for hand rubs B, C, and D. The reference treatment reduced test bacteria by 2.39 log(10). Analysis of variance revealed that both the type of hand rub and the applied volume had a highly significant influence on the mean log(10) reduction on artificially contaminated hands (P < .001). Hand rubs applied in amounts sufficient to cover both hands may not reduce the bacterial density by even 2 log(10) steps. Based on our findings, the general trend toward alcohol-based hand rubs should not overlook evidence of significant differences in efficacy that appear to be related primarily to a product's overall concentration of alcohol.

Investigation of the Effects of Consumer Market Lotions vs. Professional Grade Lotions in Combination with Alcohol Hand Antiseptics: A Comparative Study of Skin Health Effects and Glove Barrier Integrity

BACKGROUND/OBJECTIVES: The routine use of professional grade, hospital-approved lotions and crèmes has been shown to lead to improvement in overall skin health and better hand hygiene compliance, and, it may be argued, may actually help in reducing the potential for colonization of transient bacteria on the hands1. Many consumer lotions, while effective at maintaining skin health, contain high levels of petroleum-based emollients (e.g. petrolatum, mineral oil). These products can affect the barrier properties of gloves, which compromises infection control. Other consumer lotions, while not compromising glove effectiveness, and cosmetically appealing, simply are not effective enough to yield the moisturization required to maintain users' skin health under the frequent washing conditions experienced in health care settings. There is a significant concern of the use of non-approved lotions inhibiting the bactericidal properties of cationic antimicrobial hand soaps (e.g. Chlorhexidine Gluconate)2. Use of non-approved, consumer level lotions has also been linked to the possibility of infection due to contamination3. A comparison between the effects of using a professional grade lotion and 2 consumer lotions, both on glove integrity and on skin condition (SC), in conjunction with frequent use of alcohol-based hand antiseptics (AHAs) has been made.

Investigation of the Relative Performance of Various Alcohol-Based, Foam Hand Antiseptics: A Comparison of Antimicrobial Efficacy and Skin Compatibility

BACKGROUND/OBJECTIVES: The use and acceptance of alcohol-based hand antiseptics in the U.S. has increased dramatically in recent years. Foam products have been particularly well accepted, in large part due to the favorable perception of the aesthetics of foam by users. Although many currently marketed alcohol hand antiseptic foams represent an improvement in efficacy and protection of skin health versus traditional surfactant-based, rinse off cleansers, they are often not formulated with a view toward proactive improvement of skin barrier integrity. A new, actively moisturizing, alcohol-based aerosol skin antiseptic has been formulated, incorporating a multiple moisturizer base, with a view towards maintaining or enhancing antimicrobial efficacy while also actively promoting improved skin condition upon regular use.

Investigation of the benefits of incorporating sesquiterpenoids in an alcohol-based hand antiseptic: A comparative study of skin health effects on subjects with dry skin and antimicrobial efficacy

BACKGROUND/OBJECTIVES: Terpenes have been shown to enhance antimicrobial activity in both hard surface disinfectants and in food safety applications. Particular members of the sesquiterpenoid class of terpenes are also well recognized as having benefits to the skin. The use and acceptance of alcohol-based hand antiseptics in the United States has increased dramatically in recent years. Although many currently marketed alcohol hand antiseptics represent an improvement in efficacy and protection of skin health versus traditional surfactant-based cleansers, they are not formulated with a view toward proactive improvement of skin barrier integrity. A new, moisturizing alcohol-based skin antiseptic has been formulated incorporating sesquiterpenoids, with a view toward enhancing antimicrobial efficacy and also actively promoting improved skin condition upon regular use. METHODS: Antimicrobial efficacy was determined using the glove juice method in a surgical scrub clinical simulation test. Skin condition was evaluated via a 1-week controlled application test on the legs (LCAT) of 44 subjects with mild to moderately dry skin. The test product was evaluated along with four other commercial, alcohol-based hand antiseptics. A lotion was used as positive control and untreated areas as the negative control. Product was applied four times per day for 5 days. The condition of the skin was evaluated prior to treatment and again post treatment on day 5. Determination of skin condition was based on measurements of conductivity (indicative of moisturization), trans-epidermal water loss (TEWL) (indicative of skin barrier integrity), and visual assessment by an expert grader. RESULTS: Antimicrobial efficacy of the test product was significantly greater than the comparative products at the 0-hour time point on Day 1 of the clinical simulation test. Consistent efficacy was seen at the 0-hour time point on days 2 and 5. With respect to persistence, the test product showed increased kill at the 6-hour time point (versus 0 hour results) on days 2 and 5. The LCAT test results showed improvement in both moisturization and reduction in TEWL after the treatment period. CONCLUSIONS: The sesquiterpenoid containing test product shows superior or equivalent efficacy at all time points in the surgical scrub clinical simulation test. The test product also shows excellent skin compatibility, with improvement in moisturization and reduction in TEWL after 1 week's controlled use.

Comparison of Waterless Alcohol-Based Hand Antiseptics on Moisturization Efficacy in Subjects with Dry Skin

BACKGROUND: Waterless hand antiseptics frequently increase skin dryness due to their high alcohol content. This study evaluated three hand antiseptics containing moisturizers for their ability to increase moisturization in subjects with dry skin. METHODS: After a “wash out” period and equilibration in a controlled environment, 10 subjects with dry skin were studied. Ten 0.2 mL applications/site of three hand antiseptics and five applications/site of a lotion (positive control) were applied to the legs within 1 hour. One of the hand antiseptics was applied to a site on the hand in a similar manner. Untreated sites were designated as negative controls. NOVA readings for skin surface moisturization of each site were taken at baseline, as well as at 30 minutes and 1 hour after the last application. RESULTS: At the 30-minute evaluation on the legs, all three antiseptics produced a statistically significant increase in moisturization over baseline values (18%–64%, p<0.017); however, only one of the hand antiseptics demonstrated a significant improvement over the untreated site (p<0.01). At the 1-hour evaluation, all tested hand antiseptics increased moisturization on the legs over baseline (10%–14%; p<0.01); however, none of the hand antiseptics showed a significant increase (p>0.05) over the untreated site. On the hand, the hand antiseptic significantly increased moisturization over baseline by 18% (p=0.021) at 30 minutes and by 10% (p=0.029) at 1 hour. CONCLUSIONS: Instant hand antiseptics containing moisturizing ingredients help minimize the drying effects commonly seen from their use. There are quantifiable differences among these products in their ability to moisturize the skin at 30 minutes and 1 hour after application.

Comparison of Waterless Alcohol-Based Hand Antiseptics on Moisturization Efficacy in Subjects with Dry Skin

Comparison of Waterless Alcohol-Based Hand Antiseptics on Moisturization Efficacy in Subjects with Dry Skin

Evaluating the Effectiveness of Contact Isolation in Preventing Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infection

ISSUE: Most hospitals follow the Centers for Disease Control and Prevention (CDC) recommendation in the Isolation guideline to implement contact precautions (CP) for patients with resistant organisms. Although our hospital has reported increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA), there has been no associated increase in healthcare-acquired MRSA infections. Increasing MRSA prevalence rates coupled with low rates of healthcare-associated MRSA infection speak for an infection control program that works. There are a number of reasons for the success of the program. First, there has been consistent emphasis placed on hand hygiene in this hospital. Second, the use of alcohol-based hand antiseptics has been in place since their inception. And finally, all patient rooms are private rooms, with the exception of a handful of inpatient rehabilitation and psychiatric beds. Upon careful review of this history, and the recommendations made by CDC in their Isolation guideline, infection control practitioners (ICPs) at our hospital elected, as early as 1995, not to require CP for patients infected or colonized with MRSA, but instead to use standard precautions (SP). Recently, however, increasing pressure from medical staff and the community has prompted a change in practice, specifically to require CP for patients infected with MRSA. PROJECT: Implementation of CP for MRSA–infected or –colonized patients began with extensive inservice education for all healthcare workers. Over 70 inservices were conducted in this 250-bed acute care hospital. Inservices included a review of SP, hand hygiene, and proper procedures for implementing CP. After implementation, rates of healthcare-associated infections caused by MRSA in critical care patient populations were compared to rates in the same populations during 2001. RESULTS: There was no difference in the rates of healthcare-associated transmission of MRSA before and after initiating CP in this hospital setting. LESSONS LEARNED: In order to continue to be of value to healthcare facilities, ICPs need to administer infection control programs that are not only cost-effective but also science-based. Scarce healthcare dollars were wasted in our hospital on implementation of processes that made no difference in outcomes.

Adverse reactions associated with an alcohol-based hand antiseptic among nurses in a neonatal intensive care unit

Background: Alcohol-based hand antiseptics are strongly recommended in the 2002 Centers for Disease Control and Prevention's hand-hygiene guideline. In a study comparing 2 hand-hygiene regimes, an alcohol-based (61% ethyl) antiseptic and a detergent containing 2% chlorhexidine gluconate in 2 neonatal intensive care units, we noted adverse reactions associated with the alcohol-based antiseptic. Methods: A prospective study was conducted of the skin condition of 58 nurses using an alcohol-based product from March 2001 to January 2002. Adverse reactions to the alcohol-based product were noted and the Fisher exact test was used to determine factors associated with these reactions. Nurses with reactions to the alcohol product who were available to follow-up were patch tested to the product. Results: Of 58 (1.1/100 nursing mo) nurses, 7 were evaluated by occupational health services for dermatologic symptoms that varied from mild to severe after use of the alcohol product, but 4 of 7 have resumed use. Nurses who had adverse reactions develop had been employed on the study unit and in the nursing profession for significantly less time than those with no reactions (P =.037 and P =.002, respectively), and were significantly more likely to report a history of itchy, sore skin (P =.047). A positive patch-test result was noted in 3 of 4 nurses with a previous reaction to the product. Conclusion: This case series will alert users in the United States and elsewhere to the nature of reactions to alcohol products and how these reactions differ from reactions to traditional hand antiseptic products. (Am J Infect Control 2003;31:43-8.)

Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic

Objective: The objective of the study was to improve health care workers' compliance with hand hygiene after patient contact by use of an alcohol-based hand antiseptic. Design and Methods: Six commercially available alcohol-based hand antiseptics were evaluated. The one most pleasing to the evaluators' hands was selected for the study. Baseline handwashing rates were assessed on 2 medical wards. Alcohol dispensers were mounted by every door on the 2 wards. An educational campaign was conducted with 4 weekly visits to these floors to remind and reinstruct staff about the use of the alcohol dispensers and to address questions. After 2 months handwashing rates were reassessed. Setting: The study was set in a university hospital. Results: The baseline handwashing rate was 60% (76/126). Physicians were most compliant (83%), followed by nurses (60%), technologists (56%), and housekeepers (36%). Two months later overall hand hygiene rates had decreased to 52% (P = .26). Nurses were most compliant (67%), followed by technologists (57%), physicians (29%), and housekeepers (25%). Physician compliance was associated with compliance by attending physicians whose example was usually followed by all other physicians on rounds. Conclusions: A brief educational campaign and installation of dispensers containing a rapidly acting hand hygiene product near hospital rooms did not affect hand hygiene compliance. The behavior of attending physicians was predictive of handwashing rates for all others in the attending's retinue. Compliance with handwashing after half of all patient contacts was a result of perfect compliance by some and total noncompliance by others being observed. (AJIC Am J Infect Control 2000;28:273-6)