World Health Organization Formulation 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

Rapid Preparation of Hand Sanitizer Using WHO Formulation in Hospital Settings during Restricted Supply Due to COVID-19 Pandemic

Good hand hygiene practices include cleaning of hands either by handwash or by hand rub In healthcare settings, it is not easy to wash hands with soap after seeing each patient and is time-consuming as doctors are already working overtime Hence, in hospital settings, it is also recommended to use alcohol-based hand sanitizers that can rapidly kill microorganisms, which spread various contagious diseases Amidst the COVID-19 outbreak, the demand for essential commodities such as hand sanitizer, masks, etc , increased and hampered the hospital supplies To address the shortage and limited supply of hand sanitizers to the various medical and paramedical departments of a tertiary hospital, the Department of Community Medicine and School of Public Health in coordination with the Pharmacology and Medical Microbiology Department prepared hands sanitizers following the World Health Organization (WHO) guidelines The paper discusses the procedure that was followed for the preparation of hand sanitizer to meet the institutional demand and motivate others in similar settings to address the issue of restricted supply during the COVID-19 pandemic

Analytical examination of alcohol-based hand disinfectants in our country and evaluation with respect to COVID-19 pandemic

Objectives: The use of alcohol-based hand disinfectants (ABHD) is recommended in the COVID-19 pandemic. This study, it was aimed to analyze the content of ABEDs in our country and to discuss the findings in the light of literature. Materials and Methods: ABHDs in our country were searched on the Google search engine. Content information of the commercial product was saved. Data were analyzed under 5 headings: according to the alcohol ratio, the presence of ethyl and/or isopropyl alcohol, the presence of other disinfectants, the presence of the moisturizer, and the formulation recommended according to the World Health Organization (WHO). Results: The most frequently observed alcohol ratios were as follows: 70%, 75%, 65%, and 80%. 21% of the products have only ethanol, 15% have only isopropyl alcohol, 34% have ethanol and isopropyl alcohol. Hydrogen peroxide was observed in 6.5% of the products. 44% of the products had glycerin, 10% had glycerin and lanolin. The formulation suggested by WHO was exactly observed in one product. Conclusion: Sars-CoV-2 virus can be inactivated by ethanol (> 75%) and isopropanol (> 70%). One of the WHO formulations contain 80% ethanol and the other 75% isopropanol. The alcohol ratio was 70% and above in more than half of ABHDs in our country. These were ethyl and/or isopropyl alcohol. Only one product complied with the WHO formulation. As a result, the most important step for hand hygiene in the COVID-19 pandemic should be the selection of ABHD with the appropriate formulation. © 2021 Ankara Yildirim Beyazit University.

Corrosion Resistance of Aluminum Beer Cans Containing Hand Sanitizer

The COVID-19 crisis and ensuing supply chain disruptions prompted many breweries and distilleries to repurpose their facilities for the production of hand sanitizer, with the vast majority following the World Health Organization formulation (80% v/v ethanol, 1.45% v/v glycerol and 0.125% v/v hydrogen peroxide). The long term shift from bottling to canning among craft brewers left canning as the sole scalable option for many facilities to package hand sanitizer. With essential services desperate for hand sanitizer to help protect their staff, patients, and clients, many breweries moved to package these products in cans despite warnings that they are not designed to hold solutions containing high ethanol concentrations or strong oxidizers. The present study explores the resistance of ubiquitous can liners, WB Modified Epoxy and BPANI Gen 2, to WHO formulated hand sanitizer. Shelf life observations and microscopic visualization show the WB Modified Epoxy liner withstands hand sanitizer with little observable disruption at room temperature, while BPANI Gen 2 liners permit package failure and liquid leakage within 30 days. Incubation at 37 °C accelerated the rate of failure sixfold in BPANI Gen 2 lined cans versus room temperature incubation, providing a basis by which to expect an approximately 72 day shelf life for WB Modified Epoxy lined cans. Because of the inherent risk to consumers presented by these data and despite lack of clear guidance from regulatory agencies, manufacturers should strive to cease packaging hand sanitizer in cans and instead find supplies of inert non-beverage containers.

Evaluation of World Health Organization–Recommended Hand Hygiene Formulations

As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.

Production and optimization of hand disinfection solution based on the World Health Organization formulation: Short Communication

Hand hygiene is the most effective, simplest, and least expensive way to prevent the spread of hospital infections. Hand hygiene needs an ingredient that shows effectiveness in reducing microbial load in a way; alcohol-based hand rubs have more effective, fast and long-lasting disinfection than other antiseptics. The aim of this study was to prepare and optimization of an alcohol-based hand rub solution recommended by World Health Organization (WHO) to reduce expenses in sanction situations and also enhance the satisfaction and tolerability of the product. Key Words: Alcohol-Based Hand Rub; Disinfection; Optimization; Production; World Health Organization

Production and optimization of hand disinfection solution based on the World Health Organization formulation: a short article

Hand hygiene is the most effective, simplest, and least expensive way to prevent the spread of hospital infections. Hand hygiene needs an ingredient that shows effectiveness in reducing microbial load in a way; alcohol-based hand rubs have more effective, fast and long-lasting disinfection than other antiseptics. The aim of this study was to prepare and optimization of an alcoholbased hand rub solution recommended by world health organization to reduce expenses in sanction situations and also enhance the satisfaction and tolerability of the product. Key Words: Alcohol-Based Hand Rub; Disinfection; Optimization; Production; World Health Organization

Improvement of the Efficacy an WHO Alcohol-based Hand Rub Formulation by Reducing Isopropanol Content and Associating Syzygium aromarticum and Piper nigrum Essential Oils

Aim: This work was carried out in order to reduce the isopropanol contain of a World Health Organization (WHO) basic alcohol based hand rub (ABHR) formulation by substituting part of it with ethanol and essential oils.
 Study Design: A quasi-experimental design was used, based on WHO basic formulation modification, antimicrobial assessment followed by a panel test and challenge test of the best formulation.
 Place and Duration of the Study: The study was carried out in different laboratory of the University of Yaoundé 1 during March 2017 to July 2018.
 Methodology: This study was performed by producing different formulations nested from the WHO basic formulation and testing their antimicrobial capacity on selected strains based on the microbial percentage reduction. Following this, the best formulation was compared to two commercial products trough a panel test and later challenged with selected organism (Staphylococcus aureus SR196, Salmonella Typhi 15SA, Escherichia coli ATTC25922 and Pseudomonas aeruginosa PA01) inoculated in the product after different storage periods for one year and the antimicrobial stability assessed on the same strain for the same length of conservation.
 Results: The partial substitution of isopropanol with ethanol and Piper nigrum and Syzygium aromaticum essential oils proved to possess more antimicrobial properties than the original WHO formulation. The best formulation caused a 6 Log cells/ml reduction of the initial population compared to the 4 Log cells/ml of the WHO formulation. The product also proved to maintain its activity for one year and to be able to deactivate possible contaminations by Salmonella Typhi 15SA, Staphylococcus aureus NCTC10652, Escherichia coli ATCC25922, Pseudomonas aeruginosa PA01.
 Conclusion: The present work is a contribution to the improvement of ABHRs and could permit the reduction of hand hygiene associated infections in industries and health care facilities.

Infection control knowledge, attitudes, and practices among healthcare workers in Addis Ababa, Ethiopia.

To better understand hospital infection control practices in Ethiopia. A cross-sectional evaluation of healthcare worker (HCW) knowledge, attitudes, and practices about hand hygiene and tuberculosis (TB) infection control measures. An anonymous 76-item questionnaire was administered to HCWs at 2 university hospitals in Addis Ababa, Ethiopia. Knowledge items were scored as correct/incorrect. Attitude and practice items were assessed using a Likert scale. In total, 261 surveys were completed by physicians (51%) and nurses (49%). Fifty-one percent of respondents were male; mean age was 30 years. While hand hygiene knowledge was fair, self-reported practice was suboptimal. Physicians reported performing hand hygiene 7% and 48% before and after patient contact, respectively. Barriers for performing hand hygiene included lack of hand hygiene agents (77%), sinks (30%), and proper training (50%) as well as irritation and dryness (67%) caused by hand sanitizer made in accordance with the World Health Organization formulation. TB infection control knowledge was excellent (more than 90% correct). Most HCWs felt that they were at high risk for occupational acquisition of TB (71%) and that proper TB infection control can prevent nosocomial transmission (92%). Only 12% of HCWs regularly wore a mask when caring for TB patients. Only 8% of HCWs reported that masks were regularly available, and 76% cited a lack of infrastructure to isolate suspected/known TB patients. Training HCWs about the importance and proper practice of hand hygiene along with improving hand sanitizer options may improve patient safety. Additionally, enhanced infrastructure is needed to improve TB infection control practices and allay HCW concerns about acquiring TB in the hospital.

Local production of WHO-recommended alcohol-based handrubs: feasibility, advantages, barriers and costs.

Reduction of health-care-associated infections in low- and middle-income countries is hampered by inadequate supplies of soap and water and the lack or high cost of alcohol-based handrubs (ABHs). In 2005, the World Health Organization (WHO) developed and tested two formulations for ABHs that were suitable for production in health-care facilities. In 2011, the feasibility, advantages and costs of the local production of the two formulations - and the barriers to such production - were evaluated in an online survey. The survey included 34 health-care facilities and 5 private companies in 29 countries. Local production of one of the WHO formulations was feasible in every participating site. Twenty-one (54%) of the sites had replaced a previously used ABH with one of the WHO formulations. In 32 sites, the WHO formulation that had been produced was well tolerated and accepted by health-care workers. The WHO formulations were found to be less expensive than marketed ABHs. Barriers to local production included difficulty in identifying staff with adequate skills, the need for staff training, and constraints in ingredient and dispenser procurement. The WHO formulations can be easily produced locally at low cost. They are well tolerated and accepted by health-care workers. Potential barriers to their local production - such as their smell and problems in the procurement of ingredients and dispensers and in performing quality control - require further investigation.

Virucidal activity of Formulation I of the World Health Organization's alcohol-based handrubs: impact of changes in key ingredient levels and test parameters

BackgroundA recently modified World Health Organization (WHO) Formulation I was examined as 80% and 97% solutions against poliovirus type 1, adenovirus type 5 and murine norovirus according to the new European Norm prEN 14476:2011. In a previous study the unmodified WHO Formulation I had failed to demonstrate a sufficient activity against poliovirus type 1 according to the European Norm EN 14476–2007 whereas a sufficient activity was seen with adeno- and norovirus.FindingsThe modified WHO Formulation I demonstrated a virucidal activity against all 3 test viruses of the European Norm prEN 14476:2011 under clean conditions. This was achieved as 80% solution against adeno- and norovirus within 30 seconds and as 97% solution against poliovirus within 60 seconds. Testing the unmodified WHO Formulation I against poliovirus type 1 in the 97% assay of the European Norm prEN 14476:2011 an identical activity could be demonstrated. When comparing the 80% and the 97% assay of the European Norm prEN 14476:2011 the modified WHO Formulation I as 80% solution was active against adenovirus type 5 within 30 seconds whereas the 97% solution failed within 2 minutes exposure time.ConclusionsThe technical possibility in the new European Norm prEN 14476:2011 allows testing a ready-to-use disinfectant as 97% solution and is responsible for the new virucidal claim of the modified WHO Formulation I. In contrast to the improvements with poliovirus type 1 the activity against adenovirus type 5 decreased when increasing the test concentration from 80% to 97%.

Effectiveness of Multifaceted Hand Hygiene Interventions in Long-Term Care Facilities in Hong Kong: A Cluster-Randomized Controlled Trial

To determine the effectiveness of World Health Organization (WHO) multimodal strategy in promoting hand hygiene (HH) among healthcare workers (HCWs) in long-term care facilities (LTCFs). Cluster-randomized controlled trial. Eighteen homes for the elderly in Hong Kong were randomly allocated to 2 intervention arms and a control arm. Direct observation of HH practice was conducted by trained nurses. Either handrubbing with alcohol-based handrub (ABHR) or handwashing with liquid soap and water was counted as a compliant action. Disease notification data during 2007-2010 were used to calculate incidence rate ratio (IRR). Managers and HCWs of the participating homes. The WHO multimodal strategy was employed. All intervention homes were supplied with ABHR (WHO formulation I), ABHR racks, pull reels, HH posters and reminders, a health talk, video clips, training materials, and performance feedback. The only difference was that intervention arms 1 and 2 were provided with slightly powdered and powderless gloves, respectively. A total of 11,669 HH opportunities were observed. HH compliance increased from 27.0% to 60.6% and from 22.2% to 48.6% in intervention arms 1 and 2, respectively. Both intervention arms showed increased HH compliance after intervention compared to controls, at 21.6% compliance (both [Formula: see text]). Provision of slightly powdered versus powderless gloves did not have any significant impact on ABHR usage. Respiratory outbreaks (IRR, 0.12; 95% confidence interval [CI], 0.01-0.93; [Formula: see text]) and methicillin-resistant Staphylococcus aureus infections requiring hospital admission (IRR, 0.61; 95% CI, 0.38-0.97; [Formula: see text]) were reduced after intervention. A promotion program applying the WHO multimodal strategy was effective in improving HH among HCWs in LTCFs.

Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy

In Central Europe, alcohol-based hand rubs have been the preferred choice for hand hygiene, whereas, in other countries, other preparations have been used that are based on other active agents. Recently, a move towards alcohol-based hand rubs has begun, but they may be costly and unaffordable to some. Therefore, the World Health Organization (WHO) has recommended 2 hand rub formulations (WHO I and WHO II) for local production in health care settings where commercial products are not available or are too expensive. WHO I, based on ethanol 80% (vol/vol), and WHO II, based on isopropanol 75% (vol/vol), were investigated for their bactericidal efficacy in their application as hygienic hand rubs. The investigation took place at the Institute for Hygiene and Applied Immunology, Medical University Vienna, Austria, as a prospective, randomized, in vivo laboratory study, comparative in crossover design. Both formulations were tested according to the European Standard EN 1500 in 2 applications (1 × 3 mL/30 seconds or 2 × 3 mL/2 × 30 seconds). Additionally, modifications with increased alcohol concentrations (weight instead of volume percent) were tested in the short application. Bactericidal efficacies were compared with those of the respective reference procedure "R," ie, rubbing 2 × 3 mL 60% vol/vol isopropanol for 2 × 30 seconds onto hands artificially contaminated with Escherichia coli K12. The short application of either WHO formulation resulted in bacterial reductions significantly inferior to the respective ones of R. However, prolonging the contact time to 60 seconds or increasing the alcohol content produced reductions similar to those of R. Both WHO-recommended formulations meet the efficacy requirements of EN 1500 within 60 seconds but not within 30 seconds. Increasing the respective alcohol concentrations from 80% vol/vol to 80% wt/wt and 75% vol/vol to 75% wt/wt renders the formulations sufficiently active to conform to the norm also within 30 sections.

Oral rehydration therapy for diarrhea in children--a basic primer.

This article reviews current knowledge on oral rehydration therapy (ORT) for diarrhea in children. The World Health Organization (WHO) has formulated an ORT solution suitable for most cases of diarrhea, regardless of etiology or patient's age. At least 65 separate studies in 21 countries have documented successful use of ORT (largely the WHO formulation). Although it is popularly believed that food intake should be minimized during diarrhea to rest the bowel, fasting impairs the absorption of glucose, salt, water, amino acids, and the activity of disaccharidases. However, even children with intractable diarrhea gain weight and have less diarrhea on diets that are predigested but not hypertonic. Locally available food, such as rice and rice water, and breast milk can be tolerated by children with diarrhea. ORT can play a positive role in reducing anorexia and promoting food intake by restoring appetite. ORT must be delivered through a community-based distribution program to reach the majority of people in developing countries. The minimum elements for such a program are the chemicals, a means to measure them, a container, a source of potable water, education of deliverers and family, and managerial surveillance. Medical backup for ORT failures and evaluation of outcomes are also desirable features. Although ORT packets can be produced for US8 cents, they are not always available to remote areas, leading some to advocate use of table salt and household sugar solutions. The problems of delivery of ORT to those most in need mirror more general problems in health care delivery in developing countries. Nonetheless, in comparison with many curative and preventive health care measures, ORT has an exceptionally high cost-benefit ratio.

Oral therapy for acute diarrhoea.

There are 3 mainand related problems that must be considered in managing acute watery diarrheas -- the treatment of fluid loss and related metabolic disturbances nutritional management and drug therapy but the prime objective in the treamtment of patients with acute diarrhea is to replace lost fluids. The importance of the intact sodium ion glucose absorption system in the toxigenic diarrheas is that it provides a mechanism for hydration via the intestine despite the enterotoxin induced fluid secretion into the gut lumen. This is the basic for oral rehydration therapy (ORT) which is being promoted vigorously by the World Health Organization (WHO) and has been adopted with considerable success in dozens of developing countries. The current question is whether this medical advance can be transferred from the developing to the developed countries. There is good evidence that the time is right for this change. The rehydration solution recommended by WHO has the following composition: sodium 90 mmol/L; potassium 20 mmol/L; chloride 80 mmol/L; bicarbonate 30 mmol/L; and glucose 111 mmol/L and can be made by dissolving 3.5 gm of sodium chloride 2.5 gm of sodium bicarbonate 1.5 gm of potassium chloride and 20 gm of glucose (or 40 gm of sucrose) in 1 liter of water. Experience in field trials has shown that most patients with mild to moderate dehydration can be managed effectively by oral therapy based on the above mentioned electrolyte solution. It must be recongnized that more seriously dehydrated patients will require initially more rapid intravenous rehydration followed by oral rehydration to replace continuing fluid losses. It is important also to appreciate that once a person becomes dehydrated replacement therapy should cover both the rehydration pase and the maintenance phase. The aim of ORT is to avoid unnecessary intravenous therapy and its attendant risks. It must supply maintenance fluid requirements and replace fluids lost in watery stools. ORT can work even in patients who are vomiting provided that small volumes of fluid are given frequently but special care must be taken in children under age 2 and particularly in infants under 6 months of age in whom dehydration tends to be rapid. In general terms the WHO formulation has proven satisfactory as a basis for ORT in patients with acute diarrheas and some commercially available products closely resemble this formulation. The WHO formulation perhaps with a lower sodium content could be used as a safe guide for oral therapy for patients with acute diarrhea in Australia.