The impact of alcohol hand sanitizer use on skin health between healthcare worker: Cross-sectional study.

BACKGROUND: 2020 Coronavirus disease 2019 (COVID-19) has become a global health crisis, so hand alcohol-based sanitizers have become essential to preventive measures. Previous studies reported that hand sanitizers could kill bacteria and viruses; however, using them excessively can lead to health problems if misused. In light of sanitizer overuse, the availability of various products and qualities in the market, and the absence of data on skin problems, we conducted a survey study about the impact of commonly used sanitizers on skin health, particularly on hands. The study aimed to determine the prevalence and the correlation between hand sanitizer and skin health during the COVID-19 pandemic at the National Guard Institute- Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted using a self-administered online questionnaire by sending an invitation link to students and employees of the National Guard Institute- Jeddah, Saudi Arabia, in 2021. A chi-squared test was used to obtain differences concerning awareness of hand sanitizer use/type and hand skin health. RESULTS: In the total 216 participants, there were considerably more skin conditions reported by women (62.5%) and respondents ages 31-40 (36.6%). For the types of hand sanitizers, 89.8%, 40.9%, 30.2%, 4.7%, and 6% were recorded: gel, spray, wipes, foam, and others, respectively, and the survey applicants were filled by 60.6% of non-medical workers. According to the survey, 32.9% of participants experienced a hand crack, which was the most common hand side effect. The handwashing frequency was reported between 3 to 7 times per day during the COVID-19 pandemic, and 9.3% of participants used hand sanitizers more than 10 times daily. CONCLUSION: It was found that during the pandemic, skin changes were common among the NGHA population and healthcare workers. Consequently, the adverse health effects of these hand sanitizers on human health may result in multiple infections and toxicity. The present study provides appropriate knowledge on the types and ingredients of hand sanitizers as essential factors for skin health, preventing health risks during this pandemic.

Antibiotic resistance pattern of bacterial strains emerged using frequent hand sanitizers during corona pandemic.

Hands are in fact the main route of transmission of pathogenic infections. By using proper hand sanitization, we can break the virus's transmission chain, which is especially important in the ongoing COVID pandemic outbreaks. The effectiveness of hand sanitization is solely dependent on the use of sufficient antibacterial agents, which come in a variety of levels and types, including antimicrobials commercial, water-based, or alcohol-based hand sanitizer, the latter being widely used during pandemics. Therefore, the sudden overuse of sanitizers also could lead to an increase in the tolerance limit for normal hand flora and the new development of antimicrobial resistance (AMR). In this study, we investigated the relationship between hand sanitizer-tolerant bacteria and their antibiotic resistance profile to multiple antibiotic agents. On a timely basis before and after using different hand sanitizers, bacterial strains were collected from the volunteers of CSIR-Central Salt and Marine Chemicals Research Institute (CSIR-CSMCRI). Sanitizer tolerant bacterial strains were observed also just after the application of sanitizers, which also showed the AMR phenomenon. The resultant sanitizers' resistant microbiome showed the dominant presence of Bacillus sp., Staphyloccocus sp., Paenibacillus sp., Lysinibacillus sp., Exiguobacterium sp. and Leclercia sp. All 36 nos of bacterial strains showed MDR (> 5 nos).

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.

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.

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.

Impact of coronavirus disease 2019 on infectious disease treatment and infection control at a tertiary hospital in Japan.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has greatly impacted medical care practices. Although the effects on infectious disease treatment and infection control, such as antimicrobial resistance, have been specified, very few reports exist on the specific effects of COVID-19. METHODS: We investigated the effects of COVID-19 on daily medical practices at a tertiary hospital in Japan by comparing the use of hand sanitizers, the detection of bacteria from blood cultures, and the amount dose of antibacterial drugs used for one year before (April 2019 to March 2020, fiscal year 2019.) and after COVID-19 admissions began (April 2020 to March 2021, fiscal year 2020). RESULTS: The use of hand sanitizers increased by 1.4-3 times during the year after COVID-19 admissions began; the incidence of methicillin-susceptible Staphylococcus aureus and all S. aureus detected in blood cultures reduced in all departments. No decrease was observed in the usage of all antibacterial drugs; rather, the usage of all antibacterial drugs tended to increase in all departments. Therefore, no significant change was observed in the detection of drug-resistant bacteria and the trends of antibacterial drug use based on the acceptance of COVID-19 patients. CONCLUSIONS: The prevalence of drug-resistant bacteria and trends of antibacterial drug use remained unchanged despite the increased use of hand sanitizers due to the admission of patients with COVID-19.

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.

Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: A randomized clinical trial.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has increased the frequency of handwashing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice. OBJECTIVE: To compare the impact on skin barrier function of different hand hygiene measures in healthcare workers in daily practice. METHODS: A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHSs), or disinfectant wipes during their 8-hour working shift. Epidermal barrier functional parameters, such as transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the working day. Tolerance and acceptability of each product were recorded after work. RESULTS: Sixty-two participants were included and 20, 21, and 21 were randomized to use water and soap, ABHS, and disinfectant wipes, respectively. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45 vs +3.87 vs -1.46 g h-1  m-2 , respectively; P = .023). Bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P = .013) compared with water and soap and ABHS. CONCLUSION: Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.

Spectroscopic methods for assessment of hand sanitizers.

Sanitization of inanimate objects or body surfaces using disinfectant is essential for eliminating disease-causing pathogens and maintaining personal hygiene. With the advent of health emergencies, the importance and high demand for hand sanitizers (HS) are observed in everyday life. It is also important to know the constituent added to formulate HS, as the presence of harsh chemicals can cause skin irritation. In this study, different spectroscopic techniques were used to assess several commercially available HS along with the in-house prepared HS as per the WHO protocol. Fourier transform infrared spectroscopy and Raman spectroscopy identified the different HS chemical bonds and quantified the amount of alcohol and water in the HS. Varying amount of alcohols in HS, calibration profile was generated to identify its amount in commercial samples. Further, the commercial samples were also checked for contaminants whose presence in the HS might bring down its sanitization efficacy. Supplementary Information: The online version contains supplementary material available at 10.1007/s11696-022-02208-x.

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

BACKGROUND: During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes. METHODS: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019). RESULTS: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). CONCLUSION: The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.

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.

Toxicology Practice During COVID-19 Pandemic: Experience of the Dammam Poison Control Center-Eastern Province, Saudi Arabia.

BACKGROUND: The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems. OBJECTIVE: To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics. METHODS: Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019. RESULTS: Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086). CONCLUSION: The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.

[Basic hygiene measures in the delivery room-also during a pandemic]. / Basis-Hygienemaßnahmen im Kreißsaal ­ auch in Zeiten einer Pandemie.

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.

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.

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.

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.

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.

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

INTRODUCTION: Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. MATERIALS AND METHODS: Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. RESULTS: Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. DISCUSSION AND CONCLUSION: Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

In vitro assessment and comparison of quality of alcohol-based hand rubs, pre- and peri-COVID-19 pandemic outbreak in Kenya.

Background: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended the use of alcohol-based hand rubs (ABHRs) to curb transmission, leading to increased production and use. This has posed a danger of production and use of poor-quality ABHRs. Methods: This study assessed and compared the quality of ABHRs in the Kenyan market that were produced before and after the outbreak of the COVID-19 pandemic in March 2020. Quality testing was carried out against European EN 1500:2013 and Kenyan EAS 789:2013 Standards and 20 samples analyzed for alcohol content by GC-FID. Results: The study found that 27.8% of the peri-COVID-19 pandemic sanitizers had less than 90% bactericidal reduction activity as compared to 12.5% manufactured pre-COVID-19 pandemic. Only 25% peri-COVID-19 pandemic ABHRs met the EAS 789:2013 acceptable limit of over 60% alcohol content. Product adulteration with methanol was found in 20 % of the samples with only 5% complying with FDA approval limit of <0.063% v/v methanol. Study found no correlation between the total alcohol content and the efficacy of ABHRs. Conclusions: The study found that more substandard products were produced during the pandemic. This raises a concern about possible emergence of alcohol resistant strains of microorganisms. The study therefore recommends an adequate quality monitoring system to curb against substandard products.

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.