A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial.

BACKGROUND: Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations. METHOD: This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21. RESULTS: Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46). CONCLUSION: Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.

Enterotoxigenic Staphylococcus aureus in Brazilian artisanal cheeses: Occurrence, counts, phenotypic and genotypic profiles.

The present study aimed to assess the occurrence and counts of Staphylococcus aureus in Brazilian artisanal cheeses (BAC) produced in five regions of Brazil: Coalho and Manteiga (Northeast region); Colonial and Serrano (South); Caipira (Central-West); Marajó (North); and Minas Artisanal cheeses, from Araxá, Campos das Vertentes, Cerrado, Serro and Canastra microregions (Southeast). The resistance to chlorine-based sanitizers, ability to attach to stainless steel surfaces, and antibiogram profile of a large set of S. aureus strains (n = 585) were assessed. Further, a total of 42 isolates were evaluated for the presence of enterotoxigenic genes (sea, seb, sec, sed, see, seg, sei, sej, and ser) and submitted to typing using pulsed-field gel electrophoresis (PFGE). BAC presented high counts of S. aureus (3.4-6.4 log CFU/g), varying from 25 to 62.5%. From the S. aureus strains (n = 585) assessed, 16% could resist 200 ppm of sodium hypochlorite, whereas 87.6% produced strong ability to attach to stainless steel surfaces, corroborating with S. aureus ability to persist and spread in the environment. Furthermore, the relatively high frequency (80.5%) of multidrug-resistant S. aureus and the presence of enterotoxin genes in 92.6% of the strains is of utmost attention. It reveals the lurking threat of SFP that can survive when conditions are favorable. The presence of enterotoxigenic and antimicrobial-resistant strains of S. aureus in cheese constitutes a potential risk to public health. This result calls for better control of cheese contamination sources, and taking hygienic measures is necessary for food safety. More attention should be paid to animal welfare and hygiene practices in some dairy farms during manufacturing to enhance the microbiological quality of traditional cheese products.

Availability of Hand Sanitizers in Food Establishments of New York City: An Observational Study.

Hand hygiene is a crucial tool to limit the transmission of common respiratory and gastrointestinal infections. While hand sanitizers were ubiquitous early in the COVID-19 pandemic, the number of food establishments that have adequately maintained them remains unknown. Through systematic observations in 89 New York City food establishments, we found that hand sanitizer dispensers were present in only 40% of the stores, and only 23% had functional ones. This scarcity highlights the necessity of providing ongoing support to small business owners nationwide to promote and maintain primary prevention measures at all times, extending beyond periods of public health crises.

Evaluation of in vitro SARS-CoV-2 inactivation by a new quaternary ammonium compound: Bromiphen bromide.

The pneumonia (COVID-19) outbreak caused by the novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which unpredictably exploded in late December of 2019 has stressed the importance of being able to control potential pathogens with the aim of limiting their spread. Although vaccines are well known as a powerful tool for ensuring public health and controlling the pandemic, disinfection and hygiene habits remain crucial to prevent infection from spreading and maintain the barrier, especially when the microorganism can persist and survive on textiles, surfaces, and medical devices. During the coronavirus disease pandemic, around half of the disinfectants authorized by the US Environmental Protection Agency contained quaternary ammonium compounds (QACs); their effectiveness had not been proven. Herein, the in vitro SARS-CoV-2 inactivation by p-bromodomiphen bromide, namely bromiphen (BRO), a new, potent, and fast-acting QAC is reported. This study demonstrates that BRO, with a dose as low as 0.02%, can completely inhibit SARS-CoV-2 replication in just 30 s. Its virucidal activity was 10- and 100-fold more robust compared to other commercially available QACs, namely domiphen bromide and benzalkonium chloride. The critical micellar concentration and the molecular lipophilicity potential surface area support the relevance of the lipophilic nature of these molecules for their activity.

Skin- and Eco-Friendly Hand Sanitizer: A Novel Composition of Natural Extracts to Prevent the Spread of Respiratory Viruses.

Respiratory diseases caused by viruses are a serious global health threat. Although the use of hand sanitizers containing alcohol and synthetic antiseptic agents is recognized as an effective, simple, and low-cost measure to combat viral transmission, they can harm human health and the environment. Thus, this work aimed to study the efficacy of combining Camellia sinensis and Chamomilla recutita extracts in a skin- and eco-friendly leave-on hand sanitizer to prevent the spread of respiratory viruses. An oil-in-water emulsion containing C. recutita oily extract (5.0%), C. recutita glycolic extract (0.2%) and C. sinensis glycolic extract (5.0%) showed virucidal activity against HAdV-2 (respiratory virus) and two surrogate viruses of SARS-CoV-2 (HSV-1 and MVH-3), showing great potential to prevent the spread of respiratory viruses. These natural extracts combined are also promising to combat a broad spectrum of other viruses, in the form of antiseptic mouthwashes or throat sprays, surface disinfectants, and veterinary products, among others. Complementally, the developed hand sanitizer demonstrated efficacy against bacteria and fungus.

In vitro activity of sanitizers against mono- and polymicrobial biofilms of C. parapsilosis and S. aureus.

The emergence of disinfectant-resistant microorganisms poses a significant threat to public health. These resilient pathogens can survive and thrive in hospital settings despite routine disinfection practices, leading to persistent infections and the potential for outbreaks. In this study, we investigated the impact of 11 different commercial sanitizers at various concentrations and exposure times on biofilms consisting of clinical and nosocomial environmental isolates of Candida parapsilosis and Staphylococcus aureus. Among the sanitizers tested, 0.5% and 2.0% chlorhexidine (CLX), 10% polyvinyl pyrrolidone (PVP-I), a disinfectant based on quaternary ammonium compound (QAC), 2% glutaraldehyde, and 0.55% orthophthalaldehyde (OPA) demonstrated efficacy against both C. parapsilosis and S. aureus in monospecies and mixed biofilms. Analysis showed that 0.5% CLX and 10% PVP-I had fungicidal and bactericidal activity against all biofilms. However, the sanitizer based on QAC and 0.55% OPA proved to be bacteriostatic and fungicidal against both monospecies and mixed biofilms. In mixed biofilms, despite the last four sanitizers exerting fungicidal action, the reduction of fungal cells was approximately 4 log10 CFU/mL compared to monospecies biofilms, showing that the interaction provided more resistance of the yeast to the sanitizer. Formation of mixed biofilms in hospital settings can create an ecological niche that enhances the survival of pathogens against routine sanitization procedures. Therefore, effective sanitization practices, including regular cleaning with effective sanitizers, should be implemented to prevent C. parapsilosis/S. aureus biofilm formation in healthcare settings.

Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN).

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

Impact on touch DNA of an alcohol-based hand sanitizer used in COVID-19 prevention.

In the last years, forensic research has been focused on touch DNA in order to improve its evidential value in criminal activity investigations as well as to understand the variables impacting touch DNA. One of the emerging variables is represented by the use of alcohol-based sanitizers, which was suggested for hand hygiene during the COVID-19 pandemic. The aims of the present study were to assess the effect of a hand sanitizer on touch DNA deposition, transfer, and recovery and also to evaluate STR typing success, quality of DNA profiles, and personal identification. Before and after the use of an alcohol-based hand sanitizer, 20 volunteers deposited on glass surfaces 120 fingerprints, containing skin-derived or salivary DNA. Samples were quantified by real-time quantitative PCR (q-PCR), and 76 samples yielding > 15 pg/µl were typed for 21 autosomal STRs by GlobalFiler® PCR Amplification Kit. DNA profiles were classified into single source, mixed, and inconclusive profiles, and a LR assessment was performed by comparison to the reference samples using LRmix Studio software. After the use of hand sanitizer, samples yielded lower quantities of recovered transferred DNA, especially considering samples containing salivary DNA (p < 0.05 by Friedman test). All the 76 amplified samples (63.3% of the total) showed at least 10 typed loci, and 83-100% of profiles were consistent with the reference ones on the basis of a LR value ≥ 106. Results showed that, although the hand sanitizer reduces the DNA recovering, touch DNA samples might still be useful for forensic personal identification even when hand sanitizers are used.

Effectiveness of plant-based hand sanitizer incorporating Quercus infectoria gall extract.

AIMS: Quercus infectoria (Qi), a traditional herbal plant with a broad spectrum of activities on multidrug-resistant bacteria, has been developed for hand sanitizer applications. METHODS AND RESULTS: Antimicrobial activity was evaluated using agar-well diffusion and broth microdilution method. Bactericidal activity was determined following the European Standard 1276 antibacterial suspension test. Neutralization assay was performed to assess antirespiratory syncytial virus. Safety, stability, and skin permeation of Qi hand gel was investigated. Qi hand sanitizer gel inhibited microorganisms ranging from 99.9% to 99.999% against Enterococcus faecalis, Staphylococcus aureus, methicillin-resistant Staph. aureus, Staph. epidermidis, Staph. pseudintermedius, Staph. saprophyticus, Streptococcus pyogenes, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans. A significant reduction in main human dermatophytes including Microsporum canis, M. gypseum, and Talaromyces marneffei of ∼50% was observed (P < .05). Qi hand sanitizer gel inactivated >99% viral particles entering human laryngeal epidermoid carcinoma cells in a dose-dependent manner. Scanning electron micrographs further illustrated that Qi hand sanitizer gel disrupted microbial cell membrane after 1-min contact time resulting in cell death. Qi hand sanitizer gel delivered emollient compounds through simulated human skin layers and showed no cytotoxicity on fibroblast cells. Moreover, Qi hand sanitizer gel demonstrated stability under extreme conditions. CONCLUSIONS: Qi hand sanitizer gel was able to inhibit various microorganisms including bacteria, dermatophytes, and virus.

Protective role of Acinetobacter and Bacillus for Escherichia coli O157:H7 in biofilms against sodium hypochlorite and extracellular matrix-degrading enzymes.

Foodborne pathogenic bacteria in multi-species biofilms in food manufacturing facilities have been suspected to be the cause of cross-contamination leading to foodborne illness. We studied if cafeteria kitchen-associated bacterial isolates can have any protective effect on E. coli O157:H7 in biofilm against extracellular polymeric substances (EPS)-degrading enzymes and sodium hypochlorite. We investigated multi-species biofilm-forming ability and the efficacy of EPS-degrading enzymes using crystal violet assay. The susceptibility of E. coli O157:H7 to sodium hypochlorite (NaClO) was evaluated using propidium monoazide combined with quantitative PCR (PMA-qPCR). Then, a combined treatment with enzymes followed by NaClO was also tested. Most cafeteria kitchen isolates of Acinetobacter and Bacillus were able to form biofilms. Several of them showed a protective effect on E. coli O157:H7 against NaClO after forming multi-species biofilms, particularly in Acinetobacter. This protective effect on E. coli O157:H7 was also noticed after the enzyme or the combined treatment with NaClO. Our results give us an insight into the protective role of food-associated environmental bacteria for E. coli O157:H7 in biofilms against common sanitizers and warrant further study to develop effective control methods. Our study also highlights the importance of preventing contamination or biofilm formation by environmental microorganisms, eventually reducing foodborne illness.

Comparative evaluation of the effectiveness of alcohol-based sanitizers, UV-C radiation and hot air on three-age Salmonella biofilms.

Dry sanitation is recommended to control contamination and prevent microbial growth and biofilm formation in the low-moisture food manufacturing plants. The objective of this study was to evaluate the effectiveness of dry sanitation protocols on Salmonella three-age biofilms formed on stainless steel (SS) and polypropylene (PP). Biofilms were formed for 24, 48 and 96 h at 37 °C using a cocktail of six Salmonella strains (Muenster, Miami, Glostrup, Javiana, Oranienburg, Yoruba) isolated from the peanut supply chain. Then, the surfaces were exposed to UV-C radiation, hot air (90 °C), 70% ethanol and a commercial product based on isopropyl alcohol for 5, 10, 15 and 30 min. After 30min exposure, on PP the reductions ranged from 3.2 to 4.2 log CFU/cm2 for UV-C, from 2.6 to 3.0 log CFU/cm2 for hot air, from 1.6 to 3.2 log CFU/cm2 for 70% ethanol and from 1.5 to 1.9 log CFU/cm2 for the commercial product. On SS, after the same exposure time, reductions of 1.3-2.2 log CFU/cm2, 2.2 to 3.3 log CFU/cm2, 1.7 to 2.0 log CFU/cm2 and 1.6 to 2.4 log CFU/cm2 were observed for UV-C, hot air, 70% ethanol and commercial product, respectively. UV-C was the only treatment affected by the surface material (p < 0.05) whereas the biofilm age influenced the effectiveness of UV-C and hot air (p < 0.05). For most treatment, there was significant difference among the exposure times (p < 0.05). Overall, the fastest loss in the biofilm viability was noted in the first 5 min, followed by a tail phase. The time predicted by the Weibull model for the first decimal reduction ranged from 0.04 to 9.9 min on PP and from 0.7 to 8.5 min on SS. In addition, the Weibull model indicates that most of treatments (79%) required a long-term exposure time (>30 min) to achieve 3-log reductions of Salmonella biofilms. In summary, UV-C showed the best performance on PP whereas hot air was noted to be the most effective on SS.

Association of resistance to quaternary ammonium compounds and organic acids with genetic markers and their relationship to Escherichia coli serogroup.

Sanitizer resistance is being extensively investigated due to the potential for bacterial survival and cross-resistance with other antimicrobials. Similarly, organic acids are being used due to their microbial inactivation potential as well as being generally recognized as safe (GRAS). However, little is known about associations of genetic and phenotypic factors in Escherichia coli related to resistance to sanitizers and organic acids as well as differences between "Top 7" serogroups. Therefore, we investigated 746 E. coli isolates for resistance to lactic acid and two commercial sanitizers based on quaternary ammonium and peracetic acid. Furthermore, we correlated resistance to several genetic markers and investigated 44 isolates using Whole Genome Sequencing. Results indicate that factors related to motility, biofilm formation, and Locus of Heat Resistance played a role in resistance to sanitizers and lactic acid. In addition, Top 7 serogroups significantly differed in sanitizer and acid resistance, with O157 being the most consistently resistant to all treatments. Finally, mutations in rpoA, rpoC, and rpoS genes were observed, in addition to presence of a Gad gene with alpha-toxin formation in all O121 and O145 isolates, which may be related to increased resistance of these serogroups to the acids used in the present study.

Analysis of the spread of SARS-CoV-2 in a hospital isolation room using CFD and Lagrangian Coherent Structures.

This research paper presents an analysis of the propagation of the SARS-CoV-2, or other similar pathogens, in a hospital isolation room using computational fluid dynamics (CFD) and Lagrangian Coherent Structures (LCS). The study investigates the airflow dispersion and droplets in the room under air conditioning vent and sanitizer conditions. The CFD simulation results show that both the air conditioner and sanitizer systems significantly influence the dispersion of the virus in the room. The use of LCS enables acquiring a deep understanding of the dispersion of suspended particles, providing insights into the mechanisms of virus transmission. The findings of this study could help in developing strategies for improving the design and operation of isolation rooms to minimize the likelihood of virus dissemination within hospitals.

A Systematic Review and Quantitative Synthesis of the Efficacy of Quaternary Ammonium Disinfestants Against Fungal Plant Pathogens.

Quaternary ammonium compounds (QACs) have been used as disinfestants in plant production systems since the late 20th century. In studies on the control of fungal pathogens in agricultural and horticultural crop production systems, the efficacy of QAC disinfestants is variable, ranging from very high to ineffective. A systematic review and meta-analysis were performed to establish and understand how pathogen- and application-related factors influenced product efficacy. The meta-analysis was based on 124 studies involving 14 fungal plant pathogen genera, eight target materials, and four generations of QAC products that contained different mixtures of active ingredients. A significant (P < 0.0001) reduction in either disease intensity or propagule viability resulted following disinfestation using QAC products. Hedges' g standardized mean difference (g̅+) across the studies was 2.16, indicating that QACs, on average, were highly effective against fungal pathogens. Heterogeneity was significant (P < 0.0001), indicating that effect sizes (g) were not representative of a common mean effect size and supported selection of a random effects model. In all, 78.5% of the observed variance consisted of variance in true effects with a high estimate of between-study variability (τ2 = 2.15). For fungal genus, subgroup g̅+ for genera Pseudonectria and Calonectria was significantly (P < 0.0038) higher than for all other genus subgroups, except Fusarium. For target materials, subgroup g̅+ for solution, cloth, plant, and metal were significantly (P > 0.0071) higher than for inorganic material or wood. For product generation, subgroup g̅+ for fifth-generation products was significantly (P > 0.0071) higher than for fourth-, third-, and second-generation products. Dose and time accounted for only 8 and 4%, respectively, of the true variance in effect sizes in the regression model dose, time, and dose-time (P = 0.0004). Genus accounted for 40 and 51% of the true variance in effect sizes in the regression models dose and genus (P = 0.0008) and time and genus (P = 0.0007), respectively. Target material accounted for 18 and 19% of the true variance in effect sizes in the regression models dose and target (P = 0.0001) and time and target (P = 0.0001), respectively. QAC product generation accounted for 24 and 21% of the true variance in effect sizes in the regression models dose and QAC generation (P = 0.0034) and time and QAC generation (P = 0.0189), respectively. These results show that the current recommended rates for dose and contact time are generally expected to result in effective disinfestation for commercial QAC products. However, the efficacy against fungal plant pathogens is likely to be influenced by the fungal genus and target being treated and the generation of the QAC product that is used for disinfestation.

A Systematic Review and Quantitative Synthesis of the Efficacy of Quaternary Ammonium Compounds in Disinfesting Nonfungal Plant Pathogens.

This quantitative review and systematic analysis of the effectiveness of quaternary ammonium compounds (QACs) in disinfesting nonfungal plant pathogens in agricultural and horticultural cropping systems is a complementary follow-up to a previous study that evaluated the efficacy of QACs against fungal plant pathogens. In the present study, a meta-analysis involving 67 studies was conducted to assess the overall efficacy of QACs against plant pathogenic bacteria, oomycetes, and viruses and to identify factors associated with observed differences in product efficacy. Across all studies, QACs resulted in a significant (P < 0.0001) reduction in either disease intensity or propagule viability with a mean Hedges' g ([Formula: see text]) of 1.75, indicating that overall QAC treatments were moderately effective against nonfungal pathogens. Significant differences in product efficacy were observed between organism types (P = 0.0001), with QAC interventions resulting in higher efficacy (P = 0.0002) against oomycetes ([Formula: see text] = 4.20) than against viruses ([Formula: see text] = 1.42) and bacteria ([Formula: see text] = 1.07), which were not different (P = 0.2689) from each other. As a result, bacterium and virus types were combined into a composite set (BacVir). QAC intervention against BacVir resulted in significant differences in efficacy within categorical moderator subgroups for genus (P = 0.0133), target material (P = 0.0001), and QAC product generation (P = 0.0281). QAC intervention against oomycetes resulted in significant differences in efficacy only for genus (P < 0.0001). For the BacVir composite, five random effect (RE) meta-regression models were significant (P = 0.05), where models with dose and time, dose and genus, time and genus, dose and target, and time and target accounted for 62, 61, 52, 83, and 88%, respectively, of the variance in true effect sizes (R2) associated with [Formula: see text]. For oomycetes, three RE meta-regression models were significant (P = 0.05), where models with dose and time, dose and genus, and time and genus accounted for 64, 86, and 90%, respectively, of R2 associated with [Formula: see text]. These results show that while QACs are moderately effective against nonfungal plant pathogens, the observed variability in their efficacy due to dose of active ingredient and contact time of these products can be influenced by organism type, genus within organism type, the target being treated, and the generation of QAC products.

Natural sanitizer potential of Cuminum cyminum and applicable approach for calculation of Kováts retention index of its compounds.

The demand for natural agents instead of chemicals in terms of food and health safety is increasing day by day. This study aimed to investigate the potential of the methanolic extract of Cuminum cyminum (C. cyminum) in the fight against Escherichia coli (E. coli), Staphylococcus aureus (S. aureus)and Candida (C. albicans). The chemical composition of the methanolic extract of C. cyminum was analyzed using GS-MS. Also, Kováts retention indices were calculated for the detected compounds using an applicable formula. The most basic substance was cuminic aldehyde (27.86%) and p-(Dimethoxymethyl)-isopropylbenze (18.32%). The Minimum Inhibitory Concentration (MIC) of the extract was 0.1 g/mL for S. aureus and C. albicans while it was > 0.1 for E. coli. Although the methanol extract of C. cyminum acts against all three microorganisms, the most lasting effect was on S. aureus, indicating that it can be recommended as a strong antibacterial disinfectant for S. aureus.

Reduced norovirus epidemic follows increased sales of hand hygiene products in Japan, 2020-2021.

During the recent emergence of COVID-19, an increased practice of hand hygiene coincided with the reduced incidence of the norovirus epidemic in Japan, which is similar to experience with the pandemic flu in 2009. We investigated the relationship between the sales of hand hygiene products, including liquid hand soap and alcohol-based hand sanitizer, and the trend of norovirus epidemic. We used national gastroenteritis surveillance data across Japan in 2020 and 2021 and compared the base statistics of incidence of these two years with the average of the previous 10 years (2010-2019). We calculated the correlations (Spearman's Rho) between monthly sales of hand hygiene products and monthly norovirus cases and fitted them to a regression model. In 2020, there was no epidemic, and the incidence peak was the lowest in recent norovirus epidemics. In 2021, the incidence peak was delayed for five weeks to the usual epidemic seasons. Correlation coefficients between monthly sales of liquid hand soap and skin antiseptics and norovirus incidence showed a significantly negative correlation (Spearman's Rho = -0.88 and p = 0.002 for liquid hand soap; Spearman's Rho = -0.81 and p = 0.007 for skin antiseptics). Exponential regression models were fitted between the sales of each hand hygiene product and norovirus cases, respectively. The results suggest hand hygiene using these products is a potentially useful prevention method against norovirus epidemics. Effective ways of hand hygiene for increasing the prevention of norovirus should therefore be studied.

Integrative Assessment of Reduced Listeria monocytogenes Susceptibility to Benzalkonium Chloride in Produce Processing Environments.

For decades, quaternary ammonium compounds (QAC)-based sanitizers have been broadly used in food processing environments to control foodborne pathogens such as Listeria monocytogenes. Still, there is a lack of consensus on the likelihood and implication of reduced Listeria susceptibility to benzalkonium chloride (BC) that may emerge due to sublethal exposure to the sanitizers in food processing environments. With a focus on fresh produce processing, we attempted to fill multiple data and evidence gaps surrounding the debate. We determined a strong correlation between tolerance phenotypes and known genetic determinants of BC tolerance with an extensive set of fresh produce isolates. We assessed BC selection on L. monocytogenes through a large-scale and source-structured genomic survey of 25,083 publicly available L. monocytogenes genomes from diverse sources in the United States. With the consideration of processing environment constraints, we monitored the temporal onset and duration of adaptive BC tolerance in both tolerant and sensitive isolates. Finally, we examined residual BC concentrations throughout a fresh produce processing facility at different time points during daily operation. While genomic evidence supports elevated BC selection and the recommendation for sanitizer rotation in the general context of food processing environments, it also suggests a marked variation in the occurrence and potential impact of the selection among different commodities and sectors. For the processing of fresh fruits and vegetables, we conclude that properly sanitized and cleaned facilities are less affected by BC selection and unlikely to provide conditions that are conducive for the emergence of adaptive BC tolerance in L. monocytogenes. IMPORTANCE Our study demonstrates an integrative approach to improve food safety assessment and control strategies in food processing environments through the collective leveraging of genomic surveys, laboratory assays, and processing facility sampling. In the example of assessing reduced Listeria susceptibility to a widely used sanitizer, this approach yielded multifaceted evidence that incorporates population genetic signals, experimental findings, and real-world constraints to help address a lasting debate of policy and practical importance.

Study of post-opening stability of active ingredients in hand sanitizers.

INTRODUCTION: Hand disinfection plays an important role in infection control. Currently, hand sanitizers containing ethanol and chlorhexidine gluconate as active ingredients are widely used. Most of hand sanitizers have a defined expiration date for use. However, there was no rule about the expiration date after opening defined with the evidence. Therefore, we examined the fluctuation of active ingredients and disinfection effect after opening the bottle. METHOD: Twelve hand sanitizers from 44 to 921 days after opening set in different places in the hospital were examined and unopened hand sanitizer used as a control. Chlorhexidine gluconate and ethanol of each samples were measured by high performance liquid chromatography and gas chromatography, respectively. The correlation between the concentration of each ingredient obtained and the number of days after opening, bottle weight, storage temperature and humidity was analyzed. A time-kill test based on ASTM E2315-03 was performed to confirm the actual disinfection effect. RESULTS: It was observed that active ingredients had not been decreased up to 921 days after opening and were not affected by storage conditions after opening. In addition, a decrease of disinfection effect was not observed in any sample. CONCLUSIONS: We found that hand sanitizers do not need to be discard after a number of days have passed because the active ingredients are retained even after opening in it.

Application of the Capability, Opportunity, Motivation and Behavior (COM-B) model to identify predictors of two self-reported hand hygiene behaviors (handwashing and hand sanitizer use) to prevent COVID-19 infection among U.S. adults, Fall 2020.

BACKGROUND: Handwashing with soap and water is an important way to prevent transmission of viruses and bacteria and worldwide it is estimated handwashing can prevent 1 in 5 viral respiratory infections. Frequent handwashing is associated with a decreased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Using a hand sanitizer with at least 60% alcohol when handwashing is not feasible can also help prevent the transmission of viruses and bacteria. OBJECTIVE: Since early 2020, the public has been encouraged to handwash frequently with soap and water and use alcohol-based hand sanitizer when soap and water are not available to reduce COVID-19 transmission. This study's objectives were to assess U.S. adults' perceptions of components of the Capability, Opportunity, Motivation and Behavior (COM-B) Model in relation to these two hand hygiene behaviors and to identify relationships between these components and hand hygiene behaviors. METHODS: Items assessing capability, opportunity, motivation, and hand hygiene behaviors were included in FallStyles, a survey completed by 3,625 adults in the fall of 2020 through an online panel representative of the U.S. POPULATION: We calculated composite capability, opportunity, and motivation measures and descriptive statistics for all measures. Finally, we conducted multiple logistic regressions to identify predictors of handwashing and hand sanitizer use. RESULTS: Most respondents reported frequently washing hands with soap and water (89%) and using alcohol-based hand sanitizer (72%) to prevent coronavirus. For capability, over 90% of respondents said that neither behavior takes a lot of effort, but fewer agreed that they knew when, or how, they should engage in handwashing (67%; 74%) and hand sanitizer use (62%; 64%). For opportunity, over 95% of respondents said lack of time didn't make it hard to engage in either behavior; fewer said visual cues reminded them to engage in the behaviors (handwashing: 30%; sanitizer use: 48%). For motivation, the majority believed the two behaviors were good ways to prevent coronavirus illness (handwashing: 76%; sanitizer use: 59%). Regressions indicated that capability, opportunity, and particularly motivation were positively associated with both hand hygiene behaviors. CONCLUSIONS: The COM-B model was a helpful framework for increasing understanding of hand hygiene behavior; it identified capability, opportunity, and motivation as predictors of both handwashing and hand sanitizer use.