Development of a solid phase microextraction gas chromatography tandem mass spectrometry methodology for the analysis of sixty personal care products in hydroalcoholic gels - hand sanitizers - in the context of COVID-19 pandemic.

Because of the coronavirus pandemic, hydroalcoholic gels have become essential products to prevent the spread of COVID-19. This research aims to develop a simple, fast and sustainable microextraction methodology followed by gas chromatography tandem mass spectrometry (GC-MS/MS) to analyze simultaneously 60 personal care products (PCPs) including fragrances allergens, synthetic musks, preservatives and plasticizers in hand sanitizers. Micro-matrix-solid-phase dispersion (µMSPD) and solid-phase microextraction (SPME) were compared with the aim of obtaining high sensitivity and sample throughput. SPME demonstrated higher efficiency being selected as sample treatment. Different dilutions of the sample in ultrapure water were assessed to achieve high sensitivity but, at the same time, to avoid or minimize matrix effect. The most critical parameters affecting SPME (fibre coating, extraction mode and temperature) were optimized by design of experiments (DOE). The method was successfully validated in terms of linearity, precision and accuracy, obtaining recovery values between 80 and 112% for most compounds with relative standard deviation (RSD) values lower than 10%. External calibration using standards prepared in ultrapure water demonstrated suitability due to the absence of matrix effect. Finally, the simple, fast and high throughput method was applied to the analysis of real hydroalcoholic gel samples. Among the 60 target compounds, 39 of them were found, highlighting the high number of fragrance allergens, at concentrations ranging between 0.01 and 217 µg g-1. Most of the samples were not correctly labelled attending cosmetic Regulation (EU) No 1223/2009, and none of them followed the World Health Organization (WHO) recommendation for hand sanitizers formulation.

Presence of unsafe chemical impurities, accelerated evaporation of alcohol, and lack of key labeling requirements are risks and concerns for some alcohol-based hand sanitizers and dispenser practices during the COVID-19 pandemic.

Alcohol-based hand sanitizers (ABHS) have been an important hand hygiene tool during the COVID-19 pandemic. Recently, ABHS from non-traditional drug manufacturers have entered the market, triggered by a lack of ABHS availability. Some of these ABHS contain high levels of chemical impurities that may be harmful with frequent exposure. Additionally, the use of refillable dispensers designed to accept ABHS from bulk containers allows for mixing and evaporation that may compromise ABHS integrity. To understand the risks associated with low quality ABHS and bulk refilling practices, we collected 77 ABHS samples sourced from community settings (restaurants, grocery stores, etc.) and 40 samples from a single school district. All samples were obtained from bulk refillable dispensers that were in use. Samples were analyzed for alcohol content, chemical impurities, aesthetic qualities, and presence of drug labeling information. Additionally, we performed laboratory-based experiments to determine the impact of dispenser design on alcohol evaporation rates. Over 70% of samples for which photos were available showed lack of essential labeling information, including missing "Drug Facts Labels". For ABHS samples acquired from community settings, nearly 14% of samples had visible impurities, and over 30% of samples had concentrations of acetal and acetaldehyde in excess of FDA interim limits. Subpotent ethanol concentrations were observed in 9.09% and 82.05% of samples from community settings and the school district, respectively, with the school district sample results being associated with dispenser misuse. Laboratory-based experiments show dispenser design significantly impacts the rate of ethanol evaporation of ABHS products, especially if stored in open refillable dispensers without an internal reservoir. This study demonstrates risks associated with use of inferior ABHS and bulk refilling practices. Regulatory agencies should issue guidance on best practices in community settings to ensure the integrity of ABHS as an essential public health tool to prevent the spread of COVID-19 and other transmissible diseases.

Assessment of quality of alcohol-based hand sanitizers used in Johannesburg area during the CoViD-19 pandemic.

Since the outbreak of the Coronavirus Disease 2019 (CoViD-19), the World Health Organization has recommended that, in absence of soap and water, alcohol-based hand sanitizer can be used to prevent the transmission of coronaviruses. Unfortunately, many media and anecdotal reports indicate that many alcohol-based hand sanitizers sold in South Africa are substandard and some contain potentially toxic ingredients. The study aimed to identify hand sanitizers used in the Johannesburg area during the CoViD-19 pandemic that do not contain the recommended alcohol concentration of at least 70% propanol or 60% ethanol, and contain traces of toxic ingredients. Hand sanitizers randomly collected from various traders around Johannesburg were analyzed using Agilent auto sampler coupled to a gas chromatograph utilizing flame ionisation detection. Of the 94 hand sanitizer samples collected, three preparations contained no alcohol, whereas the rest contained either ethanol, 2-propanol or 1-propanol or a combination of two alcohols. Of the alcohol-containing hand sanitizers, 37 (41%) contained less than 60% alcohol. Ethyl acetate, isobutanol and other non-recommended alcohols (methanol and 3-methyl-butanol) were also identified. Consumers are therefore warned that among the many brands of hand sanitizers found around Johannesburg, there are some substandard preparations and some that contain traces of toxic ingredients.

Coronavirus versus 70% Alcohol: Comments and Some Fundamental Definitions

Abstract The new coronavirus pandemic (COVID-19) is a global problem that is having severe impacts on health systems worldwide. One particular characteristic of this virus is its high transmission rate, which has led to a high demand for personal care materials such as masks, gloves, and alcohol for asepsis. Seventy percent is the ideal concentration for the ethanol used in hand sanitizers; however, this concentration can be expressed in different ways, and, consequently, the different solutions will have different antiseptic activity. In this manuscript we comment on some characteristics of alcohol-based preparations and the different ways of expressing the concentrations.

Could Alcohol-Based Hand Sanitizer Be an Option for Hand Hygiene for Households in Rural Bangladesh?

In low- and middle-income countries (LMICs), hand sanitizer may be a convenient alternative to soap and water to increase hand hygiene practices. We explored perceptions, acceptability, and use of hand sanitizer in rural Bangladesh. We enrolled 120 households from three rural villages. Promoters distributed free alcohol-based hand sanitizer, installed handwashing stations (bucket with tap, stand, basin, and bottle for soapy water), and conducted household visits and community meetings. During Phase 1, promoters recommended handwashing with soap or soapy water, or hand sanitizer after defecation, after cleaning a child's anus/feces, and before food preparation. In Phase 2, they recommended separate key times for hand sanitizer: before touching a child ≤ 6 months and after returning home. Three to 4 months after each intervention phase, we conducted a survey, in-depth interviews, and group discussions with child caregivers and male household members. After Phase 1, 82/89 (92%) households reported handwashing with soap after defecation versus 38 (43%) reported hand sanitizer use. Participants thought soap and water removed dirt from their hands, whereas hand sanitizer killed germs. In Phase 2, 76/87 (87%) reported using hand sanitizer after returning home and 71/87 (82%) before touching a child ≤ 6 months. Qualitative study participants reported that Phase 2-recommended times for hand sanitizer use were acceptable, but handwashing with soap was preferred over hand sanitizer when there was uncertainty over choosing between the two. Hand sanitizer use was liked by household members and has potential for use in LMICs, including during the coronavirus pandemic.

Allergenic Ingredients in Health Care Hand Sanitizers in the United States.

BACKGROUND: Health care workers with occupational contact dermatitis often attribute their symptoms to frequent use of alcohol-based hand sanitizers. However, ingredient lists are difficult to obtain, and safe alternatives typically must accommodate brands utilized by a particular hospital system. OBJECTIVE: The aims of this study were to investigate allergenic ingredients present within health care hand sanitizers and to provide a comprehensive product list to assist with allergen avoidance. METHODS: Five major hospitals in Minnesota and 20 hospitals across the United States were called to obtain a product list. The National Library of Medicine's DailyMed Web site was searched to retrieve ingredients. Ingredients were compared with the American Contact Dermatitis Society 2017 Core Allergen Series and cross-reactors. RESULTS: The most common brands included Purell, Ecolab, DebMed, and Avagard. Active ingredients consisted of ethyl alcohol (85.0%), benzalkonium chloride (8.8%), or isopropyl alcohol (2.5%). Top 5 allergens included tocopherol (51.3%), fragrance (40.0%), propylene glycol (27.5%), benzoates (25.0%), and cetyl stearyl alcohol (12.5%). Four sanitizers were free of all American Contact Dermatitis Society allergens; 15 products contained only tocopherol or propylene glycol as allergens. CONCLUSIONS: We identified 19 low-allergen hand sanitizers within the most common brands utilized by US hospital systems. This product list will be useful for patients and health care workers seeking allergen avoidance.

Use of Ethanol-Based Hand Disinfectants: Source of Increased Ethyl Glucuronide Levels in Hair?

AIM: Due to the COVID-19 pandemic increasing the use of hand disinfectants, we investigated the effect of frequent use of ethanol-based hand disinfectants (EBHD) on the levels of the alcohol marker ethyl glucuronide (EtG) in hair. METHOD: Hair samples were collected from 10 health professionals (8 nondrinkers, 2 rarely drinking individuals) and EtG was examined in hair. RESULT: EtG (~2 pg/mg) was only detected in the hair sample of a nondrinker using EBHD 60-70 times per working day. CONCLUSION: Our data provide no evidence that frequent EBHD use results in hair EtG levels above the recommended Society of Hair Testing cutoff for repeated alcohol consumption (5 pg/mg).

Analysis of Commercial Hand Sanitisers amid CoViD-19: Are We Getting the Products that We Need?

The CoViD-19 pandemic has caused a sudden spike in demand and production of hand sanitisers. Concerns are rising regarding the quality of such products, as the safeguard of consumers is a priority worldwide. We analyse here the ethanolic content of seven off-the-shelf hand sanitiser gels (two biocides and five cosmetics) from the Italian market, using gas chromatography. The WHO recommends that products containing ethanol should have 60-95% (v/v) alcohol. Four of the tested hand gels have ethanolic contents within the recommended range, while three products (all cosmetics) contain < 60% (v/v), i.e. 52.1% (w/w), ethanol. The product with the lowest alcoholic content has 37.1% w/w ethanol. Toxic methanol is not found in any of the hand sanitisers. We show, in addition, that products with the highest ethanolic content have generally greater antibacterial activity. In conclusion, all tested products are complying with the EU regulations, as the three "substandard" products are classified as cosmetics, whose purpose is cleaning and not disinfecting. Nevertheless, if such hand cleaners were inappropriately used as hand disinfectants, they might be ineffective. Thus, consumer safety relays on awareness and ability to distinguish between biocidal and cosmetics hand gels. The obtained results might sensitise the scientific community, health agencies and ultimately consumers towards the risks of using hand sanitisers of substandard alcoholic concentration. If the wrong product is chosen by consumers, public health can be compromised by the inappropriate use of "low-dosed" cosmetic gels as disinfectants, particularly during the period of the CoViD-19 pandemic.

Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses.

BACKGROUND: The emergence of the novel virus, SARS-CoV-2, has posed unprecedented challenges to public health around the world. Currently, strategies to deal with COVID-19 are purely supportive and preventative, aimed at reducing transmission. An effective and simple method for reducing transmission of infections in public or healthcare settings is hand hygiene. Unfortunately, little is known regarding the efficacy of hand sanitizers against SARS-CoV-2. METHODS: In this review, an extensive literature search was performed to succinctly summarize the primary active ingredients and mechanisms of action of hand sanitizers, compare the effectiveness and compliance of gel and foam sanitizers, and predict whether alcohol and non-alcohol hand sanitizers would be effective against SARS-CoV-2. RESULTS: Most alcohol-based hand sanitizers are effective at inactivating enveloped viruses, including coronaviruses. With what is currently known in the literature, one may not confidently suggest one mode of hand sanitizing delivery over the other. When hand washing with soap and water is unavailable, a sufficient volume of sanitizer is necessary to ensure complete hand coverage, and compliance is critical for appropriate hand hygiene. CONCLUSIONS: By extrapolating effectiveness of hand sanitizers on viruses of similar structure to SARS-CoV-2, this virus should be effectively inactivated with current hand hygiene products, though future research should attempt to determine this directly.

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.

Lavado en seco y carga bacteriana en manos de personal hospitalario / Dry cleaning and bacterial load in the hands of hospital staff

Introducción: numerosos estudios han confirmado que el lavado de manos en seco con soluciones con una concentración de 60-70% de alcohol reducen significativamente la cantidad de gérmenes. Metodología: se realizó un estudio cuasi experimental con el objetivo de comparar carga bacteriana en manos de personal sanitario antes y después de lavado convencional y lavado en seco. Se incluyó 22 trabajadores sanitarios, divididos en 2 grupos al azar (grupo A y B), a todos se les hizo cultivo en agar sangre y agar McConkey previo al lavado. El grupo A (11 participantes) realizó lavado convencional, tomando cultivos nuevamente, luego realizó lavado en seco, se tomó nueva muestra de cultivos. El grupo B (11 participantes), luego de lavado en seco se realizó nuevo cultivo de manos. Se compararon todos los grupos con prueba T Student. Resultados: se identificaron 1521 UFC previo al lavado de manos convencional (A1), con una reducción del 38% en carga bacteriana después de lavado (A2) sin encontrar diferencia estadísticamente significativa (p 0.052), posterior a lavado convencional más lavado en seco (A3) se encontró reducción de 62.66% de UFC con respecto a A1, encontrando una diferencia estadísticamente significativa (p 0.014). En el lavado en seco se identificaron 1503 UFC previo a lavado de manos con una reducción del 62.72% de UFC posterior a lavado, encontrando diferencia estadísticamente significativa (p 0.0026). Conclusión: El lavado de manos con jabón de base alcohólica es mas eficaz en la reducción de carga bacteriana que lavado de manos convencional con agua y jabón...AU)

Introduction: numerous studies have confirmed that the hand rub with solutions with a concentration of 60% -70% alcohol significantly reduce the amount of germs. Methodology: quasi-experimental study was performed in order to compare bacterial load in the hands of medical personnel before and after conventional washing and alcohol based hand rub. It included 22 health workers, divided randomly into 2 groups (group A and B), all they did blood agar and McConkey agar culture prior to washing. The group A (11 participants) performed conventional washing, taking culture again, then performed alcohol based hand rub, new sample for culture was taken The group B (11 participants), then alcohol based hand rub performed new culture of hands. All groups were compared with Student test. Results: 1521 CFU were identified prior to conventional hand washing (A1) with a 38% reduction in bacterial load after washing (A2) found no statistically significant difference (p 0.052), after conventional washing over alcohol based hand rub (A3) was found 62.66% reduction of CFU with respect to A1, finding a statistically significant (p 0.014). In the dry cleaning UFC 1503 were identified prior to washing hands with a 62.72% reduction of CFU after washing, finding statistically significant difference (p 0.0026). Conclusion: Alcohol based hand rub is more effective in reducing bacterial load than conventional hand washing with soap and water...(AU)

Estudio comparativo sobre la higiene de manos prequirúrgica con solución hidroalcohólica frente a la higiene prequirúrgica tradicional / Comparative study of presurgical hand hygiene with hydroalcoholic solution versus traditional presurgical hand hygiene

Objetivo: Comparar la higiene de manos prequirúrgica con solución hidroalcohólica siguiendo el protocolo de la OMS con la higiene de manos prequirúrgica tradicional. Método: Se realizaron cultivos de las manos de cirujanos y enfermeros quirúrgicos antes y después de la higiene de manos prequirúrgica y tras la retirada de los guantes al acabar la cirugía. Los cultivos se hicieron en 2 días diferentes: el primero tras la higiene de manos prequirúrgica tradicional y el segundo tras la higiene de manos prequirúrgica con solución hidroalcohólica siguiendo el protocolo de la OMS. Se cronometró el tiempo de realización de la higiene de manos tradicional y se comparó con los 3 min del protocolo de la OMS. El coste de los productos usados para la técnica tradicional se comparó con el coste de la solución hidroalcohólica utilizada. La variabilidad de la técnica tradicional se obtuvo observando a cada participante en el estudio durante su realización. Resultados: Tras la higiene prequirúrgica con solución hidroalcohólica se detectaron unidades formadoras de colonias (UFC) en 5 sujetos (7,3%) mientras que tras la higiene prequirúrgica tradicional, se detectaron UFC en 14 sujetos (20,5%) (p<0,05). Tras la retirada de los guantes, el recuento de UFC fue similar (p<0,7). El tiempo de realización de la higiene con solución hidroalcohólica (3 min) fue inferior al de la higiene tradicional (p<0,05), su coste fue la mitad y se eliminó la variabilidad. Conclusiones: Comparada con otras técnicas, la higiene de manos prequirúrgica con solución hidroalcohólica disminuye de forma significativa las UFC, se acompaña de un tiempo de latencia similar, tiene menor coste y ahorra tiempo (AU)

Objective: To compare presurgical hand hygiene with hydroalcoholic solution following the WHO protocol with traditional presurgical hand hygiene. Methods: Cultures of the hands of surgeons and surgical nurses were performed before and after presurgical hand hygiene and after removing gloves at the end of surgery. Cultures were done in 2different days: the first day after traditional presurgical hand hygiene, and the second day after presurgical hand hygiene with hydroalcoholic solution following the WHO protocol. The duration of the traditional hand hygiene was measured and compared with the duration (3min) of the WHO protocol. The cost of the products used in the traditional technique was compared with the cost of the hydroalcoholic solution used. The variability of the traditional technique was determined by observation. Results: Following presurgical hand hygiene with hydroalcoholic solution, colony-forming units (CFU) were detected in 5 (7.3%) subjects, whereas after traditional presurgical hand hygiene CFU were detected in 14 subjects (20.5%) (p < 0.05). After glove removal, the numbers of CFU were similar. The time employed in hand hygiene with hydroalcoholic solution (3min) was inferior to the time employed in the traditional technique (p < 0.05), its cost was less than half, and there was no variability. Conclusions: Compared with other techniques, presurgical hand hygiene with hydroalcoholic solution significantly decreases CFU, has similar latency time, a lower cost, and saves time (AU)

Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene.

To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 patients, a single-use ethanol hand sanitizer packet took less time to access than a single-use moist towelette packet (3 vs 23 seconds) and was preferred by 74% of patients for mealtime hand hygiene. Performance of patient hand hygiene increased when a reminder was provided at the time of meal tray delivery.

Evaluación de formación y destreza de la asepsia de manos empleando lámpara ultravioleta / Evaluation of education and skills in hand hygiene using ultraviolet light lamp

Objetivo principal: La higiene de manos (HM) es fundamental para una atención sanitaria limpia y segura. Los futuros profesionales de enfermería deben adquirir conocimientos tanto teóricos como prácticos en materia de HM. Metodología: Se evaluó la técnica de HM, registrando las regiones de las manos con/sin exposición a la solución alcohólica marcada con fluoresceína mediante una lámpara de luz ultravioleta. Resultados principales: Evaluamos 71 alumnos, 56,3 % de 2o curso y 43,7% de 3er curso de Enfermería. El 73,3% fueron mujeres. Realizaron la HM bien o muy bien el 45,1% de los alumnos. Las zonas donde con más frecuencia no se extendió la solución alcohólica fueron los pulgares (54,9%) y dorso (46,5%). No hubo diferencias significativas entre los dos cursos. Conclusión principal: El papel de la educación es fundamental para sentar las bases de buenas prácticas en HM, en conocimientos teóricos y en el desarrollo de habilidades y reforzamiento de buenas prácticas

Objective: Hand hygiene (HH) is essential for a clean and safe healthcare. The future nurses have to acquire both, theoretical and practical, knowledge, competencies and skills on HH. Methods: The HH technique was evaluated using an alcoholic solution incorporating fluorescent marker and ultraviolet lamp, and recording regions of the hands with / without exposure. Results: We evaluated 71 students, 56.3% in the 2nd year and 43.7% of 3rd year of Nursing School. The 73.3% were women. The HH was performed very good or good by 45.1% of students. The areas that alcoholic solution didn't reached most frequently were thumbs (54.9%) and dorsal part of hand (46.5%). No significant differences between courses were found. Conclusions: The role of education is essential to lay the foundation of good technique in HH, in theoretical knowledge and in the development of skills and reinforcement of good practices