Analysis of alcohol-based hand sanitizer delivery systems: Efficacy of foam, gel, and wipes against influenza A (H1N1) virus on hands

doi:10.1016/j.ajic.2011.10.016

American Journal of Infection Control

Volume 40, Issue 9, November 2012, Pages 806-809

https://doi.org/10.1016/j.ajic.2011.10.016 Get rights and content

Background

Minimal research has been published evaluating the effectiveness of hand hygiene delivery systems (ie, rubs, foams, or wipes) at removing viruses from hands. The purposes of this study were to determine the effect of several alcohol-based hand sanitizers in removing influenza A (H1N1) virus, and to compare the effectiveness of foam, gel, and hand wipe products.

Methods

Hands of 30 volunteers were inoculated with H1N1 and randomized to treatment with foam, gel, or hand wipe applied to half of each volunteer’s finger pads. The log₁₀ count of each subject’s treated and untreated finger pads were averaged. Log₁₀ reductions were calculated from these differences and averaged within treatment group. Between-treatment analysis compared changes from the untreated finger pads using analysis of covariance with treatment as a factor and the average log₁₀ untreated finger pads as the covariate.

Results

Log₁₀ counts on control finger pads were 2.7-5.3 log₁₀ of the 50% infectious dose for tissue culture (TCID₅₀/0.1 mL) (mean, 3.8 ± 0.5 log₁₀ TCID₅₀/0.1 mL), and treated finger pad counts for all test products were 0.5-1.9 log₁₀ TCID₅₀/0.1 mL (mean, 0.53 ± 0.17 log₁₀ TCID₅₀/0.1 mL). Treatments with all products resulted in a significant reduction in viral titers (>3 logs) at their respective exposure times that were statistically comparable.

Conclusions

All 3 delivery systems (foam, gel, and wipe) produced significantly reduced viral counts on hands.

Section snippets

Sample and setting

Thirty-three research subjects were selected from a proprietary database of volunteers maintained by Hill Top Research, Inc (Miamiville, OH). Inclusion criteria were age 18-65 years; male or nonpregnant female; in good health with no skin lesions, tattoos, or diseases, such as psoriasis; no artificial nails; no responsibilities for care of children age <3 years or diapering, care of wounds, intravenous management, or any other bedridden- related care roles.

Test products

Three hand sanitizers—a foam rub, a

Results

For all subjects, log₁₀ counts on untreated (control) finger pads (finger pads inoculated with virus and allowed to dry but not treated with test product) were 2.7-5.3 log₁₀ TCID₅₀/0.1 mL (mean, 3.8 ± 0.5 log₁₀ TCID₅₀/0.1 mL) and treated finger pad counts for all test products were 0.5-1.9 log₁₀ TCID₅₀/0.1 mL (mean, 0.53 ± 0.17 log₁₀ TCID₅₀/0.1 mL). Titers of 0.5 TCID₅₀/0.1 mL were the zero detection limit with this method. All product treatments resulted in a significant reduction in viral

Discussion

Although good hand hygiene has been shown to reduce rates of respiratory infection in community studies,7, 8 there have been few comparisons of the relative efficacy of various hand hygiene products. Grayson et al⁹ examined the viability of influenza A (H1N1) on hands and assessed the effectiveness of 4 hand hygiene products (soap and water and 3 alcohol-containing sanitizers) in 20 volunteers using an artificial contamination method similar to ours. Significant reductions in counts were seen

References (16)

J.M. Boyce et al.
Guideline for hand hygeine in the healthcare setting
Am J Infect Control
(2002)
A.M. Butz et al.
Alcohol-impregnated wipes as an alternative in hand hygiene
Am J Infect Control
(1990)
A. Kramer et al.
Limited efficacy of alcohol-based hand gels
Lancet
(2002)
N.N. D’Antonio et al.
Revisiting the hand wipe versus gel rub debate: is a higher-ethanol content hand wipe more effective than an ethanol gel rub?
Am J Infect Control
(2010)
World Health Organization. Guidelines on hand hygiene in health care, 2009. Available from:...
K. Ellingson et al.
Reexamining methods and messaging for hand hygiene in the era of increasing Clostridium difficile colonization and infection
Infect Control Hosp Epidemiol
(2010)
S.A. Ansari et al.
Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14
J Clin Microbiol
(1991)
L. Reed et al.
A simple method of estimating fifty percent endpoints
Am J Hygiene
(1938)

There are more references available in the full text version of this article.

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Citation Excerpt :
There is limited research on comparing the efficacy of various sanitizer delivery systems on virucidal efficacy. One study with 30 human volunteers showed >3 log10 reductions of H1N1 viral counts on finger pads with foam, gel, and wipes with no differences in efficacy among delivery types.50 Similar findings were seen by Grayson et al, comparing ethanol based gel and liquid forms on H1N1.51
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.
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.
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.
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.
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To test whether sprayed ABHR can be an alternative (non-inferior) method for effective hand hygiene with/without handrubbing.
A laboratory experiment was conducted with ABHR (isopropanol 60% v/v) according to European Norm 1500. Hand hygiene was performed by: (1) handrubbing with ABHR poured on to the palm of the hand; (2) handrubbing with sprayed ABHR; and (3) applying sprayed ABHR to hands without handrubbing. Hands were contaminated with Escherichia coli ATCC 10536, followed by hand hygiene and microbiological sampling. A generalized linear mixed model with a random intercept per subject was used to analyse the reduction in bacterial count following hand hygiene.
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: Supported in part by funding from Professional Disposables International, Inc, Orangeburg, NY.

: Conflict of interest: None to report.

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American Journal of Infection Control

Background

Methods

Results

Conclusions

Section snippets

Sample and setting

Test products

Results

Discussion

References (16)

Guideline for hand hygeine in the healthcare setting

Am J Infect Control

Alcohol-impregnated wipes as an alternative in hand hygiene

Am J Infect Control

Limited efficacy of alcohol-based hand gels

Lancet

Revisiting the hand wipe versus gel rub debate: is a higher-ethanol content hand wipe more effective than an ethanol gel rub?

Am J Infect Control

Reexamining methods and messaging for hand hygiene in the era of increasing Clostridium difficile colonization and infection

Infect Control Hosp Epidemiol

Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14

J Clin Microbiol

A simple method of estimating fifty percent endpoints

Am J Hygiene

Cited by (59)

Biosynthesis of silver nanoparticles using nitrate reductase from Aspergillus terreus N4 and their potential use as a non-alcoholic disinfectant

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

Handrubbing with sprayed alcohol-based hand rub: an alternative method for effective hand hygiene

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update

Alcohol-based hand sanitizers as first line of defense against SARS CoV-2: A review of biology, chemistry and formulations

Quality and safety of South African hand sanitisers during the COVID-19 pandemic

Major articleAnalysis of alcohol-based hand sanitizer delivery systems: Efficacy of foam, gel, and wipes against influenza A (H1N1) virus on hands

Background

Methods

Results

Conclusions

Section snippets

Sample and setting

Test products

Results

Discussion

Am J Infect Control

Am J Infect Control

Lancet

Am J Infect Control

Reexamining methods and messaging for hand hygiene in the era of increasing Clostridium difficile colonization and infection

Infect Control Hosp Epidemiol

Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14

J Clin Microbiol

A simple method of estimating fifty percent endpoints

Am J Hygiene

Major article
Analysis of alcohol-based hand sanitizer delivery systems: Efficacy of foam, gel, and wipes against influenza A (H1N1) virus on hands