INF ECTION P R EVENTION
also needs consideration. In a study of 100 patients, the hands of 39% were found to be contaminated with at least one pathogenic organism within 48 hours of hospital admission. This indicates that hand hygiene measures should also include patients.17 Hand hygiene with alcohol-based hand rub (ABHR) is widely accepted as one of the most effective, simple and low-cost procedures to help prevent cross-transmission of pathogens. By denaturing proteins, alcohol inactivates enveloped viruses such as coronaviruses and ABHR formulations with at least 60% ethanol have been proven to be effective for hand hygiene. 18 Researchers found that when exposed to an ethanol-based disinfectant, the SARS- CoV-2 virus on human skin is completely inactivated within 15 seconds.15 An in vitro experiment also demonstrated that alcohol solutions are effective against enveloped viruses including severe acute respiratory syndrome coronavirus, Ebola virus, and Zika virus.19
The actual formulation of an ABHR is critical. The antimicrobial agents within the product need to work in conjunction with added components like moisturiser, without compromising each other. An ABHR for use in hospitals should conform to stringent testing, for example European Norms (EN): EN 1500, EN 12791 and EN 14476. When selecting an ABHR for use in hospitals, it is essential that it is formulated with additional moisturisers and re-fattening agents to help protect the hands. This is also likely to improve compliance if the ABHR is not drying out the hands. In the healthcare environment staff use a hand sanitiser nine times an hour, on average.20 There is, however, limited data for the virucidal efficacy of non-alcohol- based sanitisers containing quaternary ammonium compounds (most commonly benzalkonium chloride) and therefore they are not recommended for protection against COVID-19.21
Even with high vaccination rates in the UK, the transmission of SARS-CoV-2 and other potentially nosocomial pathogens remain a considerable risk in healthcare settings. Breaking the chain of hands and environmental cross-contamination is a key strategy in protecting both staff and patients from infection.
J Environ Res Public Health. 2020;17(9):3132. Published 2020 Apr 30. doi:10.3390/ ijerph17093132
3 Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents [published correction appears in J Hosp Infect. 2020 Jun 17;:]. J Hosp Infect. 2020;104(3):246- 251. doi:10.1016/j.jhin.2020.01.022
4 Yezli S, Barbut F, Otter JA. Surface contamination in operating rooms: a risk for transmission of pathogens?. Surg Infect (Larchmt). 2014;15(6):694-699. doi:10.1089/sur.2014.011
5 Russotto V, Cortegiani A, Raineri SM, Giarratano A. Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. J Intensive Care. 2015;3:54. Published 2015 Dec 10. doi:10.1186/s40560-015-0120-5
6 Kraay ANM, Hayashi MAL et al, Fomite-mediated transmission as a sufficient pathway: a comparative analysis across three viral pathogens BMC Infect Dis. 2018 Oct 29;18(1):540.
7 van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS- CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/ NEJMc2004973
8 Guo ZD, Wang ZY, Zhang SF, et al. Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020. Emerg Infect Dis. 2020;26(7):1583- 1591. doi:10.3201/eid2607.200885
9 Chia PY, Coleman KK, Tan YK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun. 2020;11(1):2800. Published 2020 May 29. doi:10.1038/s41467-020-16670-2
10 Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, Marimuthu K (2020) Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. Jama. 10.1001/jama.2020.3227
11 Lee SE, Lee DY, Lee WG, et al. Detection of Novel Coronavirus on the Surface of Environmental Materials Contaminated by COVID-19 Patients in the Republic of Korea. Osong Public Health Res Perspect. 2020;11(3):128-132. doi:10.24171/j. phrp.2020.11.3.03
CSJ
References 1 Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg SD, Weber DJ. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. J Hosp Infect. 2016;92(3):235-250. doi:10.1016/j.jhin.2015.08.027
2 Fiorillo L, Cervino G, Matarese M, et al. COVID-19 Surface Persistence: A Recent Data Summary and Its Importance for Medical and Dental Settings. Int
MAY 2021
12 Zhou J, Otter JA, Price JR, et al. Investigating SARS- CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London [published online ahead of print, 2020 Jul 8]. Clin Infect Dis. 2020;ciaa905. doi:10.1093/cid/ciaa905
13 World Health Organization, 2020, accessed 090421
https://who.int/infection-prevention/campaigns/ clean-hands
14 Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk Factors of Healthcare Workers With Coronavirus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China. Clin Infect Dis. 2020;71(16):2218-2221. doi:10.1093/cid/ ciaa287
15 Hirose R, Ikegaya H, Naito Y, et al. Survival of SARS-CoV-2 and influenza virus on the human skin:
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About the author
Dr Kayleigh Cox-Nowak received her
M.Chem in biological chemistry and Ph.D. in chemistry from the University of Sheffield. She subsequently spent 8 years working in chemical manufacturing, starting as a research and development chemist and progressing to technical manager. In 2020 she joined Schülke & Mayr UK as technical support manager.
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