Home and community hygiene and the use of alcoholbased hand sanitizers

1
Home and community hygiene and the use of
alcohol-based hand sanitizers
Sally Bloomfield, BPharm, PhD Chairman and
Scientific Advisory Board Member, IFH Hon.
Professor, London School of Hygiene and Tropical
Medicine
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The International Scientific Forum on Home
Hygiene (IFH)
www.ifh-homehygiene.org

• A not-for-profit, non-governmental organization
  comprising scientists healthcare professionals
• Primary objectives
• Promote awareness and understanding of good
  hygiene practice and its importance in the home -
  based on scientific evidence
• Target Audience
• Public health scientists, opinion formers, health
  professionals, community workers
• Activities
• Detailed review of scientific literature on home
  hygiene
• Formulate Guidelines on home hygiene

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The role of home and community hygiene

• Good hygiene practice is key to reducing
  infection risks
• even in 21st century where we have access to
  clean water, sanitation, vaccines, antibiotics
  etc
• Good hygiene practice is important
• in the home
• in social and workplace settings
• child and elderly daycare centers
• schools, offices
• theaters, cinemas, cafes, restaurants
• military establishments
• travel by rail, air, ship
• The home forms a continuum with community
  settings

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IFH - developing effective policy for home
hygiene

• In formulating home hygiene policy, the IFH has
  adopted a risk assessment approach (HACCP)
• This has come to be known as targeted hygiene
• Infectious disease agents are continually brought
  into the home
• People infected or carriers
• Food up to 50 of raw chicken may contain
  Salmonella or Campylobacter
• Pets up to 39 of dogs may carry Campylobacter,
  10-27 may carry Salmonella cats are also
  carriers
• Toilets, basins, wet cloths etc can support
  growth of microbes and become a source of
  infectious agents

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IFH - developing effective policy for home
hygiene

• Targeted hygiene
• is not about trying to eradicate pathogenic
  microbes from the home through daily cleaning
• means targeting hygiene measures to places and
  times that matter

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Targeted home hygiene - importance of hands

• Since targeted hygiene focuses on preventing
  spread of germs, major target sites are hands,
  and hand and food contact surfaces, and cloths -
  in the kitchen, bathroom and toilet
• Indications are that the hands are probably the
  most important agents for disease transmission in
  the home

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Handwashing intervention studies

• Aiello and Larson (2002) evaluated intervention
  observational studies, 1980 - 2001, in US, Canada
  and Australia.

Risk reduction ranged from 21-77
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Microbiological studies

• In recent years a range of microbiological
  studies have been published, many related
  specifically to the home community which
  indicate
• infectious agents continually brought into these
  settings
• dispersed to hands and other surfaces
• survive for significant periods
• transfer of pathogens via the hands to the mouth,
  nose, conjunctiva etc and/or to ready to eat
  foods in sufficient numbers to cause infections
• In view of problems of performing clinical trials
  for prophylactic measures such as home hygiene -
  it is important that we use these data (e.g in
  QMRA) for assessing infection risks - and the
  impact of hygiene practices

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Targeted home hygiene - Handwashing and risk
reduction

• In situations where there is significant risk of
  infection, hygiene procedures are used to reduce
  the risks by eliminating contamination and
  preventing further spread.
• For hand hygiene
• generally assumed that contamination can be
  effectively removed using soap (or detergent) and
  water.
• since this process relies on mechanical release
  of microbes, to be effective it must be applied
  in conjunction with rinsing with running water.

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Targeted home hygiene Alcohol-based hand
sanitizers

• Because soap and water are not always available
• especially in out-of-home settings - schools,
  daycare centers, social settings, travel etc.
• There is a need for products that are portable,
  convenient, waterless, and effective.
• No rinse alcohol-based hand sanitizers (ABHS)
  meet the need for maintaining hand hygiene when
  soap and water are not available and when hands
  are not visibly dirty.

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Effectiveness of alcohol-based hand sanitizers

• No-rinse hand sanitizers need to be
• active against a broad spectrum of bacteria,
  viruses and fungi representative of infectious
  agents commonly found in home and out-of-home
  settings, and for which there is evidence of
  infection spread via the hands
• fast acting - 30 seconds to one minute
• equally or more effective than soap and water
• Available data on ABHS indicate good efficacy
  profile
• in vivo (panel tests) reduction of bacteria and
  viruses on artificially contaminated hands
• in vitro time-kill studies to evaluate spectrum
  of activity
• intervention studies

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In vivo testing of alcohol-based hand sanitizers
Efficacy of ABHS in reduction of microbes on
contaminated hands
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In vitro testing of alcohol-based hand sanitizers
some strains of rhinovirus (e.g. type 16) give
log redn gt4.25
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Intervention studies with alcohol-based hand
sanitizers
Intervention HW handwashing HE hygiene
education ABHS use of ABHS (ethyl or isopropyl
alcohol 60-90) NSR no significant reduction
For infectious illness/symptoms across all
studies - median reduction was 22.0 (range
8-66) Personal communication from A. Aiello
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Safety of alcohol-based hand sanitizers

• No evidence of alcohol or antibiotic resistance
  associated with the use of ABHS
• non selective action - membrane disruption,
  coagulation of cell contents
• evaporates - leaves no active residue
• active against antibiotic resistant strains, e.g.
  MRSA
• EPA concludes that aliphatic alcohols not
  intended for ingestion are of low acute toxicity
• ABHS formulated with appropriate emollients cause
  less skin irritation than soap and water in
  frequent-use situations

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Conclusions

• Home hygiene practice is key to reducing the
  burden of infectious disease in the community
• Hand hygiene is a key component of good hygiene
  practice
• Alcohol-based hand sanitizers provide an
  effective alternative in situations where soap
  and water are not available and may encourage
  compliance
• Based on their safety and lack of antimicrobial
  resistance/ cross-resistance, alcohol-based hand
  sanitizers are appropriate for use in consumer
  settings
• Benefit/ risk profile is positive

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US government non-governmental organizations
recommend use of alcohol-based hand sanitizers
when soap and water are not available

• Governmental organizations include
• Federal Food and Drug Administration
• Federal Trade Commission
• U.S. Departments of Education and Labor
• Centers for Disease Control and Prevention
• Environmental Protection Agency
• National Institute of Allergy and Infectious
  Diseases
• State Departments of Health, county governments,
  and public schools
• U.S. Military branches include
• Air Force, Army, Navy
• Non-governmental groups include
• American Red Cross
• American Association of Occupational Health
  Nurses
• American Hospital Association
• Association for Professionals in Infection
  Control and Epidemiology
• Infectious Diseases Society of America
• Society for Healthcare Epidemiology of America