# Presentation: 572210

## 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**

## The International Scientific Forum on Home Hygiene (IFH)	

**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”**

- www.ifh-homehygiene.org

## 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**** **

## 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**

## 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**

## 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**

## Handwashing intervention studies

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

**Risk reduction: ranged from 21-77%**

## 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**

## 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.**

## 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. **

## 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**

## In vivo testing of alcohol-based hand sanitizers

**Efficacy of ABHS in reduction of microbes on contaminated hands**

## In vitro testing of alcohol-based hand sanitizers

- *some strains of rhinovirus (e.g. type 16) give log red’n >4.25

## 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**

## 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**

## 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**

## 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