Disinfecting hands in the coronavirus pandemic
Disinfecting hands has gained attention due to the SARS-CoV2 pandemic. As is uniformly agreed hand hygiene is central to preventing infections from spreading. Certain aspects need to be considered in reducing the risk of infection. How, when and what exactly is used is crucial. The question of which sanitisers or spray sanitisers are suitable for hands and skin and effective in combating Covid-19 is a matter of high concern.
As to terminology it should be noted that DIN EN 1500 is the standard test to ensure that skin and hand sanitisers reduce germs by a minimum factor of 10-5.
When should hand sanitisers be used?
Private and professional environments need to be distinguished, along with how high or low the risk of pathogen transmission is and in how far pathogen transmission is a high risk for people and things.
The start of the coronavirus pandemic certainly marks a turning point. While it was frequently communicated that sanitisers do not make sense in private environments, this has now changed. Normally, the human immune system is very well able to cope with pathogens encountered in everyday life. The new coronavirus, however, is a challenge, which renders a conscious approach to new dangers highly important.
Proper and sufficient hand sanitisation is essential in professional (and private) dealings with large crowds, in professional food preparation and processing and in medical and custodial settings.
So, when should hand sanitisers be used? Not as often as possible but rather when required such as when hands may be contaminated and before touching other things that may transmit germs or viruses to other people.
How are hand sanitisers used properly?
Suitable sanitisers should be spread thoroughly on dry hands and rubbed in for 30 seconds. Hands should be kept moist during this process. If necessary, more disinfectant should be added. Normally, 3 ml are required.
If sanitisers are used by several people attention should be paid to hygienic dispensation. Non-contact dispensers with sensors or with arm levers are an option here. Elbows should be used to operate the latter.
Standard surgical hand disinfections require 2x3 ml of disinfectant and a residence time of 5 min. Applications differ according to product.
Which products are suitable?
In pandemic times safe disinfectants comprise products that have “virucidal”, “limited virucidal plus” or “limited virucidal” efficacy.
Hand sanitisers that are effective after 30 seconds accord with DIN EN 1500. Suitable products are, for instance, listed by Germany’s Robert Koch Institute (RKI) or the Association for Applied Hygiene (VAH). Such product lists also exist in other countries and usually indicate the virucidal efficacy.
Germany accredited five hand rub formulations recommended by the WHO on a temporary basis at the start of the pandemic, two of which have proven their limited virucidal efficacy. These are:
WHO formulation I with 85.5% (v/v) ethanol, 0.725% glycerol, 0.125% H2O2 and
WHO formulation II with 75.5% (w/w) isopropanol, 0.725% glycerol, 0.125% H2O2.
These special licences allowed for a speedy use of suitable hand sanitisers alongside established products such as Sterillium virugard, Sterillium med, Sterillium classic pure, Bacillol or Sagrotan.
Germany’s Federal Institute for Drugs and Medical Devices, which is responsible for licencing drugs, states that only the products containing the following active ingredients may be classed with “limited virucidal” efficacy:
Ethanol 80% v/v, ethanol 80% v/v denatured with butan-2-one, 2-propanol 70% v/v and 2-propanol 80% v/v. Other recommended formulations do not become effective within the required residence time, but rather take one minute.
As supplies of suitable and established products (i.e. Sterillium virugard, Sterillium med, Sterillium classic pure, Bacillol or Sagrotan et al.) started to run low as the virus gained momentum, other products entered the market whose efficacy could not always be proven. These comprise solubles generated by electrolytic dissolution that contain sodium hypochlorite and hypochlorous acid. Since these products filed registration in accordance with procedures set out by Germany’s Federal Institute for Drugs and Medical Devices they may be marketed, although they have not been tested for licencing.
The disruption of transmission routes by means of proper hand disinfection is vital in fighting the coronavirus. Proper usage and application and the right products are decisive.
A general awareness that induvial action can protect one’s personal health and the health of others is also essential.Sources:
- RKI - Epidemiologisches Bulletin 19/2020 7. Mai 2020
- BfArm: Allgemeinverfügung zu zeitlich befristeten Abweichungen vom Inhalt der Zulassung von alkoholhaltigen Arzneimitteln zur hygienischen Händedesinfektion
- BAuA: Allgemeinverfügung zur Zulassung 2-Propanol-haltiger und Ethanol-haltiger Biozidprodukte zur hygienischen Händedesinfektion zur Abgabe an und Verwendung durch berufsmäßige Verwender und Verbraucher sowie zur Zulassung 1-Propanol-haltiger Biozidprodukte zur hygienischen Händedesinfektion zur Abgabe an und Verwendung durch berufsmäßige Verwender aufgrund einer Gefahr für die öffentliche Gesundheit und zur Aufhebung der Allgemein-verfügungen vom 4. und vom 20. März 2020
Survey: hygiene measures in light of the coronavirus
SEEHEIM. The AUDITOR has conducted an anonymous survey on hygiene among companies in different industrial sectors. Excerpts of the answers provided are illustrated in an abstract as a means of displaying the situation in Germany.
1. Does your staff receive regular training on current stipulations, the necessity to adhere to anti-coronavirus measures and hygiene concepts?
Nearly all participants declared that updated hygiene concepts notices are well visible for all and the member of staff are regularly informed over changes. The spokesman of a large fast food chain adds: All members of staff receive regular training on updated guidelines by means of check lists and confirm training with their signatures. Restaurant managements, franchise operators and local advisors review implementations on a regular basis. A large bakery chain mentions hygiene checks that were frequently conducted by quality management at the start of the pandemic: They were meant to provide support to franchise partners in implementing measures. Our area managers, in addition, coach facilities. The implementation of all hygiene measures is reviewed at every visit and extra training provided if necessary.
2. How do you ensure that measures are implemented in such a way that they are effective?
A large retail store chain states that: Our employees are obliged to observe strict hygiene standards in accordance with the Infection Protection Act all year round. We have, in addition, provided employees with hand sanitisers, hygiene gloves and nurturing hand creams (as well as face masks). Stores will add further measures if needed. Compliance is also crucial in the fast food industry. “If employees fail to follow guidelines, they receive extra training and made aware of how important it is to abide by guidelines”, as a spokesman explains.
3. How do you respond when employees or customers deliberately ignore the regulations that apply?
Since general social distancing rules and the mandatory use of face masks apply nearly all participants agree to exercise property rights and to ask customers to leave the premise if necessary. A spokesperson from the bakery industry states that:
Clearly visible general up-to-date regulations have been put up in all stores. Customers are kindly advised to take note of the regulations that apply. Should some customers refuse to wear masks or to abide by social distancing rules, which still apply on a national level, the franchise partner or his employees may exercise property rights and ask customers to leave the store. This is necessary to protect staff and customers. A fast food representative illustrates a similarly strict response since “guests […] are advised to abide by the rules – access to a restaurant is prohibited if an amicable agreement cannot be reached.” A retailer rather relies on his customers’ common sense: Floor stickers highlight the minimum distance as preventive measure to protect staff. Due to the current situation we clarify this with signs and in-store radios. Our customers can thereby also provide a valuable contribution in keeping their distance and act in considerate and respectful manner.
4. Were your sanitary article suppliers able to provide you with all products at the start of the pandemic?
“Due to our forward-looking planning and close cooperation with our standing supplier we were able to cover our required supplies of sanitary products and prevent a shortage,” as a fast food chain explains. Good planning also guarantied supplies in the bakery industry: Despite squeezes in the market we were able to supply all stores with face masks when they became mandatory. Hygiene is of course of great importance in our area anyway. We were well equipped from the very start and experienced no shortages. There are no supply squeezes at present, and we are very well provided for.
5. Is attention being paid to using disinfectant with at least limited virucidal activity to curb the spread of viral Covid-19 agents?
Since not all agents are effective in curbing the coronavirus or other viruses precise criteria need to be in place in selecting the proper disinfectant to be used. Most participants were rather evasive in answering this question. One fast food restaurant, however, confirmed that the disinfectant it used has limited virucidal activity. A bakery chain, in addition, reported that it uses hand sanitisers and surface disinfectants that contain alcohol (propanol and ethanol), which also have virucidal efficacy.
6. How do you help staff and customers to follow guidelines?
A large retail group states that: Due to the decentralised cooperative structure I do not have any information on any ‘critical events’ in the stores. Our employees are generally required to ensure that operations are failure-free in the stores (including self-preservation and customer protection), which may mean that property rights may also be exercised. A bakery chain relies on clear signs: Every store is provided with hygiene signs, walking directions and the current access policy. Customers are advised on applicable guidelines and asked to follow them for the benefit of all before entering the stores. Pictograms are standard to help everyone pick up important information. Some stores also have displays providing customers with the latest information.
The AUDITOR thanks all participants. Please understand that only excerpts are give due to capacity reasons.