Hygienic hand antiseptics: Should they not have activity and label claims against viruses?

Abstract

Enteric and respiratory viruses are among the most frequent causes of human infections, and hands play an important role in the spread of these and many other viral diseases. Regular and proper hand hygiene by caregivers and food handlers in particular is essential to decontaminate hands and potentially interrupt such spread. What would be considered a proper decontamination of hands? Handwashing with regular soap and water is often considered sufficient, but what of hygienic handwash and handrub antiseptic products? Are they more effective? The evidence suggests that some clearly are. Activity against bacteria may not reflect the ability of hygienic hand antiseptics to deal with viruses, especially those that are nonenveloped. In spite of the acknowledged importance of hands as vehicles for viruses, there is a lack of suitable regulatory mechanism for handwash or handrub products to make claims of efficacy against viruses. This is in contrast with the ability of general-purpose disinfectants to make antiviral claims, although transmission of viruses from surfaces other than those of reusable medical devices may play only a minor role in virus transmission. This review discusses the (1). recent information on the relative importance of viruses as human pathogens, particularly those causing enteric and respiratory infections; (2). the survival of relevant viruses on human hands in comparison with common gram-negative and gram-positive bacteria; (3). the potential of hands to transfer or receive such contamination on casual contact; (4). role of hands in the spread of viruses; (5). the potential of hygienic measures to eliminate viruses from contaminated hands; (6). relative merits of available protocols to assess the activity of hygienic hand antiseptics against viruses; and (7). factors considered crucial in any tests to assess the activity of hygienic hand antiseptics against viruses. In addition, this review proposes surrogate viruses in such testing and discusses issues for additional consideration by researchers, manufacturers, end-users, and regulators.

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…212 It has been shown that RSV can be carried and spread to others on the hands of caregivers. 213 Studies have shown that health care workers have acquired infection by performing activities such as feeding, diaper change, and playing with the RSV-infected infant. Caregivers who had contact only with surfaces contaminated with the infants' secretions or touched inanimate objects in patients' rooms also acquired RSV.…”

Diagnosis and Management of Bronchiolitis

“…149 It has been shown that RSV as well as many other viruses can be carried and spread to others on the hands of caregivers. 150 Frequent hand-washing by health care workers has been shown to reduce RSV's nosocomial spread. 150 The Centers for Disease Control and Prevention published an extensive review of the hand-hygiene literature and made recommendations as to indications for hand-washing and hand antisepsis.…”

“…150 Frequent hand-washing by health care workers has been shown to reduce RSV's nosocomial spread. 150 The Centers for Disease Control and Prevention published an extensive review of the hand-hygiene literature and made recommendations as to indications for hand-washing and hand antisepsis. 151 Among the recommendations are that hands should be decontaminated before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves.…”

Hand hygiene: simple and complex

“…While these are among the most frequent causes of community and hospital infection, viruses are also extremely important and are far more difficult to investigate. 99 Studies on hand hygiene have been mainly observational and may be subject to reactive biases because of the presence of an observer. 94 Blinding, randomisation and controlling for confounding variables may not be feasible.…”