ROLE OF HAND ROLE OF HAND SANITIZERS IN SANITIZERS IN

INFECTION CONTROL INFECTION CONTROL AMONG HEALTH CARE AMONG HEALTH CARE

WORKERS (HCWs)WORKERS (HCWs)

SKP PHARMA LTD.SKP PHARMA LTD.5, Vori Close, off Acme Road, Ogba, Lagos.5, Vori Close, off Acme Road, Ogba, Lagos.

To be presented by:

OKE, MUSHAFAU ADEBAYO

INTRODUCTIONINTRODUCTION Hospital-associated infections represent a serious and Hospital-associated infections represent a serious and

growing health problem. growing health problem. (Harley et. al., 1985)(Harley et. al., 1985)

The Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC) estimates that approx. 2 million people acquire hospital-estimates that approx. 2 million people acquire hospital-associated infections each year and that approx. 90 000 associated infections each year and that approx. 90 000 of these patients die as a result of their infections.of these patients die as a result of their infections. (Zerr, et. (Zerr, et. al. 2005)al. 2005)

Healthcare workers carry antibiotic-resistant bacteria, Healthcare workers carry antibiotic-resistant bacteria, fungi, and viruses on their hands and act as a vector of fungi, and viruses on their hands and act as a vector of transmission. transmission. ( ( http://www.med.yale.edu/ynhh/infection/presentations/slide3.htmlhttp://www.med.yale.edu/ynhh/infection/presentations/slide3.html))

The CDC and many other experts promote hand hygiene The CDC and many other experts promote hand hygiene as the single most important measure in the prevention as the single most important measure in the prevention of hospital-associated infections. of hospital-associated infections. (Boyce and Pitter, 2002)(Boyce and Pitter, 2002)

Hand Hygiene has 2 major components which Hand Hygiene has 2 major components which are:are:

HandwashingHandwashing - removal of microorganisms  - removal of microorganisms (germs) with (ordinary) soap and water.(germs) with (ordinary) soap and water.

Hand AntisepsisHand Antisepsis - removal or destruction of  - removal or destruction of microorganisms using an antimicrobial soap or an microorganisms using an antimicrobial soap or an alcohol-based hand rub.alcohol-based hand rub.

Despite the evidence and expert opinion Despite the evidence and expert opinion supporting hand hygiene, many studies have supporting hand hygiene, many studies have shown that health care workers perform it approx. shown that health care workers perform it approx. 50% of the times they should. 50% of the times they should. (Zerr, et. al. 2005)(Zerr, et. al. 2005)

Barriers to HCW hand hygiene compliance:Barriers to HCW hand hygiene compliance: lack of time lack of time skin damage that accompanies frequent skin damage that accompanies frequent

washing with soap and water.washing with soap and water.

What are hand sanitizers?What are hand sanitizers? alcohol-containing preparations designed for alcohol-containing preparations designed for

application to the hands for reducing the application to the hands for reducing the number of viable microorganisms on the hands. number of viable microorganisms on the hands. (CDC, 2002)(CDC, 2002). .

They are used for avoiding the transmission of They are used for avoiding the transmission of pathogens.pathogens.

supplements or alternatives to hand washing supplements or alternatives to hand washing with soap and water. with soap and water. (FDA, 2009)(FDA, 2009). .

TypesTypes Various preparations are available, including Various preparations are available, including

gel, foam, and liquid solutions. gel, foam, and liquid solutions. Active IngredientsActive Ingredients

isopropanol, ethanol, n-propanol, or povidone-isopropanol, ethanol, n-propanol, or povidone-iodine. iodine.

Inactive IngredientsInactive Ingredients a thickening agent such as polyacrylic acid for a thickening agent such as polyacrylic acid for

alcohol gels,alcohol gels, humectants such as glycerin for liquid rubs, humectants such as glycerin for liquid rubs, propylene glycol, and essential oils of plants.propylene glycol, and essential oils of plants.

Antimicrobial ActivityAntimicrobial Activity antimicrobial activity of alcohols can be antimicrobial activity of alcohols can be

attributed to their ability to denature proteins attributed to their ability to denature proteins (Larson and Morson, 1991)(Larson and Morson, 1991) and possibly by dissolving and possibly by dissolving membrane lipids membrane lipids (Prescott et. al., 2002)(Prescott et. al., 2002)..

Alcohol solutions containing 60%–95% alcohol Alcohol solutions containing 60%–95% alcohol are most effective, are most effective,

higher concentrations are less potent because higher concentrations are less potent because proteins are not denatured easily in the absence proteins are not denatured easily in the absence of water of water ((Larson and Morson, 1991Larson and Morson, 1991)). .

Alcohol-based hand gels address the Alcohol-based hand gels address the barriers to HCW hand hygiene compliance:barriers to HCW hand hygiene compliance: they require a fraction of the time for effective they require a fraction of the time for effective

hand washing hand washing (Mody et. al., 2003)(Mody et. al., 2003)

they are less damaging to the skin than soap they are less damaging to the skin than soap and water. and water. (Boyce et. al., 2000)(Boyce et. al., 2000)

more effective in killing many microorganisms more effective in killing many microorganisms (Larson et. al., 2001)(Larson et. al., 2001)

Studies have demonstrated increased frequency Studies have demonstrated increased frequency of hand hygiene and decreased frequency of of hand hygiene and decreased frequency of hospital-associated infections with provision of hospital-associated infections with provision of alcohol hand gels in the context of institution- alcohol hand gels in the context of institution- wide hand hygiene campaigns. wide hand hygiene campaigns. (Zerr, et. al., 2005)(Zerr, et. al., 2005)

Spectrum of ActivitySpectrum of Activity Bacteria and Fungi:Bacteria and Fungi:

germicidal activity against gram-positive and germicidal activity against gram-positive and gram-negative vegetative bacteriagram-negative vegetative bacteria

multidrug-resistant pathogens (e.g., MRSA multidrug-resistant pathogens (e.g., MRSA ((Methicillin-resistant Staphylococcus aureus)Methicillin-resistant Staphylococcus aureus) and VRE (and VRE (Vancomycin-resistant Enterococci)Vancomycin-resistant Enterococci)) )

Mycobacterium tuberculosisMycobacterium tuberculosis, and various , and various fungi fungi

(Price (1939, 1938); Sakuragi et. al., 1995; Kampf et. al., 1999.)(Price (1939, 1938); Sakuragi et. al., 1995; Kampf et. al., 1999.) very poor activity against bacterial spores, very poor activity against bacterial spores,

protozoan oocysts, and certain non-enveloped protozoan oocysts, and certain non-enveloped (nonlipophilic) viruses. (nonlipophilic) viruses. (Coulthard and Sykes, 1936)(Coulthard and Sykes, 1936)

Spectrum of Activity (contd.)Spectrum of Activity (contd.) Viruses:Viruses:

herpes simplex virus, human herpes simplex virus, human immunodeficiency virus [HIV], influenza immunodeficiency virus [HIV], influenza virus, respiratory syncytial virus, and virus, respiratory syncytial virus, and vaccinia virus) vaccinia virus)

Hepatitis B and C are susceptible to 60-70% Hepatitis B and C are susceptible to 60-70% alcohol. alcohol.

rotavirus, adenovirus and rhinovirus are rotavirus, adenovirus and rhinovirus are susceptible to 60-70% ethanol and 70% susceptible to 60-70% ethanol and 70% isopropanol isopropanol .

Hepatitis A and some enteroviruses are susceptible to 70-80% ethanol.

(Platt and Bucknall, 1985; Krilov and Harkness, 1993; Sattar et al, 2001)

Effects on skin rapidly germicidal when applied to the skin.

However, regrowth of the normal skin flora occurs slowly after use (Lilly et. al., 1979).

the drying effect of alcohol on the skin can be reduced or eliminated by adding 1%–3% glycerol or other skin-conditioning agents (Walter, 1965).

Alcohol-based sanitizers vs. Alcohol-based sanitizers vs. ordinary/antimicrobial soapsordinary/antimicrobial soaps an alcohol-based rinse can prevent pathogen an alcohol-based rinse can prevent pathogen

transmission more effectively than can transmission more effectively than can handwashing with plain soap and water when handwashing with plain soap and water when the hands of HCWs are heavily contaminated. the hands of HCWs are heavily contaminated. (Ehrenkranz and Alfonso, 1991)(Ehrenkranz and Alfonso, 1991)

Alcohol-based sanitizers vs. Alcohol-based sanitizers vs. ordinary/antimicrobial soaps (contd.)ordinary/antimicrobial soaps (contd.) alcohol-based products reduced the number of alcohol-based products reduced the number of

multidrug-resistant pathogens recovered from multidrug-resistant pathogens recovered from the hands of HCWs more effectively than did the hands of HCWs more effectively than did handwashing with plain soap and water handwashing with plain soap and water (Huang et (Huang et

al, 1994)al, 1994).. alcohol reduced bacterial counts on hands alcohol reduced bacterial counts on hands

more than washing hands with antimicrobial more than washing hands with antimicrobial soaps or detergents (containing soaps or detergents (containing hexachlorophene, povidone- iodine, 4% hexachlorophene, povidone- iodine, 4% chlorhexidine, or triclosan)chlorhexidine, or triclosan) (Casewell et al, 1988)(Casewell et al, 1988)

alcohol-based rinses or gels containing alcohol-based rinses or gels containing emollients caused substantially less skin emollients caused substantially less skin irritation and dryness than the soaps or irritation and dryness than the soaps or antimicrobial detergents tested antimicrobial detergents tested (Boyce et al, 2000)(Boyce et al, 2000). .

How to useHow to use Apply enough of the product to the palm of Apply enough of the product to the palm of

your hand to wet your hands completely.your hand to wet your hands completely. Rub your hands together, covering all surfaces Rub your hands together, covering all surfaces

until they are dry.until they are dry. around the fingernails, around the fingernails, between the fingers, between the fingers, on the back of the thumb, on the back of the thumb, and around the wrist and around the wrist

If your hands are visibly dirty, however, wash If your hands are visibly dirty, however, wash with soap and water. with soap and water. [CDC, 2002 and Mayo Clinic, 2009 ][CDC, 2002 and Mayo Clinic, 2009 ]

When to UseWhen to Use For HCWFor HCW

Before entering a patient’s room Before entering a patient’s room After contact with a patient After contact with a patient After removing gloves After removing gloves ((

http://www.med.yale.edu/ynhh/infection/presentations/slide15.htmlhttp://www.med.yale.edu/ynhh/infection/presentations/slide15.html ) )

OthersOthers BeforeBefore::

preparing food, eating, treating wounds or giving preparing food, eating, treating wounds or giving medicine, touching a sick or injured person,medicine, touching a sick or injured person,

inserting or removing contact lensesinserting or removing contact lenses After After

preparing food (especially raw meat or poultry), preparing food (especially raw meat or poultry), using the toilet, changing a diaper, touching an using the toilet, changing a diaper, touching an animal or animal toys, leashes or waste, blowing animal or animal toys, leashes or waste, blowing your nose, coughing or sneezing into your hands, your nose, coughing or sneezing into your hands, treating wounds, touching a sick or injured person, treating wounds, touching a sick or injured person, handling garbage or something that could be handling garbage or something that could be contaminated, such as a cleaning cloth or soiled contaminated, such as a cleaning cloth or soiled shoes. shoes. [Mayo Clinic, 2009)[Mayo Clinic, 2009)

Religious ConcernsReligious Concerns Alcohol is considered haraam, or Alcohol is considered haraam, or

forbidden, in Islamic tradition forbidden, in Islamic tradition However, some Islamic scholars and The However, some Islamic scholars and The

Muslim Council of BritainMuslim Council of Britain state that the state that the alcohol in hand sanitizer used as medicine alcohol in hand sanitizer used as medicine is halal, or permissible is halal, or permissible [islamonline.net, 2009][islamonline.net, 2009] because protection against disease is among because protection against disease is among

the aims that Muslims are commanded to the aims that Muslims are commanded to pursue, so it is permissible to touch pursue, so it is permissible to touch [islamonline.net, 2009][islamonline.net, 2009]

the alcohol in hand sanitizer evaporates the alcohol in hand sanitizer evaporates and is not absorbed significantly through and is not absorbed significantly through the skin so it cannot cause intoxication.the skin so it cannot cause intoxication.[(http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC1803104/ ) ][(http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC1803104/ ) ]

SKP HAND SKP HAND SANITIZER GELSANITIZER GEL

Active ingredient: isopropyl alcohol 62%

Other ingredients:

•water

•glycerine

•propylene glycol

•fragrance

•triethanolamine

•carbopol 940

•acetate

•isopropyl myristate

SKP HAND SANITIZER SKP HAND SANITIZER GELGEL

Features and Benefits

•kills up to 99.9% of common germs that can be transmitted by contaminated hands.

•It is easy to use and dries quickly after rubbing for at least 15 seconds.

•provides a better skin tolerance and microbial killing strength when compared to antiseptic soaps.

•It is a viable alternative to hand washing with soap especially where there is no water or use of water may not be appropriate.

SKP HAND SANITIZER SKP HAND SANITIZER GELGEL

Features and Benefits•First to be registered by NAFDAC in Nigeria

•Portable (Different sizes -60ml and 120ml)

•Lemon fragrance

•Cheaper than imported brands

•Made in USA

•Availability

AvailableAvailable

@@ Momrota Pharmacy, Oke Oyi & General, Momrota Pharmacy, Oke Oyi & General,

Ilorin.Ilorin. Ayo Pharmacy, Oke Oyi & Amilegbe, Ilorin.Ayo Pharmacy, Oke Oyi & Amilegbe, Ilorin. Mojlat Pharmacy, Lajorin Road, Muritala, Mojlat Pharmacy, Lajorin Road, Muritala,

Ilorin.Ilorin. Food & Nut Stores, Taiwo Road, Ilorin.Food & Nut Stores, Taiwo Road, Ilorin. Martrite Supermarket, GRA, Ilorin (very Martrite Supermarket, GRA, Ilorin (very

soon).soon). Pharmacy outlets and supermarkets in Pharmacy outlets and supermarkets in

Lagos & Port-Harcourt.Lagos & Port-Harcourt.

We are hopeful that the We are hopeful that the management and staff of this management and staff of this hospital will adopt SKP Hand hospital will adopt SKP Hand Sanitizer Gel in their effort to Sanitizer Gel in their effort to

promote hand hygiene as promote hand hygiene as part of the improved part of the improved

infection control measures.infection control measures.

S/No

Product Name

Active Ingredients Intended Purpose

1 Glucotin DS Caps

Glucosamine, chondroitin, calcium, vitamin D.

Special formula for healthy joints and building block for joint and cartilage.

Effective management of osteoarthritis.

2 Calcifer Caps

Iron, folic acid, calcium, vit. B12, vit. D, magnesium, manganese, etc.

Amino acid Chelated calcium and iron for maximum absorption.

Supplement for strong bones and rich blood. Effective for anaemia and osteoporosis.

3 Osteoforte Caps

Calcium, vit. D, zinc, manganese, etc.

For strong, healthy bones and active life.

Other SKP Pharma Other SKP Pharma ProductsProducts

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