Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy

Antimicrobial Resistance & Infection Control

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[1] 0000 0001 0721 9812, grid.150338.c, Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland;0000 0004 1937 0722, grid.11899.38, Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil;0000 0004 1937 0722, grid.11899.38, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Campus Universitário, s/n, Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil;0000 0004 1937 0722, grid.11899.38, Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil;0000 0004 1937 0722, grid.11899.38, Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil;0000 0004 1937 0722, grid.11899.38, Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil;0000000122986657, grid.34477.33, University of Washington, Seattle, USA;Ribeirão Preto Nursing School, University of São Paul, Ribeirão Preto, Brazil;

关键词: Hand hygiene;    World Health Organization;    Alcohol-based hand rub;    Glycerol;    Skin tolerability;    Essential medicines list;    Low-income countries;   

DOI  :  10.1186/s13756-019-0553-z

来源: publisher

【 摘 要 】

BackgroundThe World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers’ (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting.MethodsWe conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations.ResultsAccording to the independent observation, participants had 2.4 times (95%CI: 1.12–5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11–0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used.ConclusionIn a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.

【 授权许可】

CC BY