How to use hand sanitizer, what is the history of hand sanitizer, why hand sanitizer is important, Why alcohol is used in maximum hand sanitizer, Risk and Mitigation, What are the benefits of hydrogen peroxide, Mechanism of Alcohol, Antimicrobial properties of antiseptics used in hand sanitizer.

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Presenter
Baudrul Mohammad Shahjalal
Sr. Executive, PMD
Army Pharma Limited

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According to the World Health Organization (WHO), "Hygiene refers to
conditions and practices that help to maintain health and prevent the
spread of diseases.
Many people equate hygiene with 'cleanliness,' but hygiene is a broad
term.
It includes such as
 Personal habit choices as how frequently to take a shower or bath,
wash hands, trim fingernails, and wash clothes.
 Also give attention to keeping surfaces in the home and workplace,
including bathroom facilities, clean and pathogen-free.
Hygiene is a series of practices performed to preserve health.

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The main sources of infection in the home are
Secondary reservoirs of infection
Sites that accumulate stagnant water - such as sinks, toilets, waste pipes,
cleaning tools, face cloths, etc.
People (who are carriers
or are infected)
Foods (particularly raw
foods) and water
Domestic animals

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Hand hygiene Respiratory hygiene
Food hygiene at home
Hand hygiene is defined as hand
washing or washing hands and nails
with soap and water or using
a water less hand sanitizer.
Correct respiratory and hand
hygiene when coughing and
sneezing reduces the spread of
pathogens particularly during
the cold and flu season.
Food hygiene is concerned with the hygiene practices that prevent food
poisoning. WHO 5 principles
1. Contamination food with chemicals
2. Separate raw and cooked food
3. Maintain Right time and temp to kill pathogen
4. Store in proper temp
5. Use Safe water and raw materials

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Laundry hygiene Medical hygiene at home
Laundry hygiene involves practices
that prevent disease and its spread
via soiled clothing and household
linens such as towels.
Medical hygiene pertains to the hygiene
practices that prevents or minimizes disease
and the spreading of disease in relation to
administering medical care to those who are
infected or who are more "at risk" of
infection in the home.
Hygiene in the kitchen, bathroom and toilet
Routine cleaning of (hand, food, drinking water) sites and surfaces (such as toilet
seats and flush handles, door and tap handles, work surfaces, bath and basin surfaces)
in the kitchen, bathroom and toilet reduces the risk of spread of pathogens.

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Personal hygiene Oral hygiene
It is recommended that all healthy adults
brush twice a day, softly, with the correct
technique, replacing their toothbrush
every few months (~3) or after a bout of
illness.
Floss once a day
Personal hygiene involves those
practices performed by an individual
to care for one's bodily health and
wellbeing through cleanliness.
Disinfectants and antibacterials in home hygiene
Chemical disinfectants are products that kill pathogens. If the product is a
disinfectant, the label on the product should say "disinfectant" or "kills"
pathogens.

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In the mid 1800’s – Two doctors
1. Ignaz Semmelweis in Vienna, Austria
2. Oliver Wendell Holmes in Boston, USA established that hospital-
acquired diseases were transmitted via the hands of health-care
workers.
In 1847 Semmelweis was appointed as a house officer of two obstetric
clinics of a general hospital under the University of Vienna.
Observation – high maternal mortality rate - one clinic compared with
the other (16% versus 7%)
Why – He noted that doctors and medical students often went directly to
the delivery suite after performing autopsies (a post-mortem
examination to discover the cause of death or the extent of disease) and
had a disagreeable odour on their hands despite handwashing with soap
and water before entering the clinic.

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He hypothesized therefore that “cadaverous (relating to corpse, a dead
body) particles” were transmitted via the hands of doctors and
students from the autopsy room to the delivery theatre and caused the
puerperal fever (results from infection of the placental site following
delivery or abortion)
Semmelweis recommended that hands be scrubbed in a chlorinated
lime solution before every patient contact and particularly after leaving
the autopsy room.
What happened - the mortality rate fell dramatically to 3% in the clinic.
This is the first evidence that cleansing heavily contaminated hands
with an antiseptic agent can reduce nosocomial transmission of germs
more effectively than handwashing with plain soap and water.

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Unfortunately, both Holmes and Semmelweis failed to observe a
sustained change in their colleagues’ behavior. In particular,
Semmelweis experienced great difficulties in convincing his colleagues
and administrators of the benefits of this procedure.
The 1980s United States Center for Disease Control and Prevention
(USCDCP) represented a landmark in the evolution of concepts of hand
hygiene in health care. The first national hand hygiene guidelines were
published in the 1980s.

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The skin is composed of three
layers
 Epidermis (50–100 μm)
 Dermis (1–2 mm)
 Hypodermis (1–2 mm)
Stratum corneum, the most
superficial layer of the
epidermis.
 Percutaneous absorption
(transport of chemicals from outer surface)
 Protection against microorganisms
 Permeability barrier to the
environment

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Bacterial flora can be divided into 2 categories
1. Resident flora
2. Transient flora
Established in 1938 by Price
The resident flora (resident microbiota) consists of microorganisms
residing under the superficial cells of the stratum corneum and can
also be found on the surface of the skin.
 Staphylococcus epidermidis is the dominant species. Biofilms on
cathertes (endocarditis-inflammation of the inner layer of heart)
 Other S. hominis
Function: 2 main protective function :
1. Microbial antagonism
2. The competition for nutrients in the ecosystem

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In general, resident flora is less likely to be associated with infections,
but may cause infections in sterile body cavities, the eyes, or on non-
intact skin.
Transient flora (transient microbiota), which colonizes the superficial
layers of the skin, is more amenable to removal by routine hand
hygiene. Transient microorganisms do not usually multiply on the skin,
but they survive and sporadically multiply on skin surface.
Some types of contact during routine neonatal care are more frequently
associated with higher levels of bacterial contamination of hands:
respiratory secretions, nappy/diaper change, and direct skin contact.
The transmissibility of transient flora depends on the species present,
the number of microorganisms on the surface, and the skin moisture.

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1. Ethanol
2. Hydrogen Peroxide
3. Glycerin
4. Distill water
5. Aloe vera
6. Fragrance
7. Coloring agent
Formula

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 Thousands of people
die every day
around the world
from infections
acquired while
receiving health care
 Hands are the main
pathways of germ
transmission.
 Clean your hands by rubbing them with
an alcohol-based formulation
 Wash your hands with soap and water
when hands are visibly dirty or visibly
soiled with blood or other body fluids or
after using the toilet
 If exposure to potential spore-forming
pathogens is strongly suspected or
proven, including outbreaks of
Clostridium difficile

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RUB HANDS FOR HAND HYGIENE! WASH
HANDS WHEN VISIBLY SOILED!
OTHERWISE USE HAND SANITIZER
Hand Rub: 20-30 seconds
Including Hand Wash: 40-60
Seconds
Apply a palmful of the product in a cupped hand, covering all surfaces

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Rub hands palm to palm
Right palm over left dorsum with
interlaced fingers and vice versa
Palm to palm with fingers interlaced
Backs of fingers to opposing palms
with fingers interlocked
Rotational rubbing of left thumb
clasped in right palm and vice versa
Rotational rubbing, backwards and
forwards with clasped fingers of right
hand in left palm and vice versa

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Once dry, your hands are safe

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Rinse hands with water Dry hands thoroughly with a single use towel
Use towel to turn off faucet Your hands are now safe

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Hand care
Take care of your hands by regularly
using a protective hand cream or lotion,
at least daily.
Do not routinely wash hands with soap
and water immediately before or after
using an alcohol-based handrub.
Do not use hot water to rinse your
hands. After handrubbing or
handwashing, let your hands dry
completely before putting on gloves.
Please remember
 Keep natural nails short.
Do not wear artificial
fingernails or extenders.

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Alcohol-based (hand) rub: An alcohol-containing preparation (liquid,
gel or foam) designed for application to the hands to inactivate
microorganisms and/or temporarily suppress their growth.
Antiseptic agent: An antimicrobial substance that inactivates
microorganisms or inhibits their growth on living tissues.
Examples include alcohols, chlorhexidine gluconate (CHG),
chlorine derivatives etc.

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Antiseptic hand wipe: A piece of fabric or paper pre-wetted
with an antiseptic used for wiping hands to inactivate and/or remove
Antiseptic handrubbing (or handrubbing): Applying an antiseptic
handrub to reduce or inhibit the growth of microorganisms without
the need for an exogenous source of water and requiring no rinsing or
drying with towels or other devices.
microbial contamination.

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Plain (non-antimicrobial) soap
Soaps are detergent-based products that contain esterified fatty acids
and sodium or potassium hydroxide. They are available in various
forms including bar soap, tissue, leaf, and liquid preparations. Their
cleansing activity can be attributed to their detergent properties
which result in the removal of lipid and adhering dirt, soil, and various
organic substances from the hands.
Alcohols
Most alcohol-based hand antiseptics contain either ethanol,
isopropanol or n-propanol, or a combination of two of these products.
The antimicrobial activity of alcohols results from their ability to
denature proteins.

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Chlorhexidine
CHG was developed in the UK in the early 1950s and introduced into
the USA in the 1970s. Chlorhexidine base is barely soluble in water,
but the digluconate form is water-soluble. The antimicrobial activity
of chlorhexidine appears to be attributable to the attachment
to, and subsequent disruption of cytoplasmic membranes,
resulting in precipitation of cellular contents. Chlorhexidine’s
immediate antimicrobial activity is slower than that of alcohols.
Hydrogen peroxide
It is used as an oxidizer, bleaching agent, and antiseptic.

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Hexachlorophene
Hexachlorophene as a hygienic handwash or surgical scrub
demonstrated only modest efficacy after a single handwash. Develop
Neurotoxicty if we use while bathing.
Iodine and iodophors
A number of other agents are being evaluated by the FDA for use in
antiseptics related to health care. However, the efficacy of these
agents has not been evaluated adequately for use in hand hygiene
preparations intended for use
Iodine has been recognized as an effective antiseptic since the 1800s,
though iodophors have largely replaced iodine as the active ingredient
in antiseptics because iodine often causes irritation and discolouring
of skin.

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Alcohol is effective at killing different types of microbes.
Both
 Viruses
 Bacteria
Because it unfolds and inactivates their proteins. This process, which is
called denaturation, will cripple and often kill the microbe because its
proteins will unfold and stick together.
Hydrogen Peroxide Used to inactivate contaminating bacterial spores in
the solution and is not an active substance for hand antisepsis.

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Some viruses have an outer wrapping, which is called an envelope,
while others are non-enveloped. Alcohol is effective at killing enveloped
viruses, including the coronavirus,
but is less effective at killing non enveloped viruses.
Whether you are trying to kill bacteria or viruses, many research studies
have found that an alcohol concentration of 60% or greater is
needed to be effective.

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