Identification of Adulteration in Hand Sanitizers of Jaipur City Using Raman Spectroscopy

Hand hygiene has been established as an important part of our lives leading to reduction of colonization and communicable diseases for all. Since the World Health Organization (WHO) declared COVID-19 a global pandemic, fake hand sanitizers have appeared on the market often, posing risk to the public due to the undeclared addition of methanol and Iso-propanol. This study examined the chemical components stated on the hand sanitizer component label and investigated how people used hand sanitizer and their level of chemical awareness. 30 distinct samples, both brand-name and locally produced, were gathered from Jaipur's local markets. In addition, the samples' iso-propanol and methanol contents were examined using Raman spectroscopy. The findings of this study demonstrate that almost 37% of the samples were adulterated which is still a minacious stats considering the consumption and effects these sanitizers are having on the consumers. The adsorption of such adulterated sanitizers through skin causes irritations on skin and hands which may lead to inflammation and can also have carcinogenic effects. So, the study concludes that the identification and quality assessment of such sanitizers should be done on a large scale to prevent the spread of toxicity.Copyright © 2022, Medico Legal Society. All rights reserved.

Impact of COVID-19 on the number and type of calls to the Belgian Poison Centre

Objective: The present study provides an overview of the number and type of calls to the Belgian Poison Centre (BPC), and the impact of COVID-19. Methods: Data of all calls to the BPC (1 January - 31 December 2020) were collected and analysed using appropriate statistics (SAS). Results: The BPC received 65,308 calls in 2020 (60,668 in 2019, p<0.05). The vast majority (35.9%) of exposures were drugrelated (21,151 in 2019 versus 20,666 in 2020, p>0.05), followed by the use of chemical household products (11,836 in 2019 versus 12,247 in 2020 (p>0.05)). A 12.3% increase in the number of cosmetic- and food-related exposures was noted (8,291 in 2019 versus 9,308 in 2020, p<0.05). Within this group, a stable number of exposures (877 in 2019 versus 876 in 2020, p>0.05) due to essential oil exposures were observed. Partly due to the impact of the COVID-19 [1] pandemic, exposures to biocides doubled (104.9%) from 1,964 in 2019 to 4,024 in 2020 (p<0.05). Exposures to type 1 biocides (i.e. human hygiene products, which include alcohol-based hand sanitisers (ABHS)) significantly increased from 322 in 2019 to 1,676 in 2020 (p<0.05), and exposures to type 2 biocides (i.e. disinfectants and algaecides not intended for direct application to humans or animals) from 406 to 902 (p<0.05). In 2020 the BPC received a five-fold increase in the number of calls involving ABHS incidents (both liquid and gel-based, as well as ethanol and isopropanol products) compared to 2019 (1,676 versus 323 in 2019 versus 1,676 in 2020 calls, p<0.05), accounting for 2.6% of all calls in 2020. In 71% of exposures, ingestion was the primary route (1,195/1,676), followed by 28.6% accidental ocular exposures (480/1,676) of which more than half of the incidents involved children (257/480, p<0.05), primarily young children aged 1-4 years (136/257, p<0.05). Finally, as people went into the garden and nature to relax during lockdown, a 28.2% increase in exposures related to the group 'plants, mushrooms and animals' was found, with 3,256 exposures in 2019 and 4,175 in 2020 (p<0.05). Conclusion: In its history, the BPC has never received as many calls as in 2020. The COVID-19 pandemic contributed to a significant number of additional exposures, and requests for toxicologic advice.

Poison Center hand sanitizer exposure characterization peri- and during the COVID-19 pandemic

Objective: Poison centers frequently manage calls involving ethanol-containing hand sanitizers. During the 2020 COVID-19 pandemic, our Specialists in Poison Information sensed rising numbers of cases. The increased use was not surprising due to the desire to sanitize skin and reduce transmission of COVID-19. We sought to compare hand sanitizer trends pre-pandemic and during the pandemic including a sub-analysis for children 0-5 years. Methods: We queried the National Poison Data System for human exposures of all ages within our 4-state poison center from 1 January 2015 to 31 October 2021. Generic codes for all types of hand sanitizers were included plus 2 product codes for methanol-containing hand sanitizer. Data captured included age range, product type, reason, gender, route, clinical effect, medical outcome, month, management site, and therapies. The query was repeated for the same parameters in children 0-5 years old. Descriptive statistical analyses were utilized. Results: Our poison center managed 5,819 human hand sanitizer exposures during the study period;67% occurred in children 0-5 years old. From 2019 (n=723) to 2020 (n=1,272), hand sanitizer exposures increased by 76%, 38% [all ages, children 0-5 years];52% were male. Most [77%, 99%] of these exposures were unintentional and [89%, 96%] involved ingestion as the primary route and exposures in children 0-5 years represented 64% of the total number of ingestion cases. Exposures in 2020 occurred throughout the year with higher volumes in March and July through December. Most cases were managed on-site (non-hospital) [81%, 89%], with [18%, 11%] evaluated in or referred to a hospital. Most [87%, 89%] clinical outcomes were minor or no effect overall, with similar numbers in 2020 [82%, 87%]. The top clinical effect in children 0-5 years was vomiting. For all ages, the most common effects were vomiting, nausea, and drowsiness. There was one death involving an adult who intentionally consumed hand sanitizer as an alcohol substitute. The product was contaminated with methanol and he died from methanol intoxication. Non-ethanol or isopropanol hand sanitizers were involved in 10% of exposures during the study period and 19% of exposures in 2020. Conclusion: We confirmed our suspicion that hand sanitizer exposures rose significantly in 2020. Explanations include increased usage and availability in the home paired with more time spent at home overall due to coronavirus school restrictions, working from home, and quarantine. Fortunately, even during 2020, most medical outcomes resulted in none or minor effects. Additional sub-analyses are needed to characterize other aspects including non-ethanol hand sanitizer exposures.

EVALUATION OF ENVIRONMENTAL BACTERIA BY NORMAL CLEANING AND HYPOCHLOROUS ACID SPRAY IN AN ENDOSCOPY UNIT

DDW 2022 Author Disclosures: KUMIKO UCHIDA: NO financial relationship with a commercial interest ;Takao Itoi: NO financial relationship with a commercial interest ;Masakatsu Fukuzawa: NO financial relationship with a commercial interest ;Akira Madarame: NO financial relationship with a commercial interest ;Takashi Kawai: NO financial relationship with a commercial interest Background: The outbreak of coronavirus infection (COVID-19) in 2020 has not yet ended in Japan and overseas, and droplet, contact, and aerosol infections have been suggested as routes of COVID-19 infection. As COVID-19 infection spreads, supply and demand for alcohol disinfectant solutions are temporarily tight, and hypochlorous acid water has attracted attention as a material available to the consumers.Purpose: The purpose of this study was to evaluate the environmental bacteria in an endoscopy unit sprayed with hypochlorous acid water from the viewpoint of space purification as an infection control for aerosols. Methods: An unmanned endoscopy unit was used after the end of a day's work. The viable counts of environmental bacteria in the cleaning group (before and after normal cleaning) and in the spraying group (before and after spraying with hypochlorous acid water) were compared and examined. Sampling of adherent bacteria (environmental bacteria) on beds, floors, illuminating apparatus for endoscope, PC desks, and washbasins, which are considered to be exposed to aerosols, was evaluated using SCD agar medium (product name: Petan Check, manufacturer: Eiken Chemical Co., Ltd.). For normal cleaning, disinfectant solutions of quaternary ammonium, isopropyl alcohol, and 80% ethanol were use after the work was completed. The hypochlorous acid water was sprayed with IONLESSTM hypochlorous acid water (product name: CLFine, manufacturer: Nipro Corporation) in accordance with the working environment evaluation standard of the Industrial Safety and Health Act, and the atmospheric effective chlorine concentration was kept at about 0.03 ppm, which is considered to be the optimum concentration, for 5 hours. The Mann-Whitney U test was used to compare the number of adherent bacteria. Results: There was no difference in the number of bacteria on the bed, illuminating apparatus for endoscope, computer desk, and washbasin between the cleaning and spraying groups. The median number of bacteria on the floor before cleaning was 26 CFU/10cm2, while that after cleaning was 23 CFU/ 10cm2. On the other hand, in the hypochlorous acid water group, the median value before spraying was 27 CFU/10cm2 and after spraying was 4 CFU/10cm2. Although there was no statistical difference (p=0.057), the hypochlorous acid water group tended to have fewer adherent bacteria. Conclusion: The hypochlorous acid spray tended to reduce the number of adherent bacteria (environmental bacteria) on the floor where aerosol exposure was possible, and the hypochlorous acid spray was considered to be useful in reducing environmental bacteria in endoscopy unit.

The analysis of alcohol content in hand sanitisers (in the Durban region) using gas chromatography-mass spectrometry during the COVID-19 pandemic

The COVID-19 pandemic has resulted in an unprecedented surge in the demand for alcohol-based hand sanitisers (ABHS). The Centre for Disease Control (CDC) and World Health Organisation (WHO) recommend alcohol, i.e., isopropanol or ethanol, at a 60-95% concentration in ABHS for sufficient antiviral protection. Consumers need to be vigilant of substandard hand sanitisers being marketed to the public. The frequent exposure of microorganisms to alcohol concentrations below the recommended range for infection prevention may lead to resistant mutations, and above the range may be ineffective. Therefore, this study aimed to verify the stated alcohol content in hand sanitisers from their respective labels. We analysed 50 hand sanitiser samples available to our region in Durban, KwaZulu-Natal, South Africa, using a Shimadzu GC-MS-QP2010 Ultra equipped with a Zebron ZB-wax capillary column. The hand sanitisers analysed had a range of 44-93% alcohol content. The data from our study also revealed that 32% (16) of hand sanitisers did not adhere to the stated alcohol indicated on their labels. 16% (8) contained 80% and 12% (6) contained <60%, while 6% (3) of the ABHS contained 1-propanol and ethyl acetate as contaminants, respectively. This study clearly emphasises manufacturers' exploitation of the pandemic and the need for stricter guidelines and regulations for consistency amongst ABHS manufacturers. The public should also be more alert to the % alcohol stated (ideal range 60-80%) on the sanitizer bottle and note one needs to rub their hands together until it feels dry.

Hand hygiene and skin health in times of COVID-19

COVID-19, caused by SARS-CoV-2 virus, results in serious clinical manifestations in humans. The reactions, which are mainly respiratory, can also have significant effects on other body systems, such as cardiovascular, and can progress to death. Handwashing with running water and soap, and using alcohol-based antiseptic formulations are recognized measures in controlling COVID-19 spreading. Our study presents a review on hand hygiene and its relation with skin health in times of COVID-19. Handwashing with soap and running water promotes dirt removal and can inactivate SARS-CoV-2 by disrupting the viral lipid membrane. The use of alcohol-based antiseptic preparations on hands inactivates or inhibits the development of pathogenic microorganisms, such as the COVID-19 virus. World Health Organization recommends 80% ethyl alcohol-based or 75% isopropyl alcohol-based formulations for hand antisepsis, as they have a proven virucidal effect against SARS-CoV-2. Numerous problems can occur with frequent hand sanitizing regarding skin health. Skin dryness, increased skin sensitivity, and irritant contact dermatitis are some manifestations, which are mainly noticed in healthcare workers during COVID-19 pandemic. Accidents and burn risk involving alcohol-based antiseptic products are also a concern. From the pandemic beginning until November 2020, the Brazilian Burn Society has counted 700 hospitalizations due to serious burn accidents caused by 70% alcohol use, in liquid or gel form. For minimizing or avoiding dermatological reactions on hands, it is important to use antiseptic formulations and soaps containing moisturizing agents. The presence of humectants such as glycerin and emollients such as vegetable oils in the formulations can attract water and keep it in the skin, relieving hand skin irritation. So, humectants and emollients help maintaining the skin health in a proper hand hygiene routine. Even after most of world's population has been immunized with vaccines to prevent COVID-19, our hands will still have potential to transmit SARS-CoV-2 and it should not be overlooked. Understanding the state of the art of the antiseptic formulations and the impact of these products on hand skin health are critical to develop new knowledge on antiseptic products and their application in controlling infectious diseases spread, such as COVID-19.

Application of Near-infrared Spectroscopy and Multivariate Methods for the Estimation of Isopropyl Alcohol Content in Hand Sanitizer Formulation

To address the need of alcohol-based hand sanitizers during COVID-19, U.S. FDA has issued a guidance for the preparation of hand sanitizers that recommends 80% v/v ethanol or 75%v/v isopropyl alcohol (IPA) along with other ingredients. The aim of this study was to develop a new method to estimate IPA content in hand sanitizers by using Near-infrared (NIR) spectroscopy with a multivariate chemo-metric approach. Calibration samples containing 10-90% of IPA were used for model development. NIR data was mathematically pretreated with multiple scattering correction before development of partial least squares (PLSR) and principal component regressions (PCR) model. Both models showed good linearity over the selected range of IPA content with high R2 (>0.993), low root mean squared error (<2.163), minimum difference between standard errors between calibration and validation models (0.0009). The proposed NIR with multivariate methods provide rapid analysis of IPA content in the hand sanitizer.

The impactof COVID-19 restrictions on participant enrollment in the prepare trial

Introduction: PREPARE is a pragmatic clusterrandomized crossover trial that compares the effectiveness of two common pre-operative antiseptic skin solutions to reduce the risk of surgical site infection after orthopedic fracture surgery. The trial compares 2% chlorhexidine in 70% isopropyl alcohol (ChloraPrep™) versus 0.7% iodine povacrylex in 74% isopropyl alcohol (DuraPrep™), and recruiting sites alternate study solutions every 2 months. Before the US national response to the COVID-19 pandemic, all PREPARE trial clinical sites obtained informed consent in person at the hospitals or fracture clinics. However, after 13 March 2020, the COVID-19 restrictions limited inperson consenting at some hospitals. Affected clinical sites were encouraged to transition to telephone consent, which was already included as a consent option in the PREPARE protocol. We aimed to determine how COVID-19 restrictions impacted the number of enrolling clinical sites and participant enrollment in the PREPARE trial. Methods: Prior to implementing telephone consent, clinical sites had to determine local logistics and obtain institutional review board approval for telephone consent scripts and procedures from the central or local institutional review boards. We descriptively evaluated the number of clinical sites that switched to telephone consent, the number of clinical sites that had to pause enrollment, and the length of the enrollment pauses. We evaluated monthly enrollment at the following time periods: (1) prior to the COVID-19 restrictions (1 July 2019 to 13 March 2020), (2) immediately after the COVID-19 restrictions in place (March, April, and May 2020), and (3) from 1 June 2020 to 30 November 2020. Results are stratified by open and closed fractures and are summarized using descriptive statistics. Results: At the time of the pandemic, 13 clinical sites were participating in the PREPARE trial. Eleven (84.6%) clinical sites paused enrollment due to COVID- 19 restrictions. The median length of enrollment pause was 44 days (range = 7-92 days;interquartile range = 54 days). By 16 June 2020, all clinical sites resumed enrollment. The average monthly enrollment before the COVID-19 restrictions was 198 closed fracture participants (SD = 22, range = 161-227) and 41 open fracture participants (SD = 16, range = 22-60). The enrollment rate was the lowest in April 2020, when 47 closed fracture participants and nine open fracture participants were enrolled. By June 2020, enrollment began increasing. From 1 June 2020 to 30 November 2020, the average monthly enrollment rate was 183 closed fracture participants (SD = 30, range = 129-206) and 44 open fracture participants (SD = 12, range = 24-61), which was close to pre-COVID enrollment. Monthly enrollment between 2019 and 2020 was similar, except for the months of March to May 2020 for closed fracture enrollment (p = 0.001) and March and April 2020 for open fracture enrollment (p = 0.04) cohorts. Conclusion: By pre-emptively including telephone consent in the PREPARE protocol, clinical sites were quickly and ethically adapting their procedures for obtaining informed consent via telephone. Although multiple sites paused enrollment, the enrollment pause was brief and had minimal impact on enrollment. A highly pragmatic design allowed for minimal interruptions to enrollment during the pandemic.

Contact sensitizations to disinfectants containing alcohols or quaternary ammonium compounds are rarely of clinical relevance.

BACKGROUND: The use of disinfectants is part of the everyday life of people, especially in the medical profession. During the coronavirus disease 2019 (COVID-19) pandemic, the use of disinfectants continues to increase and is of fundamental importance in infection control. OBJECTIVES: To determine the frequency of sensitization and the value of patch testing to didecyldimethylammonium chloride (DDAC) and the alcohols ethanol, 1-propanol, and isopropanol. METHODS: Clinical patch test data of 145 patients with suspected contact allergy to disinfectants were retrospective analysed. RESULTS: Among the 145 patients patch tested with the different alcohols, only one nurse was detected with a possible allergy to 1-propanol. Additional patch testing in 84 patients with DDAC 0.05% resulted in five patients with weakly positive reactions only, without clinical relevance. Patch testing with DDAC 0.03% showed no positive reactions at all on day 3 readings. CONCLUSIONS: DDAC and alcohols are rarely responsible for allergic contact dermatitis. The accused products of the patients should be checked for other allergens and further additives with skin-irritating properties. Individual susceptibility and mishandling of the disinfectants should be considered.

Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols.

Infection control instructions call for use of alcohol-based hand rub solutions to inactivate severe acute respiratory syndrome coronavirus 2. We determined the virucidal activity of World Health Organization-recommended hand rub formulations, at full strength and multiple dilutions, and of the active ingredients. All disinfectants demonstrated efficient virus inactivation.