ANTIMICROBIAL EFFICACY OF SELECTED DISINFECTANTS
Hospital and community-acquired infections are escalating and pose a serious public health problem worldwide. Hands are considered to be the primary route for transmitting microbes and infections to the individuals. Personal as well as hand hygiene is important to prevent many communicable diseases. The word “hygiene” is derived from the ancient Greek goddess “Hygeia” that means “goddess of healing.” The importance of hygiene is universally recognized and evidence-based. It is well known that hand hygiene is crucial to prevent and minimize healthcare-associated infections. The Centers for Disease Control and Prevention, the World Health Organization, and many other health experts promote hand hygiene as the single most important measure in the prevention of hospital-acquired infections. Several studies have shown the importance of proper hand hygiene in reducing the incidence of nosocomial infections.[4,5,6,7,8] It is estimated that at any one time, more than 1.4 million people worldwide are suffering from infections acquired in hospitals. These nosocomial infections are also, in most cases, the result of poor hand hygiene.
At present, washing hands with appropriate soap followed by applying hand antiseptics are two important hand hygiene method in clinical practice. Hand sanitizers significantly increase the chance of maintaining the hands clean and aseptic.
Traditionally, microbes habitation on hands is divided into resident and transient floras. Involved resident floras are commonly Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecalis that colonize the deeper skin layers and are resistant to mechanical removal. The transient floras consists of S. aureus, Escherichia coli, and Pseudomonas aeruginosa that colonize the superficial layers of skin in a short period of time. Therefore, we selected these organisms to determine their susceptibility to different hand sanitizers tested in this study.
Scientific studies have shown that after hand washing, as many as 80% of individuals retain some pathogenic bacteria on their hands. Hand washing removes body’s own fatty acids from the skin, which may result in cracked skin that provides an entry portal for pathogens.[12,13] To overcome the limitations of plain hand washing, hand sanitizers were introduced claiming to be effective against those pathogenic micro-organisms as well as to improve skin condition due to the addition of emollients in it.
Hand sanitizers were also effective in reducing gastrointestinal illnesses in households, respiratory tract infections, and skin infections, in curbing absentee rates in elementary schools, and in reducing illnesses in university dormitories. Furthermore, to reduce infections in healthcare settings, alcohol-based hand sanitizers are recommended as a component of hand hygiene.
Many hand sanitizers are available in the market with varying degree of effectiveness that are registered in the National Agency for Food and Drugs Administration and Control. Moreover, in outreach programs, screening procedures in day-to-day practice, water scarcity areas, and bed-side and chair-side clinical examination, hand sanitizers could be an alternative to achieve asepsis. However, clinicians and common man face the dilemma while choosing the best among the lot.
Some products marketed to the public as antimicrobial hand sanitizers are not effective in reducing bacterial counts on hands. In fact, despite a label claim of reducing “germs and harmful bacteria” by 99.9%, some studies have observed an apparent increase in the concentration of bacteria in handprints impressed on agar plates after cleansing. Hence, there still exists a need for verification of these claims by the regulatory authorities for the enforcement of good-quality measures. To overcome this ambiguity, the present study was carried out to assess the antimicrobial effectiveness of four different hand sanitizers against the test organisms.
MATERIALS AND METHODS
The present study is an in vitro study conducted at the Department of Microbiology, Government Medical College, Dhule, Maharashtra, India. Ethical clearance for the study was obtained from the Institutional Ethical Review Committee. Four different brands of hand sanitizers were selected out of many available in the market based on their popularity and maximum usage in Dhule City. Selected hand sanitizers to test their antimicrobial efficacy were Sterillium (Bode Chemie, Hartmann Group, Germany), PureHands (Himalaya Drugs Company, India), Dettol (Reckitt Benckiser, UK), and Lifebuoy (Hindustan Unilever Pvt. Ltd., India) [Figure 1]. Recently manufactured and packed sanitizers have been purchased based on their popularity from the local retail outlet. The study was conducted over a period of 10 days. The composition of various hand sanitizers is shown in Table 1