H1N1 AND HAND HYGIENE

There is a raising concern and anxiety about the spread of H1N1 influenza among people and health care personnel, as the number of reported cases are on the hike. Eventhough the mode of transmission is by droplet spread, transmission through conta minated hands are also considered to be significant. Along with personal protection devices like N-95 mask, goggles, apron, and gloves the importance of hand hygiene is also stressed, as prevention is the major goal for the control of spread. Several studies conducted on this issue have proved that practise of safe and appropriate hand hygiene is an important public health initiative to reduce pandemic H1N1 influenza transmission.

The commercially available hand sanitisers are alcohol based with the addition of various antiseptics and emollients.They are available both in liquid form and gel form. The advantages of alcohol based sanitisers are.

• Instant in action , effective in less than 15 seconds
• Reliable, almost 99% of pathogens including viruses are killed(actiton on spores doubtful)
• Easy to use as it immediately dries up and hand washing is not necessary
• leaves less stain than other agents

Since the liquid form of alcohol can cause skin irritation and allergy in some individuals, the gel form is recommended for routine cleansing. The major ingredients of gel based sanitisers are 70%v/w denatured alcohol(ethanol),1.45%v/v glycerol, carbomer, emollients, and moisturisers.Other preparations contain alcohol 70% and 4% w/v chlorhexidine, with vitamin E or moisturisers

Research by (Ref), Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T, Birch C., Infectious Diseases Department, Austin Health, Heidelberg, Victoria 3084, Australia, showed that hand hygiene with soap and water or alcohol-based hand rub is highly effective in reducing influenza A virus on human hands, although washing with soap and water is the most effective intervention.

Following the" NO FEAR, FIGHT INFLUENZA" campaign, instant hand sanitisers are made available everywhere, including supermarkets,restaurants, clinics, schools, factories etc.One danger of alcohol based sanitisers is that they are flammable and can cause burns.It happened in one hospital where the hospital cleaner used hand wash gel after cleaning the toilets and immediately lighted up a cigarette, holding up his hands to protect the flame from the wind, and his hands burst into flames.Anoher incidence reported from a birthday party where the children were playing with a sanitiser spray and their dress caught fire from candles. So it is advised that after sanitiser use one should make sure that the hands are dry before lighting gas stove,cigarettes or candles and when handling fire or dealing with any job which produces spark for example welding works.

Agents that reduce skin microflora are called antiseptics, whereas agents that reduce microflora on non living objects are called disinfectants. Antibiotic creams or dettol(chlorhexidine) are considered antiseptics, while glutaraldehyde (cidex) or floor cleaners like lysol(phenol based) are categorised as disinfectants. The efficacy of disinfectants or antiseptics are determined by Rideal Walker coefficient and is obtained by dividing the figure indicating the degree of dilution of the disinfectant that kills a microorganism in a given time by that indicating the degree of dilution of phenol that kills the organism in the same space of time under similar conditions.
Ref: Clin Infect Dis. 2009 Feb 1;48(3):285-91.
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