Hand disinfection in the combat against COVID‐19

Dear Editor,

The World Health Organization (WHO) has declared a global health emergency over a new coronavirus. The new coronavirus (SARS‐CoV‐2) has raised global attention with raising concerns of rapid spread from human‐to‐human. Like severe acute respiratory syndrome (SARS)‐nCoV, 2019‐nCoV can be passed directly from person to person by respiratory droplets and may also be transmitted through contact and fomites. ¹

Currently, there is no vaccine or specific therapeutic option against the new virus. Hygienic hand antisepsis is one of the most important measures in preventing healthcare‐ and outbreak‐associated viral infections. Hence, there is an emergency in identifying efficacious antiviral agents to combat the disease. ²

Appropriate measures to decrease the risk of transmission from infected person to the patients, visitors and healthcare workers include hand hygiene. Appropriate care is to be considered for higher risk patients with chronic lung disease, diabetes and renal failure, as well as immunocompromised patients. WHO formulations I and II (two alcohol‐based hand rubs) or povidone‐iodine (PVP‐I) are highly effective against the enveloped coronaviruses (Table 1), as well as other antiseptic agents. ³ If alcohol‐based hand rubs (gel or foam) or povidone‐iodine are not available, ethanol 70% solution may be used. These are all available as commercial solutions – however, the correct use is crucial and has received insufficient investigation.

Table 1.

Hand disinfectants

Type of antiseptic	Inactivates
Iodine	Bacteria Bacterial spores Enveloped viruses Non‐enveloped viruses
Ethanol	Bacteria Enveloped viruses Non‐enveloped viruses ‘ variable ’
Phenolic	Bacteria Enveloped viruses Non‐enveloped viruses ‘ variable ’
Chlorine	Bacteria Bacterial spores ‘ variable ’ Enveloped viruses Non‐enveloped viruses
Quaternary ammonium	Bacteria Bacterial spores

The accessibility of the WHO/PVP‐I formulations as well as their correct use is therefore likely to be of significant benefit for human health on a global scale, particularly in the developing countries. ³ Repeated hand disinfection must be paired with simple handwashing. This has been shown to be of even increased efficiency compared to disinfection for both enveloped and non‐enveloped viruses. ⁴

Ultraviolet germicidal irradiation (UVGI) is a disinfection method that uses UV‐C radiation to inactivate microorganisms by causing deoxyribonucleic acid damage (DNA) and preventing replication. Inactivation of Middle East respiratory syndrome coronavirus (MERS‐CoV) in plasma with riboflavin and UV‐A light has been reported. In addition, the efficacy of whole room UV‐C disinfection has been reported. Whole room UV‐C disinfection system during coronaviruses outbreaks, including severe acute respiratory syndrome coronavirus (SARS‐CoV) and MERS‐CoV, has been demonstrated in previous studies. ⁵ , ⁶ This may prevent the nosocomial spread of the virus and protect staff in the process. Hamzavi et al. ⁷ proposed repurposing of phototherapy devices, including these UVB units, to serve as a platform for ultraviolet‐C (UV‐C) germicidal disinfection.

It has been also noted that 0.5% sodium hypochlorite with colour additive achieved full viral inactivation of human CoV 229E. ⁸ , ⁹ Newly implemented strategies include application of long‐lasting compounds based on quaternary ammonium chloride on buttons and check‐in kiosk and other surfaces in public spaces.

Front‐line medical workers are facing tremendous pressure, containing major risk of infection and insufficient contamination protection. Hand hygiene, while an important preventive measure, is insufficient and should not stand alone for control of SARS‐CoV‐2 spread. Currently, there are no data to describe the frequency of hands contamination with coronavirus, or the viral load on hands after patient contact or touching contaminated surfaces. WHO recommends applying alcohol‐based hand rubs for the decontamination of hands, e.g. after removing gloves. ¹⁰ Hospitals should have infection control strategies in place for managing the spread of infection, including personal protective equipment, such as N95 respirators, double gloves, gowns, and goggles, alcohol‐based hand sanitizer and soap.

Funding source

None.

Acknowledgement

We confirm that the manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met and that each author believes that the manuscript represents honest work.