Rapid Preparation of Hand Sanitizer Using WHO Formulation in Hospital Settings during Restricted Supply Due to COVID-19 Pandemic

Ravindra Khaiwal¹, Vivek Sagar², Jatina Vij³, Amit Kulashri⁴, Maninder Kaur Sidhu⁵, Bijaya Kumar Padhi⁶, Amarjeet Singh⁷

^1–7Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Corresponding Author: Ravindra Khaiwal, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, Phone: +91 7087008262, e-mail: khaiwal@yahoo.com

How to cite this article Khaiwal R, Sagar V, Vij J, et al. Rapid Preparation of Hand Sanitizer Using WHO Formulation in Hospital Settings during Restricted Supply Due to COVID-19 Pandemic. J Postgrad Med Edu Res 2020;54(3):137–138.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Good hand hygiene practices include cleaning of hands either by handwash or by hand rub. In healthcare settings, it is not easy to wash hands with soap after seeing each patient and is time-consuming as doctors are already working overtime. Hence, in hospital settings, it is also recommended to use alcohol-based hand sanitizers that can rapidly kill microorganisms, which spread various contagious diseases. Amidst the coronavirus disease-2019 (COVID-19) outbreak, the demand for essential commodities such as hand sanitizer, masks, etc., increased and hampered the hospital supplies. To address the shortage and limited supply of hand sanitizers to the various medical and paramedical departments of a tertiary hospital, the Department of Community Medicine and School of Public Health in coordination with the Pharmacology and Medical Microbiology Department prepared hands sanitizers following the World Health Organization (WHO) guidelines. The paper discusses the procedure that was followed for the preparation of hand sanitizer to meet the institutional demand and motivate others in similar settings to address the issue of restricted supply during the COVID-19 pandemic.

Keywords: COVID-19, Hand hygiene, Hand sanitizer, Hospital settings..

The mysterious outbreak of a virus was observed in the Hubei city of Wuhan Province, China, during December 2019. The new virus was named as a 2019-novel coronavirus (2019-nCoV), and disease was named as coronavirus disease-2019 (COVID-19). The first case of a patient suffering from COVID-19 was reported on December 31, 2019. After this, a rapid rise in the cases of COVID-19 was observed in the Wuhan province, China, and it became the epicenter of the disease. This disease spread fast globally despite several restrictions and preventive measures, and by the end of March 2020 affected more than 185 countries around the globe.

In India, the first confirmed case of COVID-19 was reported on January 10, 2020, in Kerala state, and then the number gradually reached 706 cases on March 28; however, out of which 66 patients recovered. With the increase in COVID-19 cases, the public felt panic and rushed to buy and stock the hand sanitizers, masks, etc. This led to the price hike and black marketing of the hand sanitizers and masks. The surge in demand for these commodities also affected the hospital’s regular supply and resulted in the shortage of sanitizer and essential personal protective equipment’s, e.g., N95 masks. The appeal by the various organizations that frequently washing hands with soap and water for 20 seconds is the best preventive measure against the spread of COVID-19 was not found practically feasible as also highlighted by WHO (2020a).^1,2 And hospitals had to plan for alternatives to meet the need of hand sanitizers. The reasons behind the noncompliance of maintaining hand hygiene among the healthcare workers are complex due to the various factors such as individual perception, knowledge, attitude, behavior, insufficient resources and infrastructure for water supply, and availability, which significantly affect handwashing practices.³ Thus, making use of hand sanitizers in hospital settings, where doctors are already overstretched, is an acceptable alternative to restrict the spread of infection against communicable diseases. Due to the surge in demand, the premier tertiary care hospital also faced the issue of procurement of the hand sanitizer. This resulted in a limited supply of hand sanitizers to the various medical and paramedical departments of a tertiary hospital. Considering this, the Department of Community Medicine and School of Public Health, in coordination with Pharmacology and Medical Microbiology Department, prepared hand sanitizers following the WHO guidelines.⁴ The WHO documents for the preparation of hand sanitizers were found to be most appropriate after thorough literature review due to their validity and prompt availability of the raw ingredients.^5,6 The WHO recommended the preparation of sanitizers by two different methods (WHO 2020b). Method 1 required reagents like ethanol (96% v/v), hydrogen peroxide (3% v/v), glycerol (98% v/v), and distilled water. Whereas, method 2 needs the reagents like isopropyl alcohol (99.8% v/v), hydrogen peroxide (3% v/v), glycerol (98% v/v), and distilled water. The availability of the raw material favored method 2 for sanitizer formulation. The WHO document stated that formulations could be used both for hygienic hand antisepsis and for presurgical hand preparation.⁷

The Department of Medical Microbiology was requested to assess the performance of the formulation of the in-house prepared hand sanitizer. The hand sanitizer was microbiologically examined using two methods, i.e., in vivo membrane method and filtration method, and was found to be effective. However, as per WHO, the efficacy of the hand rub formulation was examined following European standards (EN1500).⁸ The EN 1500 evaluates the effectiveness of a hygienic hand rub by counting the number of viable bacteria remaining on the fingertips after contamination and hand rub exposure. The results were found to be equivalent to the reference substance, i.e., isopropanol 60% v/v for hygienic hand antisepsis.

The in-house production of hand sanitizer was also found to be less costly as compared to the commercially available products. The market price of 500 mL hand sanitizers in the open market of India cost around over $7.5, whereas the in-house production cost approximately $3.0. Considering the cost-effectiveness of the in-house produced hand sanitizer, it can be recommended to be used for routine practices in the future. However, efficacy needs to tested from time to time, following international standards.⁹

Learning experience: The scarcity of the essential commodity in the market prompted the formulation of in-house production of hand sanitizers in the hospital setting, which promises to have equal efficacy as of isopropanol (60% v/v) for hygienic hand antisepsis.

REFERENCES

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8. World Health Organization. Guide to Local Production: WHO-recommended Handrub Formulations. 2020b. https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf .(last accessed, 27th March 2020.

9. World Health Organization. Recommendations to Member States to improve hand hygiene practices by providing universal access to public hand hygiene stations to help prevent the transmission of the COVID-19 virus: interim guidance, 1 April 2020. World Health Organization; 2020a.

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