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Ebola virus - The role of alcohol-based hand rubs

As international agencies and governments struggle to contain the Ebola virus, there is a renewed interest in fighting the spread of the disease. The most basic preventative measure is decontamination of hands (in the case of healthcare workers) and surfaces (in the case of patient's rooms). Products such as alcohol-based hand rubs like Sterillium from Bode are highly effective. Below is a statement from Bode regarding the decontamination of hands and surfaces in cases of Ebola virus.

If you have any additional queries please contact your local PEI hospital representative or call PEI at +353 1 419 6900.
 

Decontamination of hands and surfaces in case of Ebola virus:

Some patients with suspected or confirmed Ebola virus infection are now treated in North America and Europe. This situation raises the question on appropriate infection control measures by healthcare workers (HCWs) also in countries not directly involved in the West African ebolavirus epidemic.
 
 
Decontamination of hands (healthcare workers)

HCWs will usually approach patients with personal protection equipment which includes at least one pair of gloves (double gloving should be considered when copious amounts of blood, other body fluids, vomit, or faeces present in the environment are handled). That is why decontamination of hands will usually be done after taking off gloves. In this case hands will usually be visibly clean.

Clean hands:
The World Health Organisation (WHO; dated March 2008) recommends hand hygiene. In its own guideline published in 2009 using an alcohol-based hand rub is recommended for routine hand decontamination (1). The Centres for Disease Control and Prevention (CDC; dated 05.08.2014) recommends washing with soap and water or using alcohol-based hand rubs (2). The Robert Koch Institute (RKI; dated 25.06.2014) recommends using disinfectants which are at least effective against enveloped viruses (3). A number of hand rubs have been shown to have comprehensive efficacy against enveloped viruses (4). Washing hands is from our point of view not the best option for decontaminating clean hands. It will distribute Ebola virus into the environment where it can persist for up to 3 weeks. Although the environment of Ebola virus-infected patients is rarely contaminated with Ebola virus (5) it is nevertheless an avoidable risk for cross-contamination. Only disinfection will ensure loss of viral infectivity.

Visibly soiled hands:
WHO and CDC recommend washing hands with soap and water (1, 2). RKI recommends cleaning with soap and water or treatment with an alcohol based hand rub with at least efficacy against enveloped viruses (3).

Decontamination of surfaces (patient room)

Surfaces of Ebola patients are rarely contaminated with the virus (5) but filo viruses remain infectious for up to 5 days (6) or up to 3 weeks (7). CDC and RKI recommend the disinfection of surfaces in patient rooms (2, 3). RKI specifically recommends that a suitable disinfectant should have at least efficacy against enveloped viruses (3). The virus will usually spread by body fluids. That is why we recommend in addition using a surface disinfectant under “dirty conditions” and to use the surface only after the specific exposure time is over.

Summary

On clean hands using an alcohol-based hand rub with at least efficacy against enveloped viruses seems overall the best option for decontaminating hands. A surface disinfectant should also have at least efficacy against enveloped viruses, should be applied under “dirty condition” and the application time should be awaited before using the surface again.

BODE SCIENCE CENTRE

References:
 
1. Anonym. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care Geneva: WHO; 2009.
2. CDC. Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals. 2014:accessed 08.08.2014.
3. Robert Koch-Institut. √úbersicht Ebola-Fieber / Marburg-Fieber. 2014:accessed 08.08.2014.
4. Kampf G, Steinmann J, Rabenau H. Suitability of vaccinia virus and bovine viral diarrhea virus (BVDV) for determining activities of three commonly-used alcohol-based hand rubs against enveloped viruses. BMC Infectious Diseases. 2007;7:5.
5. Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007;196 Suppl 2:S142-7.
6. Belanov EF, Muntianov VP, Kriuk VD, et al. [Survival of Marburg virus infectivity on contaminated surfaces and in aerosols]. Vopr Virusol. 1996;41(1):32-4.
7. Piercy TJ, Smither SJ, Steward JA, Eastaugh L, Lever MS. The survival of filoviruses in liquids, on solid substrates and in a dynamic aerosol. J Appl Microbiol. 2010;109(5):1531-9. 

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