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Noroviruses (NoV) are the most common cause of acute nonbacterial gastroenteritis in the United States, and human hands play
an important role in their transmission. Little is known about the efficacy of hand hygiene agents against these highly infectious
pathogens. We investigated the activity of seven commercially available hand hygiene products...
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Context 1
... total of seven commercially available hand hygiene products were evaluated (Table 1): seven products against NV (Table 2 and Fig. 1), three against SMV (Table 3), and two against GII.4 (Table 4). The benchmark handrub (PURELL Original Instant Hand Sanitizer, subsequently referred to as ''Benchmark''), PURELL Instant Hand Sanitizer VF447 (subsequently referred to as ''VF447''), and PURELL Instant Hand Sanitizer VF481 (subsequently referred to as ''VF481'') are commercially available products from GOJO Industries Inc., Akron, OH). ...
Context 2
... investigate potential strain-to-strain differences in NoV reduction by handrubs, we evaluated the efficacy of the two most effective hand hygiene products in our first experiments (VF481 and VF447) and the benchmark handrub product against SMV in a trial with six subjects. VF481 was again the most effective product, reducing SMV RNA by a mean 2.27 log reduction using heat release RNA extraction method (Table 3). However, SMV RNA reduction was less than that observed for VF481 against NV RNA (3.74 log reduction) in the previous trial in Table 2. ...
Context 3
... most effective product tested, VF481, is a 70% ethanol gel containing additional ingredients that appear to potentiate the virucidal activity of the product. The mean NoV RNA log reductions produced by VF481 ranged from 2.27 for SMV (Table 3) to 3.74 for NV (Table 2) and 4.02 for GII.4 (Table 4) using the heat release method. The efficacy of the other five commercial products (with ethanol concentrations from 62% to 95% [see Table 1]) against NV ranged from 0.10 to 2.04 log reduction (Table 2). ...
Context 4
... finding is consistent with previous research (Butot et al. 2008(Butot et al. , 2009) but is somewhat surprising because GII.4 NoV strains have been the predominant NoV outbreaks strains for years ( Siebenga et al. 2009), therefore we expected they might be more resistant to inactivation on hands. In contrast, the SMV strain appeared to be more resistant than NV to the handrubs tested but was still significantly reduced by VF481 (Table 3 ...
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The GII.4 noroviruses (NoVs) are a single genotype that is responsible for over 50% of NoV gastroenteritis epidemics worldwide. However, GII.4 NoVs have been found to undergo antigenic drifts, likely selected by host herd immunity, which raises an issue for vaccine strategies against NoVs. We previously characterized GII.4 NoV antigenic variations...
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Unlabelled:
Human noroviruses are the dominant cause of outbreaks of gastroenteritis around the world. Human noroviruses interact with the polymorphic human histo-blood group antigens (HBGAs), and this interaction is thought to be important for infection. Indeed, synthetic HBGAs or HBGA-expressing enteric bacteria were shown to enhance norovirus i...
Noroviruses are a common cause of gastroenteritis worldwide, but outbreaks appear to be more common in industrialized countries than in developing countries, possibly reflecting differences in exposure and immunity. In this study, age-stratified sera from India and UK populations were analysed for the presence of norovirus-genogroup II specific IgG...
Norwalk virus (NV)andother small round-structured viruses (SRSVs) arefrequent causes ofgastroenteritis outbreaks. Therecent cloning andsequencing oftheNV genomehasmadeitpossible todetect NV and Norwalk-related viruses fromfecal specimens byreverse transcription (RT)-PCR. We applied thistechnique totheexamination ofatotal of139fecal specimens from19...
Citations
... Other studies should assess the in vitro broad-spectrum antiviral and virucidal efficacy of O 3 , taking into account the genetic and phenotypic diversity of enteric viruses even below the species level. For instance, marked differences in terms of resistance to chemical and physical inactivation have been observed between NoV GII.4 variants [45][46][47][48]. Likewise, marked differences in terms of resistance phenotypes have been observed between enteric and respiratory FCV isolates [49]. ...
The Caliciviridae family includes several viral pathogens of humans and animals, including norovirus (NoV), genus Norovirus, and feline calicivirus (FCV), genus Vesivirus. Due to their resistance in the environment, NoV and FCV may give rise to nosocomial infections, and indirect transmission plays a major role in their diffusion in susceptible populations. A pillar of the control of viruses resistant to an environment is the adoption of prophylaR1.6ctic measures, including disinfection. Since NoVs are not cultivatable in common cell cultures, FCV has been largely used as a surrogate of NoV for the assessment of effective disinfectants. Ozone (O3), a molecule with strong oxidizing properties, has shown strong microbicidal activity on bacteria, fungi, protozoa, and viruses. In this study, the virucidal and antiviral activities of an O3/O2 gas mixture containing O3 were tested at different concentrations (20, 35, and 50 μg/mL) for distinct contact times against FCV. The O3/O2 gas mixture showed virucidal and antiviral activities against FCV in a dose- and contact time-dependent fashion. Ozonation could be considered as a valid strategy for the disinfection of environments at risk of contamination by FCV and NoV.
... For example, FCV is a respiratory pathogen and is less acid tolerant than is hNoV; MNV is more sensitive to alcohol than is hNoV; and bacteriophage MS2 is highly resistant to ethanol (Cromeans et al., 2014). Those few studies done with hNoV show a general trend of poor efficacy for both alcohol-based products (Liu et al., 2009(Liu et al., , 2011Tuladhar et al., 2015) as well as QACs (Girard et al., 2010;Tung et al., 2013). However, with careful formulation, a few recent alcohol-based products have shown comparatively better efficacy against hNoV compared to earlier formulations (Liu et al., 2011;Escudero-Abarca et al., 2020). ...
... Those few studies done with hNoV show a general trend of poor efficacy for both alcohol-based products (Liu et al., 2009(Liu et al., , 2011Tuladhar et al., 2015) as well as QACs (Girard et al., 2010;Tung et al., 2013). However, with careful formulation, a few recent alcohol-based products have shown comparatively better efficacy against hNoV compared to earlier formulations (Liu et al., 2011;Escudero-Abarca et al., 2020). ...
... The purpose of this study was to compare the efficacy of seven commercial alcohol-based hand sanitizers, with varying concentrations of ethanol (labeled in the range of 62-85%), one commercial hand sanitizer containing the QAC BAK (0.1% BAK), and a 60% ethanol solution used as a benchmark control, on human fingerpads against hNoV using the in vivo assay ASTM E1838-17. Previous studies have utilized earlier versions of the ASTM E1838 fingerpad method (ASTM E1838-10 or earlier) to evaluate the efficacy of hand sanitizers (Macinga et al., 2008;Liu et al., 2009Liu et al., , 2011. The major differences between the two protocols are (1) the addition of friction (rubbing) during the sanitizer application step for the newer protocol; and (2) the use of an alternative elution method (Petri dish vs. cryovial) (Figure 1). ...
Human noroviruses (hNoV) are the leading cause of acute non-bacterial gastroenteritis worldwide and contaminated hands play a significant role in the spread of disease. Some hand sanitizers claim to interrupt hNoV transmission, but their antiviral efficacy on human hands is poorly characterized. The purpose of this work was to characterize the efficacy of representative commercial hand sanitizers against hNoV using an in vivo fingerpad method (ASTM E1838-17). Eight products [seven ethanol-based and one benzalkonium chloride (BAK)-based], and a benchmark 60% ethanol solution, were each evaluated on 10 human volunteers using the epidemic GII.4 hNoV strain. Virus titers before and after treatment were evaluated by RT-qPCR preceded by RNase treatment; product efficacy was characterized by log10 reduction (LR) in hNoV genome equivalent copies after treatment. The benchmark treatment produced a 1.7 ± 0.5 LR, compared with Product A (containing 85% ethanol) which produced a 3.3 ± 0.3 LR and was the most efficacious (p < 0.05). Product B (containing 70% ethanol), while less efficacious than Product A (p < 0.05), performed better than the benchmark with a LR of 2.4 ± 0.4. Five of the other ethanol-based products (labeled ethanol concentration ranges of 62–80%) showed similar efficacy to the 60% ethanol benchmark with LR ranging from 1.3 to 2.0 (p > 0.05). Product H (0.1% BAK) was less effective than the benchmark with a LR of 0.3 ± 0.2 (p < 0.05). None of the products screened were able to completely eliminate hNoV (maximum assay resolution 5.0 LR). Product performance was variable and appears driven by overall formulation. There remains a need for more hand sanitizer formulations having greater activity against hNoV, a virus that is comparatively recalcitrant relative to other pathogens of concern in community, healthcare, and food preparation environments.
... Some reports suggest that human norovirus disinfection by a variety of methods is strain-dependent. Specifically, GI strains have been found more susceptible than GII strains to inactivation by alcohols 36,37 and heat treatment. 38 A recent report by Recker and Li 9 also presents a similar trend with GII.4 Sydney being less susceptible to inactivation than GI.3B Potsdam norovirus when exposed to copper surfaces evaluated with HBGA-binding prior to RT-qPCR. ...
The antinoroviral effect of copper ions is well known, yet most of this work has previously been conducted in copper and copper alloy surfaces, not copper ions in solution. In this work, we characterized the effects that Cu ions have on human norovirus capsids' and surrogates' integrity to explain empirical data, indicating virus inactivation by copper alloy surfaces, and as means of developing novel metal ion-based virucides. Comparatively high concentrations of Cu(II) ions (>10 mM) had little effect on the infectivity of human norovirus surrogates, so we used sodium ascorbate as a reducing agent to generate unstable Cu(I) ions from solutions of copper bromide. We found that significantly lower concentrations of monovalent copper ions (∼0.1 mM) compared to divalent copper ions cause capsid protein damage that prevents human norovirus capsids from binding to cell receptors in vitro and induce a greater than 4-log reduction in infectivity of Tulane virus, a human norovirus surrogate. Further, these Cu(I) solutions caused reduction of GII.4 norovirus from stool in suspension, producing about a 2-log reduction of virus as measured by a reverse transcriptase-quantitative polymerase chain reaction. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) data indicate substantial major capsid protein cleavage of both GI.7 and GII.4 norovirus capsids, and TEM images show the complete loss of capsid integrity of GI.7 norovirus. GII.4 virus-like particles (VLPs) were less susceptible to inactivation by copper ion treatments than GI.7 VLPs based upon receptor binding and SDS-PAGE analysis of viral capsids. The combined data demonstrate that stabilized Cu(I) ion solutions show promise as highly effective noroviral disinfectants in solution that can potentially be utilized at low concentrations for inactivation of human noroviruses.
... Combined chemical disinfection methods Liu et al. (2011) assessed the inactivation of three HuNoV strains by means of five commercially available gel sanitizers and two hand rubs containing 62%-95% EtOH (v/v) further combined with citric acid, peroxyacid, QACs, or copper gluconate. After 15-s exposure, HuNoV RNA was reduced by 0.1 log 10 when the mixtures of 95% EtOH (v/v) with additives such as alkane/cycloalkanes, glycerin, myristyl alcohol, and hexane were used, and by 3.75 log 10 when the mixtures of 70% EtOH (v/v), water, IPA, copper gluconate, diisopropyl sebacate, PEG/PPG-20/6 dimethicone, pentaerythrityl tetra-di-t-butyl hydroxyhydrocinnamate, and polyquaternium-37 were used. ...
Food‐ and waterborne viruses, such as human norovirus, hepatitis A virus, hepatitis E virus, rotaviruses, astroviruses, adenoviruses, and enteroviruses, are major contributors to all foodborne illnesses. Their small size, structure, and ability to clump and attach to inanimate surfaces make viruses challenging to reduce or eliminate, especially in the presence of inorganic or organic soils. Besides traditional wet and dry methods of disinfection using chemicals and heat, emerging physical nonthermal decontamination techniques (irradiation, ultraviolet, pulsed light, high hydrostatic pressure, cold atmospheric plasma, and pulsed electric field), novel virucidal surfaces, and bioactive compounds are examined for their potential to inactivate viruses on the surfaces of foods or food contact surfaces (tools, equipment, hands, etc.). Every disinfection technique is discussed based on its efficiency against viruses, specific advantages and disadvantages, and limitations. Structure, genomic organization, and molecular biology of different virus strains are reviewed, as they are key in determining these techniques effectiveness in controlling all or specific foodborne viruses. Selecting suitable viral decontamination techniques requires that their antiviral mechanism of action and ability to reduce virus infectivity must be taken into consideration. Furthermore, details about critical treatments parameters essential to control foodborne viruses in a food production environment are discussed, as they are also determinative in defining best disinfection and hygiene practices preventing viral infection after consuming a food product.
... Ethanol was determined to be ineffective against NoV even at concentrations !90% alcohol (53,100). However, hand sanitizers containing ethanol in combination with other compounds could be effective in reducing NoV (51). Hands (finger pads) rinsed for 10 s with water alone reduced NoV levels by up to 1.58 log, which was better than for finger pads washed with antibacterial soap containing 0.5% triclosan or an alcohol-based hand sanitizer (53). ...
This critical review addresses the persistence of human norovirus (NoV) in water, shellfish, and processed meats; on berries, herbs, vegetables, fruits, and salads; and on food contact surfaces. The review focuses on studies using NoV; information from studies involving only surrogates is not included. It also addresses NoV elimination or inactivation by various chemical, physical, or processing treatments. In most studies, persistence or elimination was determined by detection and quantification of the viral genome, although improved methods for determining infectivity have been proposed. NoV persisted for 60 to 728 days in water, depending on water source. It also persisted on berries, vegetables, and fruit, often showing 8.0, freeze-drying, and UV radiation. Ineffective disinfectants included hydrogen peroxide, quaternary ammonium compounds, most ethanol-based disinfectants, and antiseptics at normally used concentrations. Thorough washing of herbs and produce was effective in reducing, but not eliminating, NoV in most products. Washing hands with soap generally reduced NoV by
... Washing hands with water and soap is recommended as the primary mode of intervention, whereas alcohol-based hand sanitizers (ABHS) can be used as an adjunct [13,14]. Interpretation of efficacy data of ABHS on noroviruses is challenging, because their effects do not necessarily depend on alcohol but rather on the formulation of the product [15,16]. ...
... Appropriate hand hygiene is the single most effective way to prevent norovirus transmission. In the laboratory, the effect of ABHS on norovirus has been studied primarily by using the Norwalk virus (GI.1) reference strain [15,31]. We recently reported significant differences in sensitivity against ethanol between GI.5 and GII.13 noroviruses [23]. ...
Alcohol-based hand sanitizers are widely used to disinfect hands to prevent the spread of pathogens including noroviruses. Alcohols inactivate norovirus by destruction of the viral capsid, resulting in the leakage of viral RNA (virolysis). Since conflicting results have been reported on the susceptibility of human noroviruses against alcohols, we exposed a panel of 30 human norovirus strains (14 GI and 16 GII strains) to different concentrations (50%, 70%, 90%) of ethanol and isopropanol and tested the viral RNA titer by RT-qPCR. Viral RNA titers of 10 (71.4%), 14 (100%), 3 (21.4%) and 7 (50%) of the 14 GI strains were reduced by > 1 log10 RNA copies/ml after exposure to 70% and 90% ethanol, and 70% and 90% isopropanol, respectively. RNA titers of 6 of the 7 non-GII 4 strains remained unaffected after alcohol exposure. Compared to GII strains, GI strains were more susceptible to ethanol than to isopropanol. At 90%, both alcohols reduced RNA titers of 8 of the 9 GII.4 strains by ≥ 1 log10 RNA copies/ml. After exposure to 70% ethanol, RNA titers of GII.4 Den Haag and Sydney strains decreased by ≥ 1.9 log10, whereas RNA reductions for GII.4 New Orleans strains were < 0.5 log10. To explain these differences, we sequenced the complete capsid gene of the 9 GII.4 strains and identified 17 amino acid substitutions in the P2 region among the 3 GII.4 variant viruses. When comparing with an additional set of 200 GII.4 VP1 sequences, only S310 and P396 were present in all GII.4 New Orleans viruses but not in the ethanol-sensitive GII.4 Sydney and GII.4 Den Haag viruses Our data demonstrate that alcohol susceptibility patterns between different norovirus genotypes vary widely and that virolysis data for a single strain or genotype are not representative for all noroviruses.
... In vivo studies involved experiments carried out with selected human volunteers to estimate the efficacy of each tested product to remove or inactivate target microorganisms from artificially contaminated whole hands, finger pads, or gloves. The vast majority of published in vivo studies were carried out on hands or finger pads artificially contaminated with pure cultures of bacteria or viruses without the presence of food components or organic material (9,14,22,25,33,34,37,39,43,51). In seven studies, the efficacy of hand washing products was evaluated in a food preparation setting with naturally and artificially soiled hands or gloves (7,8,15,16,36,40,44). ...
... Because human norovirus (HuNoV) cannot be routinely cultured in vitro, determining the effectiveness of sanitizers and disinfectants against HuNoV is difficult. Methodologies used to estimate the level of virus reduction include the use of reverse transcription quantitative real-time PCR (RT-qPCR) to quantify the number of RNA copies of HuNoV extracted and purified from tested samples (37,38,42) and the use of cultivable surrogates such as feline calicivirus (FCV) and murine norovirus (MNV). Norovirus surrogates were generally tested alone as an alternative to HuNoV (9,16,25,32,34,36,51) or in parallel with HuNoV (42). ...
... The greatest reduction was observed for water rinse only (1.38 6 0.49-log reduction) and antibacterial soap (1.1 6 0.49-log reduction). In a separate study, Liu et al. (37) tested various commercially available hand hygiene products containing 62 to 95% alcohol against multiple HuNoV strains on finger pads. The results revealed a wide range of efficacy (0.10-to 3.74-log reduction), depending on the product and strain tested. ...
Hands can be a vector for transmitting pathogenic microorganisms to foodstuffs and drinks, and to the mouths of susceptible hosts. Hand washing is the primary barrier to prevent transmission of enteric pathogens via cross-contamination from infected persons. Conventional hand washing involves the use of water, soap, and friction to remove dirt and microorganisms. The availability of hand sanitizing products for use when water and soap are unavailable has increased in recent years. The aim of this systematic review was to collate scientific information on the efficacy of hand sanitizers compared with washing hands with soap and water for the removal of foodborne pathogens from the hands of food handlers. An extensive literature search was carried out using three electronic databases: Web of Science, Scopus, and PubMed. Twenty-eight scientific publications were ultimately included in the review. Analysis of this literature revealed various limitations in the scientific information owing to the absence of a standardized protocol for evaluating the efficacy of hand products and variation in experimental conditions. However, despite conflicting results, scientific evidence seems to support the historical skepticism about the use of waterless hand sanitizers in food preparation settings. Water and soap appear to be more effective than waterless products for removal of soil and microorganisms from hands. Alcohol-based products achieve rapid and effective inactivation of various bacteria, but their efficacy is generally lower against nonenveloped viruses. The presence of food debris significantly affects the microbial inactivation rate of hand sanitizers.
... Consequently, we directly compared RT-qPCR and infectivity data from surrogates to hNoV RT-qPCR data for key treatments (excluding studies that reported on surrogates alone or hNoV RT-qPCR data alone). Data were extracted NASBA Nowak et al. (2011b) Disinfectants and sanitizers in solution hNoV RT-qPCR data only Liu et al. (2010) Liquid soap and hand sanitizers on contaminated hands hNoV RT-qPCR data only Liu et al. (2011) Alcohol based hand rubs hNoV RT-qPCR data only Mormann et al. (2010) Reduction in RT-qPCR signals following food processing conditions hNoV RT-qPCR data only Ngazoa et al. (2008) Attachment to stainless steel and household disinfection hNoV RT-qPCR data only Richards et al. (2012) Freezing and thawing and capsid integrity hNoV RT-qPCR data only D' Souza et al. (2006) Persistence on stainless steel, ceramic and formica and transfer to lettuce Qualitative RT-PCR Hudson et al. (2007) Ozone fog disinfection of surfaces Qualitative RT-PCR Barker et al. (2004) Cleaning and decontamination study Qualitative RT-PCR Bertrand et al. (2012) Review paper Avoidance of duplication Kitajima et al (2010) Chlorine inactivation in water. hNoV data was limited by the scale of the study. ...
Human noroviruses (hNoV) are the single largest cause of acute gastroenteritis in the western world. The efficacy of hNoV control measures remains largely unknown, partly owing to the inability to grow the virus in vitro and partly to the large number of surrogate studies of unknown relevance. A systematic review of the persistence and survival of hNoV in foods and the environment was undertaken based upon PRISMA (preferred reporting items for systematic reviews and meta analyses) guidelines to answer the questions: (1) "What are the natural hNoV persistence characteristics in food and the environment?" and (2) "How can these properties be altered by applying physical and/or chemical treatments to foods or food contact surfaces?" Over 10,000 citations were screened using defined inclusion and exclusion criteria. One hundred and twenty-six (126) citations were identified for further evaluation and data were extracted based upon the conditions of study and treatment (e.g., treatment parameters, pH, and temperature, time, infectivity, and RT-qPCR results). Since the only markers for hNoV persistence and survival were RT-qPCR data and human challenge studies, citations for further analysis were restricted to only those that included data on hNoV behavior (using RT-qPCR) as compared directly to surrogate virus behavior (using both RT-qPCR and infectivity) in the same study, and clinical studies. Based on these criteria, a total of 12 independent studies (5 for thermal inactivation and 7 for available chlorine) and 3 human challenge studies were identified. RT-qPCR always underestimated reductions in surrogate virus titre as a function of treatment when compared to infectivity. The corresponding reductions in RT-qPCR signals for hNoV under comparable conditions were nearly always less than those observed for the surrogates. These relationships were statistically significant for heat when comparing persistence of hNoV RT-qPCR signals with surrogate MNV-1 RT-qPCR signals (P equal persistence=<0.07); and for free chlorine when comparing persistence of hNoV RT-qPCR signals to those of FCV F-9 (p=<0.01). Overall the data suggest that hNoV are frequently more resistant to typical food and environmental control measures compared with cultivable surrogate viruses, when basing data on comparative RT-qPCR results.
... effectiveness) of alcohol-based sanitizers is a function of both: (i) their ability to inactivate viruses (i.e. efficacy), which depends both on the formulation and on the way they are tested in vitro or in vivo [29,41,77,82,83]; and (ii) compliance, which includes both the frequency of use and proper application [34]. ...
Norovirus infections are notoriously difficult to prevent and control due to their low infectious dose, high shedding titer, and environmental stability. The virus can spread through multiple transmission routes of which person-to-person and foodborne are the most important. Recent advances in molecular diagnostics, have helped to establish norovirus as the most common cause of sporadic gastroenteritis and most common cause of outbreaks of acute gastroenteritis across all ages. In this paper, we review the epidemiology and virology of noroviruses as well as prevention and control guidelines with a focus on the principles of disinfection and decontamination; Outbreak management relies on sound infection control principles including hand hygiene, limiting exposure to infectious individuals, and thorough environmental decontamination. Ideally, all infection control recommendations would rely on empirical evidence, but a number of challenges, including the inability to culture norovirus in the laboratory and the challenges of outbreak management in complex environments, has made it difficult to garner clear evidence of efficacy in certain areas of infection control. New experimental data on cultivable surrogates for human norovirus on the environmental survivability and relative resistance to commonly used disinfectants, are providing new insights in further refining disinfection practices. Finally, clinical trials are underway to evaluate the efficacy of vaccines which may shift the current infection control principles to more targeted interventions.This article is protected by copyright. All rights reserved.
... Typical ABHR activity against nonenveloped enteric viruses varies depending on the type and concentration of alcohol (5,6,14,21). Different strains of HNVs may be more resistant to antimicrobial agents than others (24). Several studies have been conducted on newly formulated ABHRs with significantly improved inactivation of nonenveloped viruses (24,28). ...
... Different strains of HNVs may be more resistant to antimicrobial agents than others (24). Several studies have been conducted on newly formulated ABHRs with significantly improved inactivation of nonenveloped viruses (24,28). A 70% ethanol advanced formula (EtOH AF) gel reduced HNV by 3.74 log units in 15 s, a significantly greater HNV reduction than produced by six other commercially available hand hygiene products (24). ...
... Several studies have been conducted on newly formulated ABHRs with significantly improved inactivation of nonenveloped viruses (24,28). A 70% ethanol advanced formula (EtOH AF) gel reduced HNV by 3.74 log units in 15 s, a significantly greater HNV reduction than produced by six other commercially available hand hygiene products (24). This gel was the most effective product tested against two strains of HNV. ...
Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E. coli, representing a moderate soil load, a regimen combining an antimicrobial hand washing product with a 70% ethanol advanced formula (EtOH AF) gel achieved a 5.22-log reduction, whereas a nonantimicrobial hand washing product alone achieved a 3.10log reduction. When hands were heavily soiled from handling ground beef containing E. coli, a wash-sanitize regimen with a 0.5% chloroxylenol antimicrobial hand washing product and the 70% EtOH AF gel achieved a 4.60-log reduction, whereas a wash-sanitize regimen with a 62% EtOH foam achieved a 4.11-log reduction. Sanitizing with the 70% EtOH AF gel alone was more effective than hand washing with a nonantimicrobial product for reducing murine norovirus (MNV), a surrogate for human norovirus, with 2.60- and 1.79-log reductions, respectively. When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the 70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms. Use of a high-efficacy sanitizer as part of a wash-sanitize regimen further increased the efficacy of the regimen. The use of a well-formulated alcohol-based hand rub as part of a wash-sanitize regimen should be considered as a means to reduce risk of infection transmission in food service facilities.
