Wolfe Marlene K, Wells Emma, Mitro Brittany, Desmarais Anne Marie, Scheinman Pamela, Lantagne Daniele
Department of Civil and Environmental Engineering, Tuft University, Medford, Massachusetts, United States of America.
Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2016 Dec 28;11(12):e0167378. doi: 10.1371/journal.pone.0167378. eCollection 2016.
To prevent disease transmission, 0.05% chlorine solution is commonly recommended for handwashing in Ebola Treatment Units. In the 2014 West Africa outbreak this recommendation was widely extended to community settings, although many organizations recommend soap and hand sanitizer over chlorine. To evaluate skin irritation caused by frequent handwashing that may increase transmission risk in Ebola-affected communities, we conducted a randomized trial with 91 subjects who washed their hands 10 times a day for 28 days. Subjects used soap and water, sanitizer, or one of four chlorine solutions used by Ebola responders (calcium hypochlorite (HTH), sodium dichloroisocyanurate (NaDCC), and generated or pH-stabilized sodium hypochlorite (NaOCl)). Outcomes were self-reported hand feel, irritation as measured by the Hand Eczema Score Index (HECSI) (range 0-360), signs of transmission risk (e.g., cracking), and dermatitis diagnosis. All groups experienced statistically significant increases in HECSI score. Subjects using sanitizer had the smallest increases, followed by higher pH chlorine solutions (HTH and stabilized NaOCl), and soap and water. The greatest increases were among neutral pH chlorine solutions (NaDCC and generated NaOCl). Signs of irritation related to higher transmission risk were observed most frequently in subjects using soap and least frequently by those using sanitizer or HTH. Despite these irritation increases, all methods represented minor changes in HECSI score. Average HECSI score was only 9.10 at endline (range 1-33) and 4% (4/91) of subjects were diagnosed with dermatitis, one each in four groups. Each handwashing method has benefits and drawbacks: soap is widely available and inexpensive, but requires water and does not inactivate the virus; sanitizer is easy-to use and effective but expensive and unacceptable to many communities, and chlorine is easy-to-use but difficult to produce properly and distribute. Overall, we recommend Ebola responders and communities use whichever handwashing method(s) are most acceptable, available, and sustainable for community handwashing.
International Standard Randomized Controlled Trial Registry ISRCTN89815514.
为防止疾病传播，埃博拉治疗单位通常建议使用0.05%的含氯溶液洗手。在2014年西非埃博拉疫情爆发期间，这一建议被广泛推广至社区环境，尽管许多组织更推荐使用肥皂和洗手液而非含氯溶液。为评估频繁洗手可能在受埃博拉影响的社区增加传播风险而导致的皮肤刺激，我们开展了一项随机试验，91名受试者每天洗手10次，持续28天。受试者使用肥皂和水、洗手液，或埃博拉应对人员使用的四种含氯溶液之一（次氯酸钙（HTH）、二氯异氰尿酸钠（NaDCC），以及自制或pH稳定的次氯酸钠（NaOCl））。观察指标包括自我报告的手部感觉、通过手部湿疹评分指数（HECSI）测量的刺激程度（范围0 - 360）、传播风险迹象（如皮肤皲裂）以及皮炎诊断。所有组的HECSI评分均有统计学意义的增加。使用洗手液的受试者增加幅度最小，其次是较高pH值的含氯溶液（HTH和稳定的NaOCl），以及肥皂和水。增加幅度最大的是中性pH值的含氯溶液（NaDCC和自制NaOCl）。在使用肥皂的受试者中，与较高传播风险相关的刺激迹象最为常见，而在使用洗手液或HTH的受试者中最少见。尽管这些刺激有所增加，但所有方法在HECSI评分上的变化都较小。在试验结束时，平均HECSI评分为9.10（范围1 - 33），4%（4/91）的受试者被诊断为皮炎，四组中各有一名。每种洗手方法都有其优缺点：肥皂广泛可得且价格低廉，但需要用水且不能灭活病毒；洗手液易于使用且有效，但价格昂贵且许多社区难以接受；含氯溶液易于使用，但难以正确配制和分发。总体而言，我们建议埃博拉应对人员和社区采用社区洗手时最可接受、可得且可持续的任何洗手方法。
国际标准随机对照试验注册库ISRCTN89815514 。
