1Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
7Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Campus Universitário, s/n, Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil.
Antimicrob Resist Infect Control. 2019 Jun 24;8:109. doi: 10.1186/s13756-019-0553-z. eCollection 2019.
The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting.
We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations.
According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used.
In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.
世界卫生组织（WHO）的乙醇基手部消毒剂（EBHR）配方含有 1.45%的甘油作为一种润肤剂，以保护医护人员（HCWs）的皮肤免受干燥和皮炎的影响。然而，甘油似乎会降低醇类的抗菌效果。此外，保护手部所需的甘油最低浓度仍不清楚。我们旨在评估在热带气候医疗环境中，使用不同浓度的甘油对 WHO EBHR 配方的 HCWs 的耐受性。
我们于 2017 年 6 月 1 日至 9 月 30 日期间在巴西一家三级医院的重症监护病房中进行了一项集群随机、双盲、交叉研究，共纳入了 40 名 HCWs。我们对含有 1.45%甘油的 WHO EBHR 原配方与另外三种浓度（0、0.5 和 0.75%）进行了测试。HCWs 在日常工作中，每次使用一种配方，持续 7 天，然后由一名外部观察者使用 WHO 视觉检查量表对其手部进行评估。参与者还使用 WHO 自我评估工具对自己的皮肤状况进行评分。我们使用广义估计方程的对数类型来比较不同配方之间的耐受性差异。
根据独立观察，与使用 1.45%甘油的制剂相比，当参与者使用 0.5%甘油的制剂时，他们的皮肤状况被认为良好的可能性高 2.4 倍（95%CI：1.12-5.15）。对于自我评估量表，与使用 WHO 标准制剂（1.45%）相比，当参与者使用不含甘油的制剂时，他们更有可能得到最差的评价（OR：0.23，95%CI：0.11-0.49），而其他制剂之间则没有差异。
在热带气候环境下，含有 0.5%甘油的 WHO 改良 EBHR 制剂的皮肤耐受性评分优于原制剂，因此在皮肤耐受性和抗菌效果之间可能达到最佳平衡。
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