Efficacy of the SuperTowel®: An Alternative Hand-washing Product for Humanitarian Emergencies

Belen Torondel, Rummana Khan, Torben Holm Larsen, Sian White, Belen Torondel, Rummana Khan, Torben Holm Larsen, Sian White

Abstract

Handwashing with soap reduces the transmission of diarrheal pathogens, but access to hand-washing facilities, water, and soap in humanitarian emergencies is limited. The SuperTowel® (ST) is a fabric treated with permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The aim of this study was to test the efficacy of the ST as a hand-cleaning product. Two sets of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of different prototypes of the ST. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the ST and handwashing with the reference soap, using a crossover design. Participants also completed a questionnaire about product perceptions. Three of the prototypes of the ST were more efficacious at removing E. coli from pre-contaminated hands than handwashing with soap (mean log10 reduction of 4.11 ± 0.47 for ST1, 3.84 ± 0.61 for ST2, and 3.71 ± 0.67 for ST3 versus 3.01 ± 0.63 for soap [P < 0.001, P = 0.002, and P = 0.005, respectively]). The ST prototypes used less water than handwashing with soap, were well accepted, and were considered preferable in communal settings. The ST has the potential to be a suitable complementary hand-cleaning product for humanitarian emergencies.

Figures

Figure 1.
Figure 1.
SuperTowel (ST) versions—left picture: ST0; middle picture: ST1, ST2, and ST3; and right picture: ST3 showing the scourer-like material in one corner.
Figure 2.
Figure 2.
Directions for handwashing provided to participants in both rounds of laboratory testing.
Figure 3.
Figure 3.
Mean log10 reduction factor of Escherichia coli after volunteers washed their hands with either the SuperTowel prototypes or the reference product (non-medicated soap). (Left side, phase 1 experiment, *P = 0.018. Right side, phase 2 experiment, **P < 0.005).

References

    1. Checchi F, Gayer M, Freeman Grais R, Mills EJ, 2007. Public Health in Crisis Affected Populations: A Practical Guide for Decision-Makers. London, United Kingdom: Humanitarian Practice Network, Overseas Development Institute.
    1. Connolly M, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL, 2004. Communicable diseases in complex emergencies: impact and challenges. Lancet 364: 1974–1983.
    1. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt WP, 2010. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 39 (Suppl 1): i193–i205.
    1. Rabie T, Curtis V, 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11: 258–267.
    1. Phillips RM, Vujcic J, Boscoe A, Handzel T, Aninyasi M, Cookson ST, Blanton C, Blum LS, Ram PK, 2015. Soap is not enough: handwashing practices and knowledge in refugee camps, Maban county, South Sudan. Confl Health 9: 39.
    1. Biran A, Schmidt WP, Zeleke L, Emukule H, Khay H, Parker J, Peprah D, 2012. Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya. Trop Med Int Health 17: 1133–1141.
    1. Aunger R, Schmidt WP, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V, 2010. Three kinds of psychological determinants for hand-washing behaviour in Kenya. Soc Sci Med 70: 383–391.
    1. Hoque BA, Mahalanabis D, Pelto B, Alam MJ, 1995. Research methodology for developing efficient handwashing options: an example from Bangladesh. J Trop Med Hyg 98: 469–475.
    1. Hirai M, Graham JP, Mattson KD, Kelsey A, Mukherji S, Cronin AA, 2016. Exploring determinants of handwashing with soap in Indonesia: a quantitative analysis. Int J Environ Res Public Health 13: E868.
    1. The Sphere Project , 2004. Sphere Handbook, Vol. 2005, Revised edition Geneva, Switzerland: The Sphere Project.
    1. UNHCR Global , 2017. Trends: Forced Displacement in 2016. Geneva, Switzerland: UNHCR.
    1. Blum LS, Yemweni A, Trinies V, Kambere M, Tolani F, Allen JV, Handzel T, Cookson S, Ram PK, 2017. A qualitative assessment of motivators and barriers to handwashing behaviors in an emergency setting in North Kivu, Democratic Republic of Congo. Am J Trop Med Hyg 97 (5 Suppl 1): 401–402.
    1. Poucher WA, 1991. Poucher’s Perfumes, Cosmetics and Soaps, Vol. 1, 9th edition London, United Kingdom: Chapman & Hall.
    1. TÜV Rheinland , 2016. Bioefficacy of the Antimicrobial Bonding Treatment as Applied to the SafePad. India: RealRelief Website.
    1. Gibson KE, Crandall PG, Ricke SC, 2012. Removal and transfer of viruses on food contact surfaces by cleaning cloths. Appl Environ Microbiol 78: 3037–3044.
    1. Lin CM, Wu FM, Kim HK, Doyle MP, Michael BS, Williams LK, 2003. A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails. J Food Prot 66: 2296–2301.
    1. McGinley KJ, Larson EL, Leyden JJ, 1988. Composition and density of microflora in the subungual space of the hand. J Clin Microbiol 26: 950–953.
    1. Friedrich MN, Julian TR, Kappler A, Nhiwatiwa T, Mosler HJ, 2017. Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe. Am J Infect Control 45: 228–233.
    1. European Committee for Standardization , 1997. EN1499: Chemical Disinfectants and Antiseptics. Hygienic Hand Wash. Test Method and Requirements. Brussels: Comite Europe en de Normalisation.
    1. Trick WE, Vernon MO, Hayes RA, Nathan C, Rice TW, Peterson BJ, Segreti J, Welbel SF, Solomon SL, Weinstein RA, 2003. Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis 36: 1383–1390.
    1. Alur AA, Rane MJ, Scheetz JP, Lorenz DJ, Gettleman L, 2009. Simulated microbe removal around finger rings using different hand sanitation methods. Int J Oral Sci 1: 136–142.
    1. Miles AA, Misra SS, Irwin JO, 1938. The estimation of the bactericidal power of the blood. J Hyg (Lond) 38:732–749.
    1. World Health Organisation , 2009. Hand Hygiene: Why, How & When? Geneva, Switzerland: WHO.
    1. Nilsen SK, Dahl I, Jørgensen O, Schneider T, 2002. Micro-fibre and ultra-micro-fibre cloths, their physical characteristics, cleaning effect, abrasion on surfaces, friction, and wear resistance. Build Environ 37: 1373–1378.
    1. Kampf AK, Kramer A, 2004. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 17: 863–893.
    1. Torondel B, Opare D, Brandberg B, Cobb E, Cairncross S, 2014. Efficacy of Moringa oleifera leaf powder as a hand-washing product: a crossover controlled study among healthy volunteers. BMC Complement Altern Med 14: 57.
    1. Rotter M, 1999. Hand washing and hand disinfection. Mayhall CG, ed. Hospital Epidemiology and Infection Control, 2nd edition Philadelphia, PA: Lippincott Williams & Wilkins, 1339–1355.
    1. Larson EL, 1995. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 23: 251–269.
    1. Garbutt C, Simmons G, Patrick D, Miller T, 2007. The public hand hygiene practices of New Zealanders: a national survey. N Z Med J 120: U2810.
    1. Mazure CM, Jones DP, 2015. Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. BMC Womens Health 15: 94.
    1. Institute of Medicine (US), Committee on Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies , 1994. Women’s participation in clinical studies. Mastroianni AC, Faden R, Federman D, eds. Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, Vol. 1 Washington, DC: National Academies Press (US).
    1. Yalcin SS, Yalcin S, Altin S, 2004. Hand washing and adolescents. A study from seven schools in Konya, Turkey. Int J Adolesc Med Health 16: 371–376.
    1. Anderson JL, Warren CA, Perez E, Louis RI, Phillips S, Wheeler J, Cole M, Misra R, 2008. Gender and ethnic differences in hand hygiene practices among college students. Am J Infect Control 36: 361–368.
    1. Mariwah S, Hampshire K, Kasim A, 2012. The impact of gender and physical environment on the handwashing behaviour of university students in Ghana. Trop Med Int Health 17: 447–454.
    1. Tao SY, Cheng YL, Lu Y, Hu YH, Chen DF, 2013. Handwashing behaviour among Chinese adults: a cross-sectional study in five provinces. Public Health 127: 620–628.
    1. To KG, Lee JK, Nam YS, Trinh OT, Van Do D, 2016. Hand washing behavior and associated factors in Vietnam based on the multiple indicator cluster survey, 2010–2011. Glob Health Action 9: 29207.
    1. Tran D, Phongsavan P, Bauman AE, Havea D, Galea G, 2006. Hygiene behaviour of adolescents in the Pacific: associations with socio-demographic, health behaviour and school environment. Asia Pac J Public Health 18: 3–11.
    1. Pengpid S, Peltzer K, 2012. Hygiene behaviour and health attitudes in African countries. Curr Opin Psychiatry 25: 149–154.
    1. Pengpid S, Peltzer K, 2011. Hygiene behaviour and associated factors among in-school adolescents in nine African countries. Int J Behav Med 18: 150–159.
    1. Abad FX, Pintó RM, Bosch A, 1994. Survival of enteric viruses on environmental fomites. Appl Environ Microbiol 60: 3704–3710.
    1. Barclay L, Park GW, Vega E, Hall A, Parashar U, Vinjé J, Lopman B, 2014. Infection control for norovirus. Clin Microbiol Infect 20: 731–740.
    1. Balsells E, Filipescu T, Kyaw MH, Wiuff C, Campbell H, Nair H, 2016. Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations. J Glob Health 6: 020410.

Source: PubMed

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