Addressing efficacy of everyday hygiene cleansing products in context of sustainable handwashing behaviour in the post-pandemic era
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- Evaluated articles (Rapid Reviews Infectious Diseases)
Abstract
Simple hygiene behaviour such as washing hands is key to improving health of individuals and reducing community transmission of communicable diseases such as respiratory and enteric infections. Consistent and relentless messaging by global and local health authorities had resulted in heightened hygiene awareness amongst the public during the COVID-19 pandemic. Unfortunately, many of the hygiene behaviours practiced during the pandemic have proven to be unsustainable in the immediate period following the pandemic. While CDC guidelines suggest washing hands with soap for a minimum of 20 seconds to prevent the spread of germs, a hygiene intervention’s effectiveness must be evaluated in context of the prevalent hygiene behaviour. Here we report our findings from an observational study conducted across India, Pakistan, Saudi Arabia, and United Arab Emirates focusing on handwashing habit of individuals in the post-pandemic period. Across all geographies, the time spent for lathering product on skin (contact time) for a significant majority of individuals recruited for the study was found to be 10 seconds and less. To ensure that marketed hygiene formulations such as liquid cleansers and sanitizers are efficacious in inactivating pathogens under conditions practiced by the majority as a part of their daily hand washing practices, we have investigated the in-vitro antimicrobial efficacy of several hygiene cleansing formulations at 10 seconds of contact time. Our results show that well-formulated cleansing solutions can reduce the input titre of both bacterial and viral pathogens by 99.9% or more, even with brief contact. With the global resurgence of both existing and emerging pathogens in the post-pandemic world, promoting sustainable handwashing practices for infection prevention remains a challenge as it is deeply rooted in the socio-economic fabric of many countries. Therefore, it is crucial to conduct regular studies like this to reassure end-users and combat complacency regarding the composition of everyday hygiene products.
Highlights
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Studies of handwashing behavior in 4 countries reveals significantly short lathering duration
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Antimicrobial efficacy testing of marketed products was conducted against a range of pathogens
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Suitably formulated hygiene products can inactivate pathogens at short durations of contact
Article activity feed
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This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/15467494.
Introduction
This preprint is a timely and useful addition to the current conversations about hygiene habits after the pandemic. The study looks at how people in India, Pakistan, Saudi Arabia, and the United Arab Emirates (UAE) wash their hands and whether the cleaning chemicals they use still work even though they wash their hands less often. The authors use observational data from 901 individuals along with in vitro testing of the antimicrobial effectiveness of body washes, hand washes, and sanitizers that are already on the market. Their main argument is that well-formulated hygiene products can still achieve significant pathogen reduction within short contact times, even though global …
This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/15467494.
Introduction
This preprint is a timely and useful addition to the current conversations about hygiene habits after the pandemic. The study looks at how people in India, Pakistan, Saudi Arabia, and the United Arab Emirates (UAE) wash their hands and whether the cleaning chemicals they use still work even though they wash their hands less often. The authors use observational data from 901 individuals along with in vitro testing of the antimicrobial effectiveness of body washes, hand washes, and sanitizers that are already on the market. Their main argument is that well-formulated hygiene products can still achieve significant pathogen reduction within short contact times, even though global guidelines recommend longer handwashing durations.
The research brings up crucial issues concerning how hygiene products are made and how public health messages are sent, but there are some problems with the study's design, generalizability, and possible conflicts of interest that need to be looked at closely.
Strengths
The study underlines the gap between suggested and actual hand cleanliness behaviors, a critical issue in infection management. By using videography for behavioral observation, the study improves its validity by lowering reliance on self-reported data, which is susceptible to recall bias.
Furthermore, combining behavioral data with laboratory efficacy testing creates a useful framework for determining whether marketed hygiene products are suitable for real-world use. The use of standardized antimicrobial testing procedures, such as ASTM E2783-22 for bactericidal activity and ASTM E1052-20 for virucidal efficacy, adds credibility to the study's conclusions.
Concerns and Limitations
Despite its merits, the study raises concerns. The most crucial issue is the potential conflict of interest, as all authors are linked with Unilever, the business that manufactures the studied hygiene products. This raises issues about bias, especially since no independent laboratories evaluated the antimicrobial efficacy data and the study did not compare Unilever formulations to competing products. Because there is no benchmarking component, it is difficult to determine whether the claimed effectiveness is unique to these products or a characteristic of all well-formulated hygiene cleansers.
Furthermore, the study's observational data has significant limitations in terms of generalizability. The sample size of 901 participants, while instructive, is insufficient to draw broad conclusions about global hand hygiene behaviors. Furthermore, the study is limited to urban populations, leaving out rural groups where access to hygiene goods and adherence to hygiene practices may vary greatly. Furthermore, the study did not stratify findings by crucial demographic parameters such as age, gender, or socioeconomic status, resulting in a missed chance to learn how hygiene behaviors change among population groups.
Pathogen testing's scope is another constraint. The study compares bacterial efficacy against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus to virucidal efficacy against Influenza A (H1N1) and Respiratory Syncytial Virus (RSV). However, it excludes non-enveloped viruses like norovirus, which are more resistant to surfactants and disinfectants.
Another issue is that the study focuses on product efficacy at short contact times, which may imply that shorter handwashing durations are equally protective. This violates public health guidelines, which emphasizes good technique, friction, and coverage above product formulation alone. Public health messaging should continue to prioritize behavioral adherence rather than relying exclusively on formulation improvement.
Areas for Improvement
Refinements may improve the study's credibility and impact. The methodology section might benefit from more clarity about inter-observer reliability in video analysis, as well as a more thorough discussion of ethical considerations in video data collecting, such as participant consent and data privacy. Furthermore, the statistical analysis of antimicrobial efficacy results should incorporate confidence intervals and significance testing to determine microbial decrease variability.
A comparison analysis of various hygiene brands could also be useful for the study. Researchers could better determine whether the stated efficacy is unique to Unilever formulas or constant across similar items if they evaluated many commercial products. Extending the study's scope to include non-enveloped viruses and potential AMR threats would provide a more complete picture of hygiene product performance.
Conclusion
This preprint gives useful information about post-pandemic hygiene practices and the antibacterial efficacy of marketed formulations. However, the study is restricted by its strong industrial association, low breadth of pathogen testing, and lack of independent confirmation. Future research should include third-party verification, increase the diversity of study participants, and compare tested goods to competitive formulations.
Competing interests
The authors declare that they have no competing interests.
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Daniele Lantagne
Review 3: "Addressing Efficacy of Everyday Hygiene Cleansing Products in Context of Sustainable Handwashing Behavior in the Post-Pandemic Era"
Reviewers found the study useful and recommended clarifying its scope and strengthening its discussion of real-world application limitations.
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Mark Cole
Review 2: "Addressing Efficacy of Everyday Hygiene Cleansing Products in Context of Sustainable Handwashing Behavior in the Post-Pandemic Era"
Reviewers found the study useful and recommended clarifying its scope and strengthening its discussion of real-world application limitations.
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Matthew Moore
Review 1: "Addressing Efficacy of Everyday Hygiene Cleansing Products in Context of Sustainable Handwashing Behavior in the Post-Pandemic Era"
Reviewers found the study useful and recommended clarifying its scope and strengthening its discussion of real-world application limitations.
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Strength of evidence
Reviewers: M Moore (University of Massachusetts Amherst) | 📒📒📒◻️◻️
M Cole (The University of Manchester) | 📒📒📒 ◻️◻️
D Lantagne (Tufts University) | 📗📗📗📗◻️ -
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