Subject: Fwd: [EXT] about use of Quaternary ammonium compounds as hand sanitizing solution for community settings - question GEO
From: Tamar Gabunia </O=EXCHORGANIZATION/OU=EXCHANGE ADMINISTRATIVE GROUP (FYDIBOHF23SPDLT)/CN=RECIPIENTS/CN=E6CA04F38EC94D0CADAB9CBDF90FCDDE-TAMAR G>
To: Eka Tikaradze <[email-masked]>; Beka Peradze </o=ExchOrganization/ou=Exchange Administrative Group (FYDIBOHF23SPDLT)/cn=Recipients/cn=01ea443dcce14da189df618b503a19aa-Beka Pe>
Date: Thu, 28 May 2020 17:24:23 +0000

Sent from my Samsung Galaxy smartphone.

-------- Original message --------

From: "COUTINHO REHSE, Ana Paula" <[email-masked]>

Date: 5/28/20 7:19 PM (GMT+04:00)

To: Marine Baidauri <[email-masked]>

Cc: Tamar Gabunia <[email-masked]>, Ekaterine Adamia <[email-masked]>, Anzor tchavtchavadze <[email-masked]>, Alisa Tsuladze <[email-masked]>, "ESENAMANOV, Vasily" <[email-masked]>, "DOMENTE, Silviu" <[email-masked]>

Subject: RE: [EXT] about use of Quaternary ammonium compounds as hand sanitizing solution for community settings - question GEO

Dear Marine,

Thank you or your message.

Here is all well, busy like everybody. I hope you and your family are doing well.

Thank you for your question regarding the use of non-alcohol ammonium based hand sanitizing solutions for the general public against SARS-COV2

To date, most of the effective hand sanitizer products are alcohol-based formulations containing 62%–95% of alcohol as it can denature the proteins of microbes and the ability to inactivate viruses. In this regard our recommendation
for hand hygiene talks about hand rub with alcohol-based solutions or hand washing with water and soap.

Like other coronaviruses, SARS-CoV-2 is an enveloped virus with a fragile outer lipid envelope that makes it more susceptible to disinfectants compared to non-enveloped viruses
such as rotavirus, norovirus and poliovirus

Quaternary ammonium compounds (QACs) are primarily bacteriostatic and fungistatic, although they are microbicidal against some organisms at high concentrations. They are more
active against Gram-positive bacteria than against Gram-negative bacilli. QACs have relatively weak activity against mycobacteria and fungi and have greater activity against lipophilic viruses. Their antimicrobial activity is adversely affected by the presence
of organic material, and they are not compatible with anionic detergents. Depending on the QACs type and formulation, the antimicrobial efficacy can be severely affected in the presence of hard water (if it is a diluted product) and fatty materials. Later
generations of QACs, e.g. didecyldimethyl ammonium chloride (DDAC), have stronger antimicrobial activity and good performance in the presence of hard water and organic soiling, but their activity has been studied on inanimate surfaces only.

In general, QACs are relatively well tolerated. Unfortunately, because of weak activity against Gram-negative bacteria, benzalkonium chloride is prone to contamination by these
organisms and a number of outbreaks of infection or pseudo-infection have been traced to QACs contaminated with Gram-negative bacilli.

Evidence from both the SARS and COVID-19 epidemics, shows that hand hygiene is very important to protect health care workers from getting infected (Seto WH et al, “Lancet” 2003;
Ran L et al, “Clin Infect Dis” 2020).

Hand washing in the community is highly effective to prevent both diarrhoeal diseases and respiratory illness (Jefferson T, et al. “BMJ” 2008). Thus, it is one of the most important
measures that can be used to prevent COVID 19 infection.

Alcohol-based hand rub products should contain at least 60% alcohol, should be certified and where supplies are limited or cost prohibitive can be made locally by carefully
following WHO Guide.

Plain soap is effective at inactivating enveloped viruses such as the COVID-virus due to the oily surface membrane that is dissolved by soap, killing the virus (Sickbert-Bennett
EE et al, “Am J Infect Control” 2005). In addition, hand washing removes germs through mechanical action (WHO Guidelines on Hand Hygiene in Health Care 2009).

Chlorinated water at 0.05% is not recommended for routine hand hygiene because it has skin and other toxic effects, and soap is easy to find and can be used effectively

Sources:

WHO guidelines on hand hygiene in health care -
https://www.who.int/infection-prevention/publications/hand-hygiene-2009/en/

Cleaning and disinfection of environmental surfaces in the context of COVID-19 -

https://www.who.int/publications-detail/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19

Interim recommendations on obligatory hand hygiene against transmission of COVID-19 -
https://www.who.int/who-documents-detail/interim-recommendations-on-obligatory-hand-hygiene-against-transmission-of-covid-19

Please let me know if the above answers your question and if you need further clarification.

Stay safe and stay well!

Kind regards

Ana Paula

Ms Ana Paula Coutinho Rehse

Technical Officer – Infection Prevention & Control

Infectious Hazard Management Programme

WHO Health Emergencies Programme

WHO Regional Office for Europe

Phone: +45 45 33 67 10

GPN: 76710

Mob : +45 23 72 90 72

e-mail:
[email-masked]

From: Marine Baidauri <[email-masked]>

Sent: Wednesday, May 27, 2020 6:48 PM

To: COUTINHO REHSE, Ana Paula <[email-masked]>

Cc: M Georgia <[email-masked]>; Ekaterine Adamia <[email-masked]>; Anzor tchavtchavadze <[email-masked]>; Alisa Tsuladze <[email-masked]>

Subject: [EXT] about hand sanitizing solutions

Dear Ana Paula,

I hope this letter finds you well, we have one question if you could kindly answer, Can we recommend non alcohol based hand sanitizing solutions to general public against Sars-cov2 ? Namely ammonium
based hand  sanitizing solution. We couldn’t find any specific recommendations on guidelines regarding this specific line of products.

Thank you very much in advance.

Best regards,

Marine Baidauri

Chief Specialist

Health policy Division of Policy Department

Ministry of
Internally Displaced Persons from the Occupied

Territories, Labour, Health and Social Affairs of Georgia

144 Tsereteli ave., 0159 Tbilisi, Georgia

Cell phone: +995 591103061

E-mail: [email-masked]