Production of the WHO-recommended alcohol-based handrub formulations in 11 different sites worldwide

Abstract number: P1138

Allegranzi B., Mathai E., Bagheri Nejad S., Dharan S., Griffiths W., Bonnabry P., Storr J., Damani N., Pittet D.

Objective: Availability of alcohol-based handrub formulations (ABHF) at the point of care is an essential element of the WHO multimodal hand hygiene (HH) improvement strategy. Tools were developed by WHO to help healthcare settings to make this system change, including a guide to the local production of 2 formulations. We evaluated the feasibility, quality control, and local production costs in different sites worldwide.

Methods: A survey was conducted in July-September 2008 to gather data on the WHO-recommended ABHF local production in 11 sites testing the WHO strategy in Bangladesh, Costa Rica, Egypt, Hong Kong SAR, Kenya, Mali, Mongolia, Pakistan (2 sites), Saudi Arabia, and Spain. Questions related to equipment used, staff involved in production, sourcing and cost of ingredients, quality control of the final product, adequacy of facility for preparation and storage, and distribution and end use; open-ended questions on lessons learnt were also included. Quality checks by gas chromatography and the titrimetric method were performed on the final products.

Results: All sites completed the survey. Apart from Bangladesh and Pakistan, all sites manufactured the ABHF based on ethanol. In 7 hospitals, local production was carried out successfully at the pharmacy. In Bangladesh, Costa Rica, Hong Kong SAR and Saudi Arabia, ABHF was produced by a pharmaceutical company for distribution to several facilities across the country. Production volumes varied significantly according to local needs (10–600,000 litres/month). In a few cases, difficulties arose for the local procurement of some ingredients and dispensers. Facilities for production and storage were considered adequate in all sites but two (Mali and Pakistan); the ABHF was shown to be stable, even at tropical temperatures (up to 19 months). Quality checks on samples from 7 sites yielded optimal results. Good tolerability and acceptability by healthcare workers were reported. Cost assessment was conducted in 5 sites and ranged between US$0.30–0.50 per 100 ml.

Conclusion: Local production of the WHO-recommended ABHF is feasible in different settings worldwide, despite some procurement obstacles. The final product was well-tolerated and very inexpensive compared to marketed formulations. After a test phase, 5 countries have decided to scale-up to national production. Local production is a very promising approach to make ABHF available in many more settings, especially those with limited resources.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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