Lompo et al., 2023. Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review

April 18, 2023

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Bacteriology

We conducted a systematic review of healthcare-associated outbreaks and cross-sectional
surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in
healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of
bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards,
13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Prod-
ucts most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary
ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales
(including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and
non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6%
of 164 isolates , respectively, from cross-sectional surveys. Risk factors included preparation (place,
utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate repro-
cessing), and practices (topping-up or too long use). Potential biases were microbiological methods
(neutralizers) and incomplete description of products’ identity, selection, and denominators. External
validity was compromised by low representativeness for remote rural settings and low-income coun-
tries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted
containers and reprocessing, in-country production, healthcare providers’ practices, and the role of
bar soap. A list of “best practices” to mitigate product contamination was compiled.

Read full resource: Lompo et al., 2023. Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review

Biosafety

Clinical

Disinfection & Antisepsis

Hospital

IPC

Outbreak

Purchase

Sterilization

Stock management