Dr Valerie Enderlin
DECAMED Skin and Laser Centre. ZURICH, Switzerland
Private Dermatology practice focused on medical and cosmetic dermatology, skin surgery and laser treatments.
We interviewed Doctor Valérie Enderlin to understand the fascinating story behind the success of the hydro-alcoholic gel ( hand sanitizer): how a Swiss Expert in infectious diseases revolutionized hand sanitization…We also learned how to select the right hand sanitizer and how to integrate it into the process of preventing infections.
Behind The Woman
About your career and the people who inspired you along your journey:
The skin -as the largest organ of the human body- and especially skin care products have fascinated me since I was a child. I loved to secretly smell my mother’s cream pots, try out creams and eagerly collected all the product samples I could get in perfumeries. After studying medicine in Zurich and Lausanne, I completed basic surgical training before starting my dermatological training in Germany and Switzerland. After various positions in clinics and dermatological practices, I opened my own dermatological practice, the Decamed Skin and Laser Centre, in 2014.
|Can you tell us about the invention from the so-called “Doctor Clean Hands”?
While many people, including doctors and other healthcare professionals take the hydro alcoholic gel for granted and think it somehow has always been there, it is actually quite a recent innovation.
Walter Koller and Manfred Rotter published in the 1970s the first work measuring the remarkable antimicrobial efficacy of hydro-alcoholic solutions. In 1976, William Griffith, at the hospital in Fribourg, Switzerland, formulated the hydro-alcoholic solution.
It has always been known that alcohol disinfects. But the application had to be practical.
The Swiss doctor, Didier Pittet, an expert in infectious diseases, observed that hand hygiene was neglected by medical staff. He quickly found out why: If nurses and caregivers washed their hands for one or two minutes between one patient and the next (as recommended), they would spend half of each working hour just washing their hands. Something faster was needed.
He had the idea of using alcohol-based hand rub at the point of care, to replace handwashing with water and soap at the sink. He created an alcohol-based gel according to the formula of pharmacist William Griffith and distributed it to the staff. Infections in the hospital were quickly reduced by 50 percent.
What is so special about the formula?
The formula combines alcohol ( ethanol or isopropanol ), hydrogen peroxide, glycerin and water. The addition of water is critical because, if one uses pure alcohol at a concentration of 100 %, it is not going to attach to the germs and kill them properly.
How did the formula become so popular and broadly used in Hospitals around the world?
Pittet published his results in 2000 in the journal “Lancet”. The World Health Organization (WHO) took note, followed his example and propagated his method. The rapid disinfection of hands with an alcohol-based agent is now standard practice worldwide. According to WHO estimates, up to eight million lives are saved every year thanks to Pittet’s method.
Is it true that the formula has not been patented?
Indeed, the fabulous story did not stop here. Doctor Pittet decided not to patent but to publish its formulation and to share it with everybody, for the greater public good. He wanted to make sure that the formula could easily be produced locally, all over the world and at low cost in order to ensure its broad usage in hospitals, for the benefits of all.
In 2007, the scientist was conferred the title of Commander of the Order of the British Empire by Queen Elizabeth II for the development of the hydroalcoholic hand disinfection solution. In 2017, he received the Robert Koch Prize, one of the most prestigious scientific awards in Germany.
How to choose and use the hydroalcoholic gel?
In my practice, I use hydro-alcoholic gel before and after each patient contact. I prefer products with added glycerine because they dry the skin less.
I would choose a hydroalcoholic gel containing either some ethylic alcohol, propylic alcohol or isopropylic alcohol with a concentration of 60% to 70%. I make sure that the formula does not contain preservatives such as Triclosan. The hydro-alcoholic solutions have bactericidal, virucidal and fungicidal properties, without any cleaning effect. As such, they do not replace basic cleansing of the hands with soap and water. So make sure you apply the product on clean skin.
It is important to respect a friction time of at minimum 30 seconds until the product has penetrated the skin. Don’t forget to friction the entire hand, the back, the palm, the thumb, the interdigital spaces and the back of the fingers.
What about “ homemade” hydroalcoholic gels?
Today, “homemade” has become a big trend especially when it comes to skincare formulation. In theory it is very easy to make your own hydro-alcoholic solution following the formula of Doctor Pittet: all the components (alcohol, hydrogen peroxide, glycerin, water) are available over the counter. Though the formula looks pretty simple in nature, I would want to use a certified product. Especially in the context of the current pandemic, one heard of illegally manufactured products that did not meet the exact requirements or even contained toxic components. The risk is that the formula might end up not being effective or potentially irritating. Therefore better rely on certified products – preferably from the pharmacy.
What about the use of Essential Oils?
Some essential oils have antibacterial, fungicide and/or anti-viral properties, however their efficacy has not been scientifically demonstrated against the prevention of epidemics, even less against the Covid-19 virus. I would recommend to favor a proper skin cleaning with soap and water and the use of hydroalcoholic gels instead.
Finally, what is your last recommendation as a Healthcare Professional?
With frequent patient contact and therefore frequent hand disinfection, the skin likes to dry out. Cracked hands are more susceptible to inflammation and as a consequence alcoholic products burn more, so you might use them less. That is why regular moisturizing is very important. If my hands are very overused, which is often the case in winter when I operate more often, I apply a thick layer of cream to my hands in the evening and put on cotton gloves. This helps to stabilize the skin barrier and keeps the skin beautifully supple.