Until infectious mucus has completely dried, infectious IAV can remain on the hands and fingers, even after appropriate AHR using EBD, thereby increasing the risk of IAV transmission. Additionally, AHW rapidly inactivated IAV. On the other hand, AHR inactivated IAV in mucus within 30 s when the mucus dried completely because the hydrogel characteristics were lost. Due to the low rate of diffusion/convection because of the physical properties of mucus as a hydrogel, the time required for the ethanol concentration to reach an IAV inactivation level and thus for EBDs to completely inactivate IAV was approximately eight times longer in mucus than in saline. IAV in mucus remained active despite 120 s of AHR however, IAV in saline was completely inactivated within 30 s. Our clinical study showed that EBD effectiveness against IAV in mucus was extremely reduced compared to IAV in saline. Additionally, AHR and AHW effectiveness against infectious mucus adhering to the hands and fingers was evaluated in 10 volunteers. We evaluated IAV inactivation and ethanol concentration change using IAV-infected patients' mucus (sputum). We aimed to elucidate the situations and mechanisms underlying the reduced efficacy of EBDs against IAV in infectious mucus. However, previous reports suggest a reduced efficacy of ethanol disinfection against pathogens in mucus. Both antiseptic hand rubbing (AHR) using ethanol-based disinfectants (EBDs) and antiseptic hand washing (AHW) are important means of infection control to prevent seasonal influenza A virus (IAV) outbreaks.
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