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Research in Social and Administrative Pharmacy xxx (xxxx) xxx

Contents lists available at ScienceDirect

Research in Social and Administrative Pharmacy


journal homepage: www.elsevier.com/locate/rsap

Changes in workflow to a University Pharmacy to facilitate compounding


and distribution of antiseptics for use against COVID-19
Fiammetta Nigro a, Melanie Tavares b, Mariana Sato de Souza de Bustamante Monteiro b,
Helena Keiko Toma c, Zaida Maria Faria de Freitas b, Denise de Abreu Garófalo b,
Maria Amélia Geraldes Bordalo MontáAlverne b, Márcia Maria Barros dos Passos b,
Elisabete Pereira dos Santos b, Eduardo Ricci-Júnior b, *
a
Instituto de Macromóleculas, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
b
Farmácia Universitária, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
c
LACMAC, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: This article is a report from an experience about a work developed by Farmácia Universitária at UFRJ (FU-UFRJ)
Coronavirus during the nCov-19 pandemic period. The aim of this work was to describe its contribution in the production of
Gels antiseptics antiseptic supplies used to prevent contagion by the new coronavirus. The work routine at the pharmacy has
Actions against Covid-19
been changed to allow the implementation of local workflow during the pandemic, and to adapt the protection
Compounding pharmacy
rules to meet the safety measures. FU-UFRJ started to manipulate two antiseptic formulations: 70% ethyl alcohol
and gel alcohol, which are included in the National Form, manufacturing around 100 L of these formulations,
weekly, to donate to different health units. The experience enabled the adaptation to emergency health stan­
dards, planning and meaningful guidance to pharmacists and technicians to attend clinics at university hospitals,
vaccination center and UFRJ city hall, in order to facilitate the access to adequate hand hygiene to the
population.

Introduction with 135,793 deaths.2,3


One of the greatest pandemic control dualities is due to the coro­
The COVID-19 pandemic is currently a major distress for public navirus route of transmission that can be direct or indirect (Fig. 1). The
health worldwide. The new coronavirus agent (nCoV-2019) is a simple direct route involves contaminated droplets (Fig. 1A) or drops (Fig. 1B)
ribonucleic acid (RNA) genome virus, with a high transmissibility po­ that are airborne to the airways (nasal and oral mucosa) and eyes. The
tential. Most symptomatic patients will develop mild symptoms. How­ indirect route involves transmission by contact with hands (Fig. 1C) or
ever, in some patients it can cause severe infection of the respiratory contaminated inanimate surfaces (contamination occurs by deposition
tract, causing pain and suffering, enabling progression to acute respi­ of drops containing the coronavirus) (Fig. 1D). Contaminated hands are
ratory failure, respiratory distress syndrome, multiple organ dysfunction the focus of transmission to inanimate surfaces or mucous membranes
and death.1 There are no proven effective treatments against nCoV-2019 (nasal or buccal), in addition to the ocular (Fig. 1E).
and the development of a safe vaccine is expected, therefore is very Thus, the use of face masks can reduce the transmissibility of the
important to prevent its spread by controlling contagion and trans­ coronavirus, and disinfectant agents, such as 70% ethyl alcohol,
mission. NCoV-2019 was discovered on December 31, 2019, after cases 0.1–0.5% sodium hypochlorite, 2% glutaraldehyde are effective in
registered in China,1 and the World Health Organization (WHO) inactivating nCov-19.5–7
declared, in March 2020, the pandemic situation for nCov-2019. Now, WHO recommends social isolation and personal hygiene care to
on 09/20/2020, the COVID-19 dashboard displays 30,675,675 reduce the transmissibility of nCov-19.8 In Brazil, the Ministry of Health
confirmed cases of COVID-19, including 954,417 deaths reported to (MS) declared the community transmission of COVID-19 throughout the
WHO, and in Brazil, 4,495,183 million confirmed cases of COVID-19, national territory. One of the containment measures is isolation for, at

* Corresponding author. Federal University of Rio de Janeiro, Carlos Chavas Filho Avenue, 373, 21.941-902, Rio de Janeiro, Brazil.
E-mail addresses: ricci@pharma.ufrj.br, ericcijunior@hotmail.com (E. Ricci-Júnior).

https://doi.org/10.1016/j.sapharm.2020.09.016
Received 27 September 2020; Accepted 28 September 2020
Available online 1 October 2020
1551-7411/© 2020 Elsevier Inc. All rights reserved.

Please cite this article as: Fiammetta Nigro, Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2020.09.016
F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx

supported by the Dean of Extension of UFRJ. Within the extension ac­


tivities, its main goal is to promote the exchange of knowledge with the
population using allopathic and homeopathic medicines manipulated at
FU-UFRJ, as well as among high school and elementary school students,
through the various extension projects developed by teachers and
pharmacists. This program displays excellent results in relation to the
professional insertion of alumni and enables the association between
education, research and extension, especially at the FU-UFRJ, as a
concrete reality. In addition, it plays an important role as a health
establishment providing opportunities for exchange between social
problems and education.15
Due to the public health emergency and the norms established by the
Health Surveillance Agency (ANVISA), FU-UFRJ started to produce
alcohol gel and 70% ethyl alcohol, according to the National Form,16
Fig. 1. Direct transmission routes vectored by airborne drops (diameter < 5
aiming to meet the needs of some clinics at the University Hospital
μm: airborne ˃ 1 m) (A) or by airborne drops (diameter ˃ 5 μm: airborne > 1 m)
Clementino Fraga Filho of UFRJ, the Vaccination Center and the City
(B). Indirect transmission routes by direct contact with contaminated hand (C)
or by indirect contact with contaminated inanimate surfaces (D). Indirect Hall.
transmission route that involves contaminated hands and inanimate sur­ According to the literature, it is very important to determine the
faces (E).4 concentration of alcohol, since the mechanism of microbicide action of
70% alcohol occurs due to the hydration degree of this presentation. In
least, 14 days for any patient with confirmed infection and mild symp­ this dilution, the alcohol has an optimal concentration for the denatur­
toms, according to Resolution No. 356.9 ation of microorganism proteins, since in the presence of water, the
The biggest challenge of this pandemic situation is the lack of specific entry of alcohol into the bacteria is facilitated, and the volatilization of
pharmacotherapies proven to date. There is no specific vaccine or alcohol is delayed, allowing longer contact time. Thus, the destruction of
antiviral drug to prevent or treat COVID-19. Infected people should the microorganism’s external cell membrane occurs by dehydration in
receive supportive care to relieve symptoms. People with serious ill­ the presence of alcohol, since the alcohol is hygroscopic and hydro­
nesses must be hospitalized.8 philic. Then the alcohol molecules penetrate the cytoplasm causing the
In this context, it is important to highlight the obstinate participation precipitation of proteins by denaturation, also promoting the coagula­
of health professionals in the fight against COVID-19. Since the dis­ tion of enzymes responsible for essential cellular activities.17
covery of the pandemic, the population has relied on the tireless work of In this context, the production of alcohol gel at 70% and ethyl
doctors, nurses, physiotherapists, pharmacists and other health pro­ alcohol at 70% by FU-UFRJ complied with the protocols and contin­
fessionals who are on the front lines. Work routines were altered by gency plans to cope with COVID-19. In February 2020, the National
additional activities related to the pandemic, to serve a much larger contingency plan for human infection was activated by nCovid-19,
number of patients on the various fronts, health posts, emergencies and which established regulatory measures that included the aforemen­
hospitals, in addition to pharmacies.10 tioned products. The use of antiseptic agents, such as 70% gel alcohol
Pharmacies, due to their capillarity and geographical distribution, and 70% ethyl alcohol, considering their ability to inactivate nCov-19,
present an important role in society.11 Compounding Pharmacies, for prevent its transmission between individuals and self-inoculation by
example, offer various medications, antipyretics, analgesics, hands has become a fundamental habit.5,6
anti-inflammatories, antimicrobials and bronchodilators in a personal­ Thus, the objective of the present study was to describe the contri­
ized way. All of it, respecting patient’s profile, which are fundamental to bution of FU-UFRJ in the production of antiseptic inputs used to prevent
manage the symptoms of the diseases, in addition to antiseptics, used in the contagion of nCovid-19, considering the public health emergency
the prevention of transmission, such as 70% ethyl alcohol in solution or and the standards established by ANVISA.
in gel form. These resources are considered highly effective for hand
hygiene at this time.12,13 Methods
Pharmacists are health professionals who work directly or indirectly
to combat the pandemic supplying the demand for health services.14 The This is a report, since it describes a particular experience over a new
roles and activities of pharmacists during the COVID-19 pandemic approach to care at work that led to reflections on the role of the
involved: provides reliable information about disease and associated pharmacists in the pandemic. In this case, the focus is on the process
symptoms to reduce health risks, educational actions in relation to adaptation to health standards for maintaining work at pandemic time.
infection control and preventive measures to reduce transmission (hand The executive time of FU-UFRJ is usually composed of seven pro­
hygiene, social distance, self-isolation), maintain continuity of phar­ fessors, thirteen pharmacists, an economist, seven pharmacy technicians
macy services, including essential drug supplies and other products and four administrative employees. However, due to the COVID-19
(hand sanitizers, protective masks and ambient sanitizers), support local pandemic, there was a reduction in the executing team, in the
and national management teams to ensure a response coordinated schedule and work regime, which started to operate in shorter periods,
health services and participate in multiprofessional study groups to from 10 to 14 h, under a rotation scheme. Hence, the executive team
enable the return of post-pandemic activities.14 became three professors, seven pharmacists, an economist, 4 pharmacy
The Farmácia Universitária at the Universidade Federal do Rio de technicians, four administrative technicians and a graduate student.
Janeiro (FU-UFRJ) is a public pharmacy, usually supporting 300 pa­ None of the professional were considered as part of the risk group.
tients/day. It was created in 1986 as a project based on the need to offer The activities started to be carried out internally, prioritizing the
curricular internship to students from the graduation courses from the production of alcohol gel and 70% ethyl alcohol, according to the Bra­
Faculty of Pharmacy at UFRJ. Until 2019, it trained approximately zilian Pharmacopeia National Form.16 The 70% ethyl alcohol used in the
6,500 undergraduate students from the University and from external preparation of both liquid forms and gel formulations was subjected to
Higher Education Institutions (IES). Also acting in the training of qual­ process control such as organoleptic characteristics and pH, both for gel
ified human resources at the postgraduate level. In 2008, the FU-UFRJ alcohol and 70% ethyl alcohol. The alcoholic level of the system was
project was made official as an Extension Program (FU-UFRJ) measured with the aid of a Gay-Lussac alcoholmeter (Incoterm), at
20 ◦ C.

2
F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx

Another action to confront COVID-19 was the development of an were manipulated, according to the GHP, with the supervision of the
alcohol formulation alternative to the one found in the Brazilian Phar­ handling process by a pharmacist, registered with the Regional Phar­
macopeia National Form,16 using ingredients with the same pharma­ macy Council of the State of Rio de Janeiro. The raw materials were from
cotechnical function, as determined by Resolution No. 347.13 In qualified suppliers and analyzed by the quality control of FU-UFRJ. The
addition, controls on the manipulated formulations were also per­ purified water was produced on the same day of the products handling at
formed, as determined by the Resolution No. 67 publicized by National the pharmacy, in addition to physical-chemical and microbiological
Health Surveillance Agency (ANVISA),18 such as: description of the tests performed at the FU-UFRJ laboratories, that belong to the Brazilian
formulations developed, aspect, organoleptic characteristics, pH (Bante Network of Analytical Health Laboratories (REBLAS); the handling
Instrument - model 9220), viscosity (Brookfield viscometer, model process followed previously defined Standard Operating Procedures
DV-II), and recorded in the manipulation order. All the manipulation (SOP). The products label presented all the information required by the
work took place in an environment that obeys Good Handling Practices legislations issued by regulatory bodies.16,18 In the face of the pandemic,
(GHP), as determined by Resolution No. 67 (ANVISA, 2007).18 In there was an increase in the consumption of gel alcohol and 70% ethyl
addition, efficacy and safety tests of the alternative formulation and alcohol, by society, as a preventive measure against the transmission of
traditional formulation of 70% alcohol gel were executed. The effec­ nCov-19. This high demand caused the lack of these products in the
tiveness of the two formulations was tested according to the protocol of market at first, in addition to the abusive price increase. Another
the National Institute for Quality Control in Health (INCQS) 65,3210, negative fact was the encouragement of homemade alcohol gel pro­
019,19 with a few modifications. Ten sterile stainless steel cylinders were duction, in addition to product counterfeiting, without considering the
dipped for 15 min at room temperature, in a pool of microorganisms risk of accidents, as they were not subjected to quality controls to
(Staphylococcus aureus, Salmonella choleraesuis and Pseudomonas aerugi­ guarantee their efficacy and safety, contrary to the Brazilian
nosa) grown in Casoy broth for 48 h at 32.5 ◦ C ± 2.5 ◦ C. Each cylinder legislation.13,16,18
was carefully removed with the aid of a sterile hook, placed on filter Selling of liquid alcohol in concentrations above 54◦ GL (Gay-Lussac)
paper and in an oven for 40 min. After that time, every 1 min, a cylinder has been forbidden by ANVISA, since 2013, according to Resolution No.
was placed in a tube containing 10 ml of each alcohol gel formulation. 46 (2002), which considered the risks offered to public health resulting
After placing the 10th cylinder, totaling 10 min, the first cylinder was from accidents, as fires, high-grade burns and skin and mucous mem­
removed and placed in a tube containing 10 mL of Casoy broth, suc­ branes irritation. For solutions with a degree above 54◦ GL, the standard
cessively repeating the procedure every 1 min for the other cylinders. gel form is allowed.21
The ten tubes containing the cylinders were incubated in a bacterio­ According to Empresa Brasil de Comunicação (EBC), Agência Brasil
logical oven at 32.5 ◦ C ± 2.5 ◦ C for 48 h. published that the Civil Police arrested a Central scheme that produced
As for safety tests, the formulations were analyzed in accordance counterfeit alcohol gel.22 This led ANVISA to publish an orientation for
with Resolution No. 481(1999) which establishes Microbiological Con­ the purchase of alcohol gel6 and a technical note on the requirements
trol Parameters for Personal Hygiene Products, Cosmetics and Per­ that must be met for the donation of 70% ethyl alcohol7 to minimize
fumes.20 According to the Resolution No. 481, for Total Count of Aerobic these risks.
Microorganisms, 10 g of sample was transferred to a flask containing 90 Thus, ANVISA has advised to always purchase these products from
ml (1:10) of Casoy broth under agitation until complete dissolution of establishments that guarantee compliance with the minimum standards
the sample. Counting was carried out using 1 ml aliquots of the 1:10 of BHP, with a professional responsible for the technical supervision of
dilution in four Petri dishes. Two plates had about 20 ml of casein-soy the activity, with raw materials that meet the technical requirements of
agar (TSA-medium for bacterial count) and for the other two, about quality and safety of the official compendiums. Besides, the labels/
20 ml of potato dextrose agar (PDA-medium for mold and yeast count), packages must include Company’s Name, CNPJ, address, telephone
in addition to 0.3 ml of 10% w/v tartaric acid. After homogenization, the number of the establishment, validity, alcohol concentration, indication
plates were incubated in a bacteriological oven at 32.5 ◦ C ± 2.5 ◦ C, for of use, complete formulation and warnings.6,7 Due to the scenario, given
24–48 h, for the TSA plates; and 22.5 ◦ C ± 2.5 ◦ C, for 5–7 days for PDA the exponential infection growth, the FU-UFRJ adopted agile and
plates. After the incubation period, the plates were examined for mi­ effective actions to enable quick and large-scale access to antiseptic
crobial development. products that could be used to combat the pandemic.
As for safety tests, the formulations were analyzed in accordance As of March 16, 2020, the FU-UFRJ with its reduced staff, started to
with Resolution No. 481 (1999) which establishes Microbiological operate according to the document prepared by the Federal Pharmacy
Control Parameters for Personal Hygiene Products, Cosmetics and Per­ Council (FPC), which describes that compounding pharmacies must
fumes.20 According to the referred Resolution, for Total Count of Aer­ implement emergency plans and local workflow during the nCov-19
obic Microorganisms, 10 g of sample was transferred to a flask pandemic.23–26
containing 90 ml (1:10) of Casoy broth under agitation until complete Therefore, to meet safety measures, FU-UFRJ provided personal
dissolution of the sample. Counting was carried out using 1 ml aliquots protective equipment (PPE), such as a face mask, disposable cap, glasses,
of the 1:10 dilution in four Petri dishes. Two plates had about 20 ml of latex gloves, disposable apron, for the whole team. In addition, recom­
casein-soy agar (TSA-bacteria count medium) and for the other two, mended 2 m distance between people, talking as little as possible. The
about 20 ml of potato dextrose agar (PDA-mold and yeast count me­ constant use of hand sanitizer was mandatory along with the attention to
dium), in addition to 0.3 ml of 10% w/v tartaric acid. After homoge­ the initial symptoms of the infection (fever, cough, body pain, indispo­
nization, the plates were incubated in a bacteriological oven at 32.5 ◦ C sition) also guided the employees when they got home on how to put on
± 2.5 ◦ C, for 24–48 h, for the TSA plates; and 22.5 ◦ C ± 2.5 ◦ C, for 5–7 all the clothes to wash, how to quarantine shoes, wash hands correctly
days, for PDA plates. After the incubation period, the plates were and finally how to take a shower.13,23,24
examined for microbial development. After the emergency plan and work flow were implemented, FU-
UFRJ started to manufacture 50 L of alcohol gel and 55 L 70% ethyl
Results and discussion alcohol weekly, according to the Brazilian pharmacopeia National
Form,16 aiming the needs of some clinics at Clementino Fraga Filho
Alcohol gel and 70% ethyl alcohol are antiseptic agents, used by the University Hospital (HU-UFRJ), the Vaccination Center and the City
population in order to mitigate the expansion and spread of nCov-19 as Hall. The City Hall that began the distribution of antiseptics to the
hand sanitizer and surface sanitizer. Therefore, it is very important to ambulance and bus drivers that continued to circulate around UFRJ
ensure the safety and effectiveness of these products. The action carried campus compliant to the rules established by ANVISA for the public
out by FU-UFRJ was relevant in the health context, as all formulations health emergence.

3
F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx

In addition, it was necessary to develop an alternative formulation Table 2


for alcohol gel, due to the various ingredients’ stock out on the market. Results of the physical-chemical analyzes of the formulations manufactured by
This was a measure recommended by Resolution No. 347 (ANVISA, FU-UFRJ.
2020).13 Table 1 shows the formulations: alcohol gel described in the Physical-chemical Alcohol gela Alcohol gel 70% Ethyl
Brazilian Pharmacopeia National Form16 and alcohol gel developed by analysis developed by the FU- Alcohola
the FU-UFRJ team. UFRJ

The substitution of acrylic derivatives, such as Carbopol®, with other Organoleptic Gel transparente e Transparent and Liquid and
thickening agents, was a way of circumventing the lack of it in the characteristics homogêneo homogeneous gel transparente
Ph 6.9 ± 0.1 5.6 ± 0.01 5.5 ± 0.01
market, considering its performance in forming gel in the presence of
Viscosity (cps) 13,700 ± 360 10,833 ± 208
high concentrations of alcohol, when compared to other hydrogels.27

a
However, the copolymer of sulfonic acid acryloyldimethyltaurate and Formulações manipuladas de acodo com o Formulário Nacional (Brasil,
vinylpyrrolidone, also known as Aristoflex® AVC, belongs to a modern 2012).
group of viscosity modifiers, conferring good spreadability and sensory
characteristics to the formulation, in a concentration of use similar to
Table 3
Carbopol®, without the need of neutralization.28 Table 2 shows the Safety results of formulations developed according to the specifications con­
physical-chemical results of the formulations manufactured by tained in the Brazilian Pharmacopoeia.30
FU-UFRJ.
Test(s) Result(s) Specifications*
It was observed that the physical-chemical characteristics obtained
were similar between the formulations for alcohol gel. On the other Standard Plate Count <10 CFU/mL Maximum limit
5 × 103 CFU/mL
hand, the pH resulting from the addition of Aristoflex® AVC showed
Yeasts and Moulds <10 CFU/mL Maximum limit
greater compatibility with the skin, considering its slightly acidic 5 × 102 CFU/mL
characteristics (4.8–5.5).29 The pH for 70% ethyl alcohol is in line with Staphylococcus aureus Absent Absent
skin pH.29 Pseudomonas aeruginosa Absent Absent
In the microbiological test, all formulations inhibited the growth of Escherichia coli Absent Absent

Staphylococcus aureus, Salmonella choleraesuis and Pseudomonas aerugi­


nosa. Therefore, no bacterial growth was evidence in any of the 10 tubes Conclusion
containing the contaminated cylinders and treated with both alcohol gel
formulations. For safety tests, both formulations presented the results FU-UFRJ, with its reduced team, managed the production of two
shown in Table 3. feasible antiseptic formulations, 70% ethyl alcohol and 70% gel alcohol.
Such results proved the safety of the formulations developed, both Both were applied in the prevention of nCov-19, considering the emer­
for the growth of non-specific microorganisms, and for Staphylococcus gency in public health and the rules established by ANVISA, and donated
aureus, Pseudomonas aeruginosa and Escherichia coli. Thus, it was possible to Clinics of University Hospitals, Vaccination Center and to City Hall of
to develop an alcohol formulation in gel alternative to the National the University, in order to facilitate the access of vulnerable population
Form, with similar characteristics of efficacy and safety. to hand sanitizer products. In addition, safety and efficacy of these
Thus, for the protection of the population against nCov-19, everyone products was guaranteed through physical-chemical and microbiolog­
should practice social isolation, wear a mask appropriately and wash ical tests performed by the university as well as the handling to GHP. FU-
their hands with soap and water. When hand washing is not feasible, for UFRJ has also developed an alternative formulation of alcohol gel that is
example, inside the market during shopping, inside pharmacies where comparatively safe and effective to the formulation described by the
medicines are dispensed, inside buses during transport to work, there is National Form. FU-UFRJ has been carrying out all its activities during
the possibility of cleaning hands with 70% alcohol gel, which is able to the nCov-19 pandemic, according to the document prepared by the
kill 99.9% of microorganisms pathogenic.31 62%–71% ethanol can Federal Pharmacy Council (FPC), employing emergency plans, modified
reduce coronavirus viability on inanimate surfaces with 1 min exposure local workflow, and meeting all security measures to protect the work
time.32 team.
All the work developed by the FU-UFRJ was publicized and recog­
nized by society, as shown by the radio interview from the Federal
Funding
University of Rio de Janeiro (UFRJ).33 Moreover, the work was publi­
cized in the UFRJ bulletin, no. 13, of April 1, 2020, which established
None.
the contingency plan for coping with the pandemic caused by the new
coronavirus within UFRJ; being the article published on the UFRJ
extension office.34 Declaration of competing interest

None.

Table 1 Author statement


Alternative formulation of alcohol gel developed by FU-UFRJ compared to the
one developed following the National Form.16 Fiammetta Nigro: Conceptualization, Methodology, Investigation.
Ingredients Alcohol gel Alcohol gel developed by the FU- Melanie Tavares: Writing-Original draft preparation Conceptualiza­
National UFRJ tion, Writing- Reviewing and Editing.
Form16
Mariana Sato de Souza de Bustamante Monteiro: Conceptualization,
Carbopol® 0.5 g – Methodology, Investigation.
Aristoflex® AVC 0.7 g

Helena Keiko Toma: Methodology, Investigation.
Aminomethylpropanol 0.06 g –
95% Zaida Maria Faria de Freitas: Methodology, Investigation, Writing-
Glycerin 1g 1g Reviewing and Editing.
Phenoxyethanol/parabens 0.5 g 0.5 g Denise de Abreu Garófalo: Methodology, Investigation.
Alcohol 96◦ GL 75.73 g 75.73 g Maria Amélia Geraldes Bordalo MontáAlverne: Methodology,
Distilled water q.s 100 g 100 g
Investigation.

4
F. Nigro et al. Research in Social and Administrative Pharmacy xxx (xxxx) xxx

Márcia Maria Barros dos Passos: Methodology, Writing- Reviewing 16. Brasilb. Brazilian pharmacopeia National Form. Ministry of health. National health
surveillance agency (ANVISA). 2nd edition (rev. 02). Brasilia, federal district:
and Editing.
Anvisa; 2012. Available from: http://portal.anvisa.gov.br/documents/33832/259
Elisabete Pereira dos Santos: Methodology, Investigation, Writing- 372/Formulario+NACIONAL+FARMACOPEIA+INGLES+com+alerta.pdf/056212e
Reviewing and Editing. a-c30e-4f80-bf0e-63a7fdf6c149. Accessed 29/09/2020.
Eduardo Ricci-Júnior: Conceptualization, General Supervision, 17. Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of
the most important agents for scrubs and rubs. Clin Microbiol Rev. 2004;17(4):
Writing- Reviewing and Editing. 863–893.
18. National Health Surveillance Agency (ANVISA). Resolution No. 67. Technical
Acknowledgements regulation that establishes good manipulation practices in pharmacies. Available
from: http://189.28.128.100/dab/docs/legislacao/resolucao67_08_10_07.pdf.
Accessed 24/09/2020.
The authors would like to thank FU-UFRJ for support in the devel­ 19. National Institute for Quality Control in Health (INCQS). Evaluation of bactericidal
opment of the work.. activity of disinfectants in spray and aerosol forms. Rev. 06. In: Quality Manual. Rio
de Janeiro, RJ: INCQS/FIOCRUZ; 2006.
20. National Health Surveillance Agency (ANVISA). Resolution No. 481. Establishes
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