Safety Assessment of Hand Sanitizers: A Comprehensive Review
Intro
The topic of hand sanitizers has garnered significant attention in recent years, especially amid global health crises. These products play a vital role in promoting hygiene and preventing the spread of infectious diseases. However, understanding their safety and effectiveness is crucial. Hand sanitizers often contain various chemical ingredients that can raise concerns among consumers. It is essential to evaluate these aspects thoroughly to ensure informed usage.
This review aims to provide a comprehensive perspective on the safety assessments of hand sanitizers. By investigating their composition, efficacy, and potential risks, we can help inform user decisions based on sound scientific evidence. We will explore key findings from recent studies and elaborate on the implications these findings may hold for public health.
Research Highlights
Key Findings
- Chemical Composition: The active ingredients in hand sanitizers, mainly alcohol-based compounds like ethanol and isopropanol, are proven to effectively eliminate various pathogens. Non-alcohol options often contain compounds such as benzalkonium chloride, raising questions about their effectiveness against certain viruses.
- Efficacy Variability: Studies indicate variability in the efficacy of different hand sanitizer formulations. Factors such as contact time, amount applied, and the presence of organic matter can significantly impact the effectiveness of these products.
- Potential Risks: The main concerns related to hand sanitizers involve skin irritation, allergic reactions, and the risks associated with ingestion, especially among children. Regulatory guidelines aim to mitigate these risks through proper labeling and safety instructions.
Implications and Applications
The findings suggest that while hand sanitizers are generally effective, their safety depends on proper usage and formulation. Individuals should be educated about choosing products that meet safety standards. Moreover, regulatory agencies must continuously monitor these products to ensure consumer safety.
Ultimately, this review highlights that hand sanitizers can be an essential part of hygiene practices, but they are not a substitute for thorough hand washing.
Methodology Overview
Research Design
The methodology employed in assessing hand sanitizer safety includes a comprehensive review of relevant literature. This approach synthesizes findings from various studies to offer a balanced understanding of hand sanitizer use and its implications.
Experimental Procedures
The review encompasses several forms of research: clinical trials, surveys, and meta-analyses. Each study type contributes insights into the effectiveness and safety of hand sanitizers. By collecting data on various formulations and their impacts, we aim to present a clear picture of the current state of knowledge in this field.
"Understanding the intricate balance between safety and efficacy in hand sanitizers is essential to optimize their role in hygiene practices."
Understanding Hand Sanitizers
Hand sanitizers have gained significant importance in recent years, particularly during health crises. The understanding of these products is crucial for evaluating their effectiveness and safety. This section will explore the definition, purpose, and types of hand sanitizers, providing key insights into their role in hygiene practices.
Definition and Purpose
Hand sanitizers are liquid or gel products formulated to reduce infectious agents on the hands. Their primary purpose is to minimize the risk of infections, making them vital in public health responses. Unlike soap and water, which physically remove germs, hand sanitizers mainly kill microorganisms, providing a quick alternative when washing hands is not feasible. When used properly, they serve as an effective tool in preventing the spread of pathogens, particularly in situations where water is unavailable or access to sanitation facilities is limited.
Types of Hand Sanitizers
Hand sanitizers generally fall into two main categories: alcohol-based and non-alcohol-based sanitizers. Understanding these types is essential, as they each function differently and deliver varying levels of efficacy.
Alcohol-Based Sanitizers
Alcohol-based sanitizers typically contain ethanol or isopropanol as active ingredients. The key characteristic of these sanitizers is their high alcohol concentration, usually between 60% to 95%. This makes them particularly effective against a wide range of microorganisms, including viruses and bacteria. Alcohol-based sanitizers are a popular choice due to their quick action and broad efficacy. The unique feature of these products is their mechanism of action, which disrupts the outer membranes of pathogens, leading to cell lysis.
Despite their benefits, there are disadvantages to consider. For instance, alcohol can be drying to the skin, potentially leading to irritation or exacerbating skin conditions with frequent use. Additionally, there is a risk of ingestion, especially in settings with children. This necessitates careful storage and supervision when using these products.
Non-Alcohol-Based Sanitizers
Non-alcohol-based sanitizers often utilize antimicrobial agents like benzalkonium chloride or triclosan. One key aspect is that these products are less drying and may be more suitable for individuals with sensitive skin. They are designed to kill germs through different mechanisms, often leaving a residual layer that continues to provide protection after application.
However, their effectiveness can be lower compared to alcohol-based options. Some studies suggest they may not be as effective against specific pathogens, particularly viruses. This can limit their use in high-risk situations where comprehensive hygiene is critical. The unique feature of non-alcohol-based sanitizers is their formulation, which appeals to users looking for gentler alternatives.
In summary, understanding the various types of hand sanitizers plays a vital role in assessing their safety and efficacy. Both alcohol-based and non-alcohol-based sanitizers have their advantages and disadvantages that influence their suitability for specific groups and occasions. The next sections of this article will delve deeper into active ingredients and the efficacy of these products in maintaining hand hygiene.
Active Ingredients in Hand Sanitizers
The active ingredients in hand sanitizers are central to the efficacy and safety of these products. Understanding these components is essential for distinguishing between various sanitization options available on the market. Hand sanitizers generally function by destroying or inhibiting the growth of pathogenic microorganisms. Therefore, the choice of active ingredients directly impacts a user's health and safety.
Ethanol and Isopropanol
Ethanol and isopropanol are the most widely used alcohol-based ingredients in hand sanitizers. These substances are effective against a broad spectrum of viruses, bacteria, and fungi. Ethanol is recognized for its rapid ability to denature proteins, which effectively disrupts the cellular structure of microorganisms. Similarly, isopropanol functions through comparable mechanisms.
- Ethanol: Recognized for its high volatility, ethanol evaporates quickly. This property ensures rapid action against germs while minimizing skin irritation caused by prolonged contact. Furthermore, products that contain at least 60% ethanol concentration have been deemed effective by health authorities, including the CDC.
- Isopropanol: While isopropanol is less common than ethanol in hand sanitizers, it still retains significant antimicrobial properties. However, its effectiveness is often linked to the presence of adequate concentrations, usually around 70%. Higher or lower concentrations tend to diminish its germicidal activity.
Other Antimicrobial Compounds
Beyond alcohol, some hand sanitizers incorporate additional antimicrobial agents to enhance their effectiveness or suitability for particular uses. It is vital to understand these compounds as they may add unique benefits or present potential risks.
Chlorhexidine
Chlorhexidine is a disinfectant and antiseptic that has gained popularity in both clinical and consumer hand sanitization products. One of its most significant characteristics is its residual effect, which allows it to continue providing antimicrobial protection long after application. This extended action can be particularly advantageous in settings where frequent sanitization is required.
However, chlorhexidine is often considered a broad-spectrum antiseptic, effective against Gram-positive and Gram-negative bacteria. The key advantage of chlorhexidine is its relatively low toxicity and lack of harmful effects on the skin when used as directed. Yet, it is essential to note that it can cause allergic reactions in sensitive individuals, underscoring the importance of proper usage guidelines when using products containing this ingredient.
Benzalkonium Chloride
Benzalkonium Chloride is another commonly used active ingredient in hand sanitizers. It belongs to a class of compounds known as quaternary ammonium compounds, which are effective in eliminating bacteria. The notable characteristic of benzalkonium chloride is its formulation as a non-alcoholic alternative, making it an appealing choice for those with sensitive skin.
However, the effectiveness of benzalkonium chloride can vary based on concentration and contact time. Some studies indicate that while it is effective against bacteria, its activity against certain viruses may not meet the same level of efficacy as alcohol-based options. This poses significant implications for public health, particularly in circumstances demanding heightened disinfection.
Efficacy of Hand Sanitizers
The efficacy of hand sanitizers is a critical aspect of their overall safety assessment. Understanding how these substances eliminate pathogens helps consumers make informed choices. Hand sanitizers have become staples in hygiene practices, particularly during public health crises. Their effectiveness can vary significantly based on numerous factors such as composition, application method, and the pathogens in question. Therefore, knowing the intricacies of their efficacy enables users to maximize their benefits while adhering to safe practices.
Mechanism of Action
Hand sanitizers primarily function through their active ingredients, such as ethanol and isopropanol. These alcohols disrupt the cell membranes of various pathogens, leading to cell death. When applied to hands, the alcohol swiftly evaporates, which aids in the removal of germs without requiring rinsing. This mechanism highlights why alcohol-based hand sanitizers are recommended by health authorities in situations where soap and water are not available.
Research shows that a concentration of at least 60% alcohol is necessary for effective microbial reduction. Lower concentrations do not effectively kill most germs and viruses, making it essential for consumers to choose products that meet this requirement. Understanding how alcohol works against pathogens lays a foundation for recognizing the importance of proper usage and concentration in ensuring hygiene effectiveness.
Comparison with Soap and Water
The comparison between hand sanitizers and traditional handwashing with soap and water is relevant for gaining insight into their respective efficacies.
- Efficacy Against Pathogens: Soap and water are generally more effective against certain types of germs, especially when hands are visibly dirty or greasy. Soap acts by creating a reaction that lifts dirt and microbes off skin, which then can be rinsed away. In contrast, hand sanitizers are superior in scenarios involving bacterial pathogens, provided they have suitable alcohol concentration.
- Time Efficiency: Hand sanitizers require less time for application than washing with soap and water, which usually involves scrubbing for at least 20 seconds. This aspect encourages more frequent use in settings where time is limited.
- Skin Health: Frequent use of alcohol-based sanitizers can lead to dry skin. Soap and water, while more labor-intensive, often are less harsh on skin health when used in moderation and supplemented with moisturizers.
Safety Concerns
The safety concerns associated with hand sanitizers are significant given the widespread adoption of these products during health crises, such as the COVID-19 pandemic. Ensuring the safe use of hand sanitizers is essential for public health. This section will explore toxicological risks and regulatory frameworks that govern hand sanitizer use. Understanding these elements contributes to more informed choices regarding hygiene practices. Evaluating safety measures lays the groundwork for responsible use while minimizing potential health risks.
Toxicological Risks
Ingestion and Poisoning
Ingestion of hand sanitizers poses a serious risk, particularly for children. The high alcohol content, typically ethanol or isopropanol, can lead to poisoning, resulting in various symptoms ranging from nausea to severe respiratory distress. This aspect emphasizes the necessity of secure packaging and public awareness campaigns aimed at preventing accidental ingestion.
The key characteristic of ingestion risk lies in its immediacy; symptoms can present quickly, necessitating prompt medical attention. Understanding this risk is crucial for education efforts on hand sanitizer safety, particularly in homes with young children. Alcohol poisoning is not only harmful but can lead to long-term health issues, which is why this topic is critical for any comprehensive analysis of hand sanitizers and their safety.
Unique features, such as the bitter additives sometimes included in formulations to deter ingestion, have been introduced. However, they are not universally applied. Thus, while these measures may decrease accidental consumption, they do not eliminate risk entirely, indicating a disadvantage in certain products.
Dermal Reactions
Dermal reactions represent another safety concern associated with hand sanitizer use. Skin irritation and allergic reactions can arise due to the chemical composition, particularly in formulations containing alcohol or certain fragrances. Prolonged use can lead to excessive dryness, cracking, or allergic dermatitis, which may affect individuals differently.
The key characteristic of dermal reactions is their variable presentation among users; some may experience mild irritation, while others could face severe allergic reactions. Recognizing this risk is essential for both manufacturers and consumers, informing product selection and usage practices.
A unique feature of this concern is the variability in skin sensitivity, influenced by factors such as age and existing dermatological conditions. While some sanitizers are designed to be more skin-friendly, they may sacrifice efficacy. This trade-off illustrates a disadvantage that can complicate personal hygiene practices.
Regulatory Guidelines
FDA Regulations
The FDA plays a crucial role in the regulation of hand sanitizers, focusing on their safety and efficacy. Regulations stipulate that these products must meet specific standards to be deemed safe for consumer use. This involves rigorous testing and oversight during the manufacturing process to ensure that products do not pose significant health risks.
The key characteristic of FDA regulations is their comprehensiveness. They not only cover the ingredients used but also monitor production processes. This comprehensive approach ensures that consumers are protected and enhances trust in hand sanitizer products.
However, the FDA's emergency use authorization during health crises can lead to some unique features, such as temporary approvals of products not fully validated for safety. While this allows for rapid response to public health needs, it also raises questions about long-term safety, posing a disadvantage.
Recommendations
The CDC provides robust recommendations to guide the public in the safe use of hand sanitizers. These guidelines are based on available science and are regularly updated to reflect new research or emerging issues related to hand hygiene.
The key characteristic of CDC recommendations is their emphasis on evidence-based practice. They focus on how to effectively use hand sanitizers, including when to use them and the appropriate concentration of alcohol for efficacy. This is beneficial as it elevates public knowledge and helps minimize misuse.
A unique feature of CDC guidelines is their public accessibility and ongoing updates. While this provides a timely resource for consumers, there can also be confusion surrounding varying recommendations, as different agencies might prioritize diverse aspects of safety. Thus, this can complicate consumer adherence to guidelines.
Proper Usage of Hand Sanitizers
Effective hand hygiene is critical in preventing the transmission of infectious diseases. Hand sanitizers, particularly during times of outbreaks, have proven their value. However, their efficacy is heavily reliant on proper usage. Understanding the correct application techniques and recommended alcohol concentration is crucial for maximizing their effectiveness while minimizing potential risks.
Application Techniques
The technique used when applying hand sanitizer is essential for achieving its full potential. Simply pouring a small amount into one’s hands and rubbing can lead to a false sense of security. It is important to follow these steps:
- Dispense an adequate amount: Use enough sanitizer to cover all surfaces of your hands. Typically, a dime-sized amount is sufficient.
- Rub hands together: Ensure to cover the back of your hands, between your fingers, and under your nails. This is crucial as germs can reside in these areas.
- Continue rubbing: Keep rubbing for at least 20 seconds until the product has completely evaporated. Wet hands will significantly reduce the sanitizer's effectiveness.
By following these steps, one can ensure that the hand sanitizer has the best chance of killing germs effectively.
Recommended Alcohol Concentration
The concentration of alcohol in hand sanitizers plays a prominent role in their germicidal ability. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend sanitizers that contain at least 60% alcohol for maximum efficacy. Here’s why:
- 60% - 95% Alcohol Range: Alcohol concentrations within this range ensure that the sanitizer is potent enough to denature proteins in microbes, leading to their inactivation.
- Below 60% Alcohol: Sanitizers with less than 60% alcohol concentration may not effectively kill many types of germs, increasing the risk of infection.
- Higher Concentration Dangers: While it might seem logical that increasing alcohol concentration could enhance efficacy, concentrations above 95% can evaporate too quickly to effectively kill germs.
Choosing a sanitizer with appropriate alcohol concentration is critical for safety and effectiveness. Moreover, it informs users of a reliable standard when selecting hand antiseptics.
Proper application and knowledge about alcohol concentration are fundamental to optimizing the benefits of hand sanitizers as effective hygiene tools.
Environmental Impact of Hand Sanitizers
The environmental impact of hand sanitizers has garnered increasing attention due to the high volume of their use, especially during health crises like the COVID-19 pandemic. Understanding this impact is critical as it encompasses the lifecycle of hand sanitizers, from production to disposal.
Hand sanitizers primarily consist of alcohol, water, and various other chemical compounds. Each of these components can present unique environmental challenges. Assessing these challenges helps inform more sustainable practices among consumers and manufacturers.
Sustainability Concerns
Sustainability concerns related to hand sanitizers address the resource consumption and waste generated throughout their lifecycle. Many hand sanitizers come in single-use plastic bottles, contributing significantly to plastic pollution. Reports indicate that billions of these bottles are discarded every year.
In addition to packaging issues, the production of hand sanitizers often requires substantial resources, including energy and water. These inputs can strain local water supplies, especially in areas already facing scarcity. Sustainable production practices can mitigate some of these concerns, such as utilizing eco-friendly materials for packaging and sourcing ingredients responsibly.
Efforts to create biodegradable or refillable options are emerging. These alternatives reduce overall waste and promote a circular economy. It is essential that consumers advocate for brands prioritizing sustainability in their practices, helping to shift market dynamics toward greener products.
"Choosing eco-friendly hand sanitizer options can contribute to reducing plastic waste significantly."
Impact on Water Systems
The impact of hand sanitizers on water systems is another critical area of concern. When hand sanitizers are used, residual chemicals can enter wastewater systems. In some cases, bacteria and viruses might develop resistance to antibacterial agents found in these products.
Chemicals such as benzalkonium chloride and other active ingredients can affect aquatic life. They may disrupt biological systems in freshwater and marine environments. It becomes imperative to evaluate the treatment processes used in wastewater facilities to ensure they adequately mitigate these effects.
Furthermore, as the demand for hand sanitizers continues, more research is necessary to determine their long-term effects on ecosystems. By prioritizing the use of safer, more environmentally friendly formulations, consumers can help minimize harmful impacts on water systems and enhance global well-being.
Alternatives to Hand Sanitizers
In the discussion of hand hygiene, the focus often rests on the efficacy of hand sanitizers. However, it is imperative to consider alternatives to hand sanitizers. These alternatives not only provide an option when sanitizers are unavailable but also offer additional benefits in terms of safety and environmental impact. Understanding these alternatives contributes to a more holistic view of hand hygiene practices.
Bar Soap and Water
Bar soap and water is widely recognized as a reliable method for hand washing. The effectiveness of soap lies in its ability to disrupt the lipid membranes of many pathogens. When used correctly, washing with soap and water can remove dirt, grease, and germs from hands effectively.
- Advantages:
- Soap acts mechanically by removing germs.
- It is safe for all age groups, reducing the risk of toxicity.
- This method does not contribute to microbial resistance, an important consideration in the ongoing battle against antibiotic-resistant bacteria.
However, there are also some limitations. For example, access to clean water can be a barrier in some settings. In such cases, using soap may not be practical if water is scarce or contaminated.
DIY Hand Sanitizers
DIY hand sanitizers have gained popularity, particularly during health crises. Crafting one’s own sanitizer allows for control over ingredients, potential allergens, and scents. It also offers an option for those who may struggle to find commercially available products in certain conditions.
Homemade Recipes
When creating homemade hand sanitizers, the main recipe includes a high percentage of alcohol, such as ethanol or isopropanol, combined with a moisturizing agent like aloe vera. A common ratio suggested is 2 parts alcohol to 1 part aloe vera gel. This composition helps achieve the desired antimicrobial effect while minimizing skin dryness.
- Key Characteristics:
- Customizability according to personal preferences and needs.
- Opportunity to avoid potentially harmful chemical additives found in some commercial sanitizers.
Despite its advantages, care must be taken to ensure that the alcohol content remains at or above 60% to be effective against pathogens. This may not be achievable with all homemade recipes and the need for accurate measuring is crucial.
Safety Considerations
The safety considerations of DIY sanitizers cannot be overlooked. Improper formulation can lead to ineffective products or even skin irritation. It is essential to be cautious with ingredient selection.
- Key Characteristics:
- Awareness of potential allergens and irritation from essential oils or additives.
- Risk of inaccurate alcohol concentrations, which may compromise effectiveness.
In summary, while alternatives to hand sanitizers exist, it is crucial to evaluate their effectiveness and safety carefully. Bar soap and water remain the gold standard for hand hygiene, while DIY sanitizers present a flexible but potentially risky option. Ensuring proper technique and formulation is essential for achieving the intended hygiene outcomes.
Public Perception and Misconceptions
Understanding the public perception of hand sanitizers is essential in evaluating their safety and efficacy. Misconceptions and myths can greatly influence how people use these products, ultimately affecting their effectiveness in preventing illness. This section will address common myths and the influence of media in shaping these perceptions.
Common Myths
Several myths exist around hand sanitizers that can lead to misuse or over-reliance on these products. One prevalent myth is the belief that hand sanitizers can replace handwashing entirely. While hand sanitizers are effective in a limited context, they do not eliminate all types of germs, particularly certain types of viruses and bacterial spores. Another myth suggests that higher alcohol content correlates with better sanitization. However, sanitizers with too high an alcohol percentage can evaporate too quickly, reducing their effectiveness. It is crucial to remain informed about these myths to promote proper hygiene practices.
"Hand sanitizers are effective as long as they contain at least 60% alcohol."
This highlights a fundamental part of personal and public health that needs clarity.
Influence of Media
Media plays a significant role in shaping public opinion on hand hygiene products. Social media platforms and news outlets often sensationalize information, leading to misunderstandings about hand sanitizers. During health crises, such as the COVID-19 pandemic, these platforms increased the visibility of hand sanitizers, sometimes leading to unsubstantiated claims about their properties. It is vital for consumers to critically evaluate the information they receive and rely on scientific consensus rather than anecdotal evidence found online. The emphasis on thoroughly assessing claims can help mitigate the spread of misinformation and promote safer practices when using hand sanitizers.
Future Directions in Hand Hygiene
The landscape of hand hygiene is evolving, particularly in the context of hand sanitizers. Understanding future directions in this field is crucial. Innovations can drive forward the efficacy and safety of hand hygiene products. As public health dilemmas continue to arise, new formulations and scientific research become increasingly important.
Innovation in Formulations
Innovation in formulations refers to the development of improved hand sanitizer products that enhance antimicrobial effectiveness while reducing potential toxicity. Researchers are examining novel ingredients and combinations to address the shortcomings of existing products.
- Biodegradable materials: This approach can reduce environmental impact while maintaining sanitation effectiveness. For example, incorporating plant-derived compounds might provide better skin tolerance without sacrificing antimicrobial properties.
- Extended-release technologies: These innovations allow for prolonged antimicrobial activity. The use of microencapsulation techniques can potentially deliver active ingredients over extended periods.
- Natural alternatives: With rising demand for natural products, there is a focus on using plant extracts and essential oils. Some essential oils exhibit antimicrobial properties, which might deliver similar effects as conventional sanitizers.
These innovations not only respond to safety concerns but also adapt to consumer preferences for safer, environmentally friendly products that do not compromise on effectiveness.
Research on Efficacy
Research on efficacy is vital to ensure that hand sanitizers meet high standards of effectiveness against various pathogens. This area of inquiry aims to provide data that informs consumers and regulatory bodies alike.
- Continuous comparative studies: Frequent evaluations of different sanitizer brands and formulations ensure that all products align with efficacy standards. Results can guide consumer choices and regulatory recommendations.
- Long-term usage effects: More research is needed on the impact of prolonged use of hand sanitizers on skin health, particularly in sensitive populations.
- Impact on resistant strains: As antibiotic resistance rises, studies examining how hand sanitizers affect microbial resistance patterns are essential. Understanding these aspects may influence future formulations to reduce the risk of promoting resistant organisms.
"Research in efficacy is not just about measurement, it is about understanding and improving the products people rely on for health and safety."
End
The conclusion of this article integrates the vital insights gathered from extensive research on hand sanitizers. Recognizing their role in public health, it is necessary to evaluate both their efficacy and safety. Hand sanitizers, while convenient and effective for killing germs, present unique challenges that demand attention.
Summary of Findings
In reviewing the safety assessment of hand sanitizers, several key findings emerge.
- Type of Sanitizers: Alcohol-based sanitizers, particularly those with at least 60% ethanol or 70% isopropanol, demonstrate superior efficacy against various pathogens.
- Potential Risks: There are documented cases of toxicological risks, such as ingestion and dermal reactions, especially in vulnerable populations.
- Regulatory Guidelines: Various organizations like the FDA and CDC provide clear standards for manufacturing and use, emphasizing the need for awareness and adherence to safety protocols.
- Usage Techniques: Proper application techniques can significantly enhance the efficacy of hand sanitizers, and adherence to recommended alcohol concentrations is crucial for safety.
- Environmental Considerations: Increased usage of hand sanitizers raises questions about their environmental impact, particularly how they affect water systems and sustainability.
This summary encapsulates the importance of understanding both the benefits and limitations of hand sanitizers in hygiene practices.
Recommendations for Safe Use
To ensure that hand sanitizers are used safely and effectively, several recommendations should be adopted:
- Choose Quality Products: Opt for hand sanitizers meeting the recommended alcohol concentration and comply with regulatory guidelines like those from the FDA.
- Follow Application Instructions: Apply the product to all surfaces of the hands and rub them together until dry, generally taking around 20 seconds. This enhances antimicrobial action.
- Educate and Inform: Increase awareness about the potential risks of hand sanitizers, particularly regarding misuse or accidental ingestion, especially in households with children.
- Monitor Environmental Impact: Stay informed about the ecological effects of overuse, using sustainable options when feasible, such as biodegradable formulations.
- Integrate with Other Hygiene Practices: Hand sanitizers should complement, not replace, traditional handwashing with soap and water, especially when hands are visibly dirty.
By implementing these strategies, individuals and communities can mitigate the risks associated with hand sanitizers while maximizing their benefits in promoting hygiene.
