Alcohol-based hand sanitizer: Can frequent use cause an elevated blood alcohol level?

Abstract

Recently health care systems and infection control organizations have begun advocating the routine use of alcohol-based instant hand sanitizers (ABHS) in conjunction with routine handwashing. 1 Health care professionals functioning in high patient census areas such as an immunization clinic or emergency department (ED) may apply ABHS more than 10 times in an hour if using these products prior to and just following patient evaluation. 2 Little is known about the effects of frequent use of ABHS on blood alcohol concentrations. Because dermal absorption of isopropyl alcohol has been demonstrated in a previous study, 3 it is of forensic and medical-legal importance to elucidate the effects of frequent use of ABHS on serum blood ethanol levels. We report a case of a negative serum ethanol level in a physician using ABHS on an extraordinarily frequent basis over a period of 2 hours. CASE REPORT A 38-year-old emergency physician was participating in a hospital-sponsored survey of various alcoholbased hand sanitizers. The hospital was attempting to decide which product to purchase and was fielding a number of products for health care providers to use and assess. The physician had tested 3 previous products and decided to test the tolerability of the fourth ABHS (a 62% denatured alcohol [ethanol] product) under the most extreme conditions, using it 25 times over the course of 2 hours. The product was used in accordance with instructions, applying 5 mL of the ABHS to both hands and forearms and rubbing until dry. Immediately following the final application of the ABHS, a blood alcohol level was drawn in conjunction with other laboratory tests that were ordered for a routine physical examination. The skin was prepped before the blood draw with a nonalcohol-based iodine product. The blood alcohol level measurement demonstrated a serum level of ,5 mg/dL (less than the minimum detection level for the laboratory).