Abstract
This study assessed the inhaled dose of alcohol during hand disinfection. Experiments were conducted with two types of hand rub using two hand disinfection procedures. Air samples were collected every 10 s from the breathing zone, by bubbling through a mixture of K2Cr2O7 and H2SO4. The reduction of dichromate ions in the presence of alcohols was followed by UV-vis spectrophotometry. The difference in intensity of the dichromate absorption peak was used to quantify the alcohol concentration expressed in ethanol equivalent. During hygienic hand disinfection, the mean ethanol equivalent concentrations peaked at around 20–30 s for both hand rubs (14.3 ± 1.4 mg/L for hand rub 1 and 13.2 ± 0.7 mg/L for hand rub 2). During surgical hand disinfection, two peaks were found at the same time (40 and 80 s) for both hand rubs. The highest mean concentrations were 20.2 ± 0.9 mg/L for hand rub 1 and 18.1 ± 0.9 mg/L for hand rub 2. For hand rub 1, the total absorbed doses, calculated from ethanol with an inhalation flow of 24 L/min and an absorption rate of 62%, were 46.5 mg after one hygienic hand disinfection and 203.9 mg after one surgical hand disinfection. Although the use of ABHRs leads to the absorption of very low doses, sudden, repeated inhalation of high alcohol concentrations raises the question of possible adverse health effects.
Highlights
The use of alcohol-based hand rubs (ABHRs) is recommended for hand hygiene instead of antiseptic soaps owing to their antimicrobial activity against most virus and bacteria inducing healthcare associated infections [1,2]
The mean ethanol concentration in air increased during hand disinfection and peaked after 30 s with hand rub 1 and after 20 s with hand rub 2
Hand rubbing is a necessary professional practice for reducing healthcare associated infections and these first results show that unintentional absorption of alcohol by healthcare workers may have different effects depending on the time scale
Summary
The use of alcohol-based hand rubs (ABHRs) is recommended for hand hygiene instead of antiseptic soaps owing to their antimicrobial activity against most virus and bacteria inducing healthcare associated infections [1,2]. Despite the increasing use of ABHRs as part of hand hygiene programs, only a few studies have assessed the issue of alcohol absorption following hand disinfection [8,9,10,11,12]. Et al [8] studied the dermal and pulmonary absorption of n-propanol and isopropanol during surgical and hand hygiene disinfection. As with ethanol-based hand rubs, the authors found that the amounts absorbed via inhalation and/or dermal contact were very low and probably unlikely to induce adverse health effects. Reisfield et al [11,12] found that intensive use of ethanol-based sanitizer and mouthwash induces an increase in concentrations of urinary ethanol biomarkers (ethyl glucuronide and ethyl sulfate), leading to false-positive results related to ethanol consumption
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