Ethyl Glucuronide, Ethyl Sulfate and Acetone as Biomarkers for Alcohol Based Hand Sanitizers Chronic Exposure in Health Care Workers

Dina El-Rafey,Ghada Mansour

doi:10.21608/ajfm.2019.41228

Abstract

Introduction: health care workers (HCWs) are exposed to alcohols during hand antisepsis by both dermal contact and inhalation. This study aimed to assess the ethanol and isopropanol (ISOP) absorption in HCWs due to alcohol based hand sanitizers (ABHSs) use in real work conditions and to characterize the highest measurable concentrations of ethyl glucuronide (EtG) and ethyl sulfate (EtS) that could be produced by ABHSs use in order to recommend appropriate threshold concentrations specific enough to eliminate the possibility of false positive results due to incidental exposures to ethanol in Egypt. Subject and Methods: ethanol and ISOP absorption were assessed in 74 HCWs using ABHSs during regular 8-hours working shift through measuring urinary concentrations of ethanol and its metabolites ethyl glucuronide (EtG) and ethyl sulfate (EtS) before the ABHSs use and for the following 24 hours as well as blood ISOP and its metabolite acetone were measured before ABHSs use and at the end of 8-hours shift. Results: the highest maximum median urinary ethanol (8.75 mg/L), EtG (538.93 ng/mL) and EtS (62 ng/mL) as well as blood ISOP (4.9 mg/L) and acetone (6.32 mg/L) concentrations were recorded in group III (excessive ABHSs use), all these parameters returned to base line within 24 hours. Parameters were correlated to frequency, quantity of ABHSs used. EtG was correlated positively to the concentration of ethanol in ABHSs. Conclusion: ABHSs use generated measurable levels of ethanol, EtG and EtS in urine as well as ISOP and acetone in blood. their concentrations decrease to baseline levels within 24 hours (not accumulated). EtG cut off of 1000 ng/ml and EtS cut off 100ng/ml seemed to be more promising in identification of incidental alcohol use in HCWs. Measuring EtS with EtG might be useful in incidental ethanol exposure.

Highlights

Hand hygiene products are heavily used in everyday life (Chan & Chan, 2018) especially in the healthcare setting where the routine use of such products is a major aspect of modern infection control procedures (Bolon, 2016).Alcohol-based hand sanitizers (ABHSs) are always preferred because of its greater effectiveness (Centre for Health Protection, 2017)
This study aimed to assess the ethanol and isopropanol (ISOP) absorption in health care workers (HCWs) due to alcohol based hand sanitizers (ABHSs) use in real work conditions and to characterize the highest measurable concentrations of ethyl glucuronide (EtG) and ethyl sulfate (EtS) that could be produced by ABHSs use in order to recommend appropriate threshold concentrations specific enough to eliminate the possibility of false positive results due to incidental exposures to ethanol in Egypt
As regard the respiratory and dermal symptoms related to ABHSs use, there was a highly significant difference between the three groups as regard respiratory symptoms with a significant increase in group III in comparison to group I and II, while a non-significant difference was found as regard dermal symptoms

Summary

Introduction

Alcohol-based hand sanitizers (ABHSs) are always preferred because of its greater effectiveness (Centre for Health Protection, 2017). Since ABHSs mostly contain ethanol, iso-propyl alcohol (ISOP), npropyl alcohol, or their combinations (Pires et al, 2017), the health care workers (HCWs) are exposed to the applied alcohols during hand antisepsis by dermal contact, and by inhalation (Arndt et al, 2014). Concerns about high alcohols absorption have been raised that may adversely affect HCWs (WHO, 2009). In the 2015, FDA indicated that, their administrative record for the safety of ABHSs is incomplete with respect to the human pharmacokinetic studies under maximal use conditions when applied topically and the effect of formulation on dermal absorption (Maier et al 2015).

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