Abstract
BackgroundDespite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical hand disinfection using three different alcohol-based hand-rubs, and to quantify absorption levels in humans.MethodsTwelve volunteers applied three hand-rubs containing 95% (hand-rub A), 85% (hand-rub B) and 55% ethanol (hand-rub C; all w/w). For hygienic hand disinfection, 4 mL were applied 20 times for 30 s, with 1 minute break between applications. For surgical hand disinfection, 20 mL of each hand rub was applied to hands and arms up to the level of the elbow 10 times for 3 minutes, with a break of 5 minutes between applications. Blood concentrations of ethanol and acetaldehyde were determined immediately prior and up to 90 minutes after application using head space gas chromatography.ResultsThe median of absorbed ethanol after hygienic hand disinfection was 1365 mg (A), 630 mg (B), and 358 mg (C). The proportion of absorbed ethanol was 2.3% (A), 1.1% (B), and 0.9% (C). After surgical hand disinfection, the median of absorbed ethanol was 1067 mg (A), 1542 mg (B), and 477 mg (C). The proportion of absorbed ethanol was 0.7% (A), 1.1% (B), and 0.5% (C). The highest median acetaldehyde concentration after 20 hygienic hand disinfections was 0.57 mg/L (hand-rub C, after 30 min), after 10 surgical hand disinfections 3.99 mg/L (hand-rub A, after 20 minutes).ConclusionThe overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based hand-rubs is safe.
Highlights
The overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based hand-rubs is safe
The CDC-guideline for hand hygiene [3], and the recently published WHO guideline on hand hygiene in healthcare [15] clearly favour the use of alcohol-based hand rubs in hospitals because other alternatives like antimicrobial soaps have significant disadvantages such as a lower efficacy [1,16], a decreased dermal tolerance [1,17], higher potential for impaired efficacy due to an incorrect performance of the procedure [18], the necessity of a wash basin, and the longer time spent for the procedure [19]
Despite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have addressed the issue of ethanol absorption when repeatedly applied to human skin
Summary
Despite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical hand disinfection using three different alcohol-based hand-rubs, and to quantify absorption levels in humans. It is stated that ethanol is absorbed by human skin in a quantity described as "toxicologically negligible" This opinion is based on earlier studies, in which the concentration of ethanol in serum was not investigated [20,21,22,23,24], or contradictory results were presented. Two investigators reported that no rise of ethanol concentrations in human serum were detectable, even when excessive ethanol exposure occurred using dressings soaked with 200 ml ethanol for 3 h [25,26] This experimental design does not allow drawing valid conclusions for hand hygiene procedures
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