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Kumar S, Das A. Hand sanitizers: Science and rationale. Indian J Dermatol Venereol Leprol 2021; 87:309-314. [PMID: 33769729 DOI: 10.25259/ijdvl_598_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Satarupa Kumar
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Scholz C, Baumgartner MR, Madry MM. Use of Ethanol-Based Hand Disinfectants: Source of Increased Ethyl Glucuronide Levels in Hair? Alcohol Alcohol 2021; 56:38-41. [PMID: 32960282 PMCID: PMC7543280 DOI: 10.1093/alcalc/agaa091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022] Open
Abstract
Aim Due to the COVID-19 pandemic increasing the use of hand disinfectants, we investigated the effect of frequent use of ethanol-based hand disinfectants (EBHD) on the levels of the alcohol marker ethyl glucuronide (EtG) in hair. Method Hair samples were collected from 10 health professionals (8 nondrinkers, 2 rarely drinking individuals) and EtG was examined in hair. Result EtG (~2 pg/mg) was only detected in the hair sample of a nondrinker using EBHD 60–70 times per working day. Conclusion Our data provide no evidence that frequent EBHD use results in hair EtG levels above the recommended Society of Hair Testing cutoff for repeated alcohol consumption (5 pg/mg).
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Affiliation(s)
- Clementine Scholz
- University of Zurich, Zurich Institute of Forensic Medicine, Center for Forensic Hair Analytics, Kurvenstrasse 17, 8006 Zurich, Switzerland
| | - Markus R Baumgartner
- University of Zurich, Zurich Institute of Forensic Medicine, Center for Forensic Hair Analytics, Kurvenstrasse 17, 8006 Zurich, Switzerland
| | - Milena M Madry
- University of Zurich, Zurich Institute of Forensic Medicine, Center for Forensic Hair Analytics, Kurvenstrasse 17, 8006 Zurich, Switzerland
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Dear K, Grayson L, Nixon R. Potential methanol toxicity and the importance of using a standardised alcohol-based hand rub formulation in the era of COVID-19. Antimicrob Resist Infect Control 2020; 9:129. [PMID: 32771064 PMCID: PMC7414286 DOI: 10.1186/s13756-020-00788-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/21/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Hand sanitisers are urgently needed in the time of COVID-19, and as a result of shortages, some people have resorted to making their own formulations, including the repurposing of distilleries. We wish to highlight the importance of those producing hand sanitisers to avoid methylated spirits containing methanol and to follow WHO recommended formulations. METHODS We explore and discuss reports of methanol toxicity through ingestion and transdermal absorption. We discuss the WHO formulations and explain the rationale behind the chosen ingredients. SHORT CONCLUSION We advise those producing hand sanitisers to follow WHO recommended formulations, and advise those producing hand sanitisers using methylated spirits, to avoid formulations which contain methanol.
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Affiliation(s)
- K Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Melbourne, Australia
| | - L Grayson
- University of Melbourne, Parkville, Victoria, Australia
| | - R Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Melbourne, Australia.
- Australia and University of Melbourne, Parkville, Victoria, Australia.
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Salomone A, Bozzo A, Di Corcia D, Gerace E, Vincenti M. Occupational Exposure to Alcohol-Based Hand Sanitizers: The Diagnostic Role of Alcohol Biomarkers in Hair. J Anal Toxicol 2018; 42:157-162. [PMID: 29206963 DOI: 10.1093/jat/bkx094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 11/16/2017] [Indexed: 01/19/2023] Open
Abstract
Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) in hair are effective direct biomarkers of ethanol ingestion, whose analytical determination can be used to discriminate between chronic and occasional ethanol intake. Ethanol is a compound widely used in some workplaces (e.g., clinics, hospitals) and is present in considerable amounts in mouthwash for oral cleaning, medications, cosmetic products, hydro-alcoholic disinfectants and antiseptics for hands. This study examined the ethyl alcohol exposure derived from hand disinfectants (in gel form) by simulating the typical occupational situation of medical-health workers (healthcare workers, nurses, surgeons, etc.) who frequently wash their hands with antiseptic sanitizer. Two types of hand disinfectants with 62% w/w of ethanol content were daily applied to the hands of a teetotaler for 20 times a day, for 4 consecutive weeks, thus simulating a typical workplace situation and a cumulative dermal exposure to ethanol of ~1,100 g. Different matrices (head, chest and beard hair, urine) were regularly sampled and analyzed using a ultra high-performance liquid chromatography tandem massspectrometry validated method for EtG and a (HS)SPME-GC-MS validated technique for FAEEs. The data obtained showed that a significant dermal absorption and/or inhalation of ethanol occurred, and that the use of detergents produce urinary EtG concentrations both higher than the cut-offs normally used for clinical and forensic analyses (either 100 and 500 ng/mL, depending on the context). The concentrations of the ethanol metabolites in the keratin matrices were, respectively, below the cut-off of 7 pg/mg for EtG and below 0.5 ng/mg for FAAEs (0.35 ng/mg for ethyl palmitate). In conclusion, the regular use of alcohol-based hand sanitizers can affect the concentration of urinary EtG and lead to positive analytical results, particularly when specimens are obtained shortly after sustained use of ethanol-containing hand sanitizer. On the other hand, direct biomarkers of alcohol abuse in the keratin matrix are capable of distinguishing between ethanol consumption and incidental exposures.
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Affiliation(s)
- A Salomone
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - A Bozzo
- Dipartimento di Chimica, Università degli Studi di Torino, via P. Giuria 7, 10125 Turin, Italy
| | - D Di Corcia
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - E Gerace
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - M Vincenti
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy.,Dipartimento di Chimica, Università degli Studi di Torino, via P. Giuria 7, 10125 Turin, Italy
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Hsieh S, Sapkota A, Wood R, Bearer C, Kapoor S. Neonatal ethanol exposure from ethanol-based hand sanitisers in isolettes. Arch Dis Child Fetal Neonatal Ed 2018; 103:F55-F58. [PMID: 28588125 DOI: 10.1136/archdischild-2016-311959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/30/2017] [Accepted: 04/20/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aims of this study is to measure the ethanol vapours in the isolette after use of hands cleaned with ethanol-based hand sanitiser (EBHS). METHODS Two squirts (1.5 mL) of hand sanitiser were rubbed on hands for 10 or 20 s before inserting the hands in the isolette for 5 min. Ethanol vapours were measured in the isolette with photoionisation detector and alcohol breathalyser for 30 min. RESULTS Peak ethanol concentration in the isolette was considerably higher with a 10 s hand rub (381±192 ppm) compared with a 20 s hand rub (99±50 ppm), and dissipated to ≤5 ppm within 30 min. Under routine care, EBHS use by care providers exposes neonates in isolettes to 3.7-7.3 or 1.4-2.8 mg/kg ethanol per day with 10 or 20 s hand rubs, respectively. The expected blood level from average single exposure is 0.036 mg/dL with 10 s hand rub and may increase further with multiple exposures in a short period. CONCLUSION Preterm neonates in the isolette are at risk of inadvertent exposure to ethanol. The expected blood alcohol level from this exposure is small and below 1 mg/dL level recommended by European Medicines Agency to limit the ethanol exposure in children. The unintended ethanol exposure can be avoided by rubbing hands for at least 20 s after applying EBHS.
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Affiliation(s)
- Shizuka Hsieh
- Chemistry Department, Trinity Washington University, Washington, DC, USA
| | - Amir Sapkota
- School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Rebecca Wood
- School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Cynthia Bearer
- Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shiv Kapoor
- Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Strawsine E, Lutmer B. The Effect of Alcohol-Based Hand Sanitizer Vapors on Evidential Breath Alcohol Test Results. J Forensic Sci 2017; 63:1284-1290. [PMID: 29143333 DOI: 10.1111/1556-4029.13691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/26/2022]
Abstract
This study was undertaken to determine if the application of alcohol-based hand sanitizers (ABHSs) to the hands of a breath test operator will affect the results obtained on evidential breath alcohol instruments (EBTs). This study obtained breath samples on three different EBTs immediately after application of either gel or foam ABHS to the operator's hands. A small, but significant, number of initial analyses (13 of 130, 10%) resulted in positive breath alcohol concentrations, while 41 samples (31.5%) resulted in a status code. These status codes were caused by ethanol vapors either in the room air or their inhalation by the subject, thereby causing a mouth alcohol effect. Replicate subject samples did not yield any consecutive positive numeric results. As ABHS application can cause a transitory mouth alcohol effect via inhalation of ABHS vapors, EBT operators should forego the use of ABHS in the 15 min preceding subject testing.
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Affiliation(s)
- Ellen Strawsine
- Breath Alcohol Program, Missouri Department of Health and Senior Services, Poplar Bluff, MO, 63901
| | - Brian Lutmer
- Breath Alcohol Program, Missouri Department of Health and Senior Services, Poplar Bluff, MO, 63901
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Emerson BL, Whitfill T, Baum CR, Garlin-Kane K, Santucci K. Effects of alcohol-based hand hygiene solutions on breath alcohol detection in the emergency department. Am J Infect Control 2016; 44:1672-1674. [PMID: 27614708 DOI: 10.1016/j.ajic.2016.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the effects of alcohol-based hand hygiene solution (ABHS) use by care providers on point-of-care alcohol breath analyzer interpretation under different clinically relevant conditions. Among each test condition (foam vehicle with immediate testing, gel vehicle with immediate testing, allowing hands to dry after the use of ABHS, and donning gloves after the use of ABHS), alcohol was detected in breath at 1 minute after use of ABHS. Because the use of ABHS by individuals administering breath alcohol detection may result in false-positive detection of alcohol, staff using these devices should consider traditional hand hygiene with soap and water.
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Affiliation(s)
- Beth L Emerson
- Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT.
| | - Travis Whitfill
- Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Karen Santucci
- Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
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Hautemanière A, Ahmed-Lecheheb D, Cunat L, Hartemann P. Assessment of transpulmonary absorption of ethanol from alcohol-based hand rub. Am J Infect Control 2013; 41:e15-9. [PMID: 23332374 DOI: 10.1016/j.ajic.2012.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/24/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol-based hand rubs (ABHRs) have been associated with a reduction of nosocomial infections. Despite the worldwide introduction of these products in health care settings, the aim of this study was to assess the transpulmonary absorption of ethanol contains in ABHRs used by health care workers (HCWs) in real conditions of work shift. METHODS Twenty-six HCWs of Nancy University Hospital were included. Research consisted in monitoring participants during 4 hours of work shift to assess their exposure to ethanol. The measurement of ethanol vapors in exhaled breath was performed using a class B ethylometer (Alco-Sensor FST). Ethanol concentration in inhaled breath was measured using Gilian pump LFS-113. Concentration of ethanol, acetaldehyde, and acetate in blood and urine samples were determined using gas chromatography with flame ionization detector. RESULTS Participants were 12% male and 88% female. The mean age was 40 ± 8 years. None of the employees included in the study presented any traces of ethanol or its metabolites in the blood or urine. Ethanol (0.08 ± 0.07 mg/L) was detected in the breath of 10 HCWs at 1 to 2 minutes postexposure. The mean concentration of ethanol in the inhaled air was 46.2 mg/m. CONCLUSION Absorption of ethanol vapor from ABHRs among HCWs during their care activities was not detected. Quantification of ethanol fumes inhaled during 4 hours of work shift was below the regulatory limitations of exposure to ethanol.
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Ali SS, Wilson MP, Castillo EM, Witucki P, Simmons TT, Vilke GM. Common hand sanitizer may distort readings of breathalyzer tests in the absence of acute intoxication. Acad Emerg Med 2013; 20:212-5. [PMID: 23406081 DOI: 10.1111/acem.12073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/14/2012] [Accepted: 08/22/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The use of alcohol-based hand sanitizers has recently become widespread. To the authors' knowledge, no previous study has examined whether application of ethanol-based hand sanitizers by the person operating a common breathalyzer machine will affect the accuracy of the readings. This was a prospective study investigating whether the use of hand sanitizer applied according to manufacturer's recommendations (Group I), applied improperly at standard doses (Group II), or applied improperly at high doses (Group III) had an effect on breathalyzer readings of individuals who had not ingested alcohol. METHODS The participants of the prospective study were divided into three groups to assess the effect of hand sanitizer on breathalyzer readings. Group I used one pump (1.5 mL) of hand sanitizer (Purell), allowing the hands to dry per manufacturer's recommendations; Group II used one pump (1.5 mL), without allowing the hands to dry; and Group III used two pumps (3 mL), without allowing the hands to dry. Breathalyzer measures for each group are presented as medians with interquartile ranges (IQR) and ranges. Differences between each sequential group (I vs. II and II vs. III) were assessed using a Mann-Whitney U-test (p < 0.05 significant). RESULTS There were 25 study participants in each group for a total of 75 participants. The initial breathalyzer readings of all study participants were 0.000 g/dL. The median breathalyzer reading was 0.004 g/dL in Group I (IQR = 0.001 to 0.008 g/dL), 0.051 g/dL in Group II (IQR = 0.043 to 0.064 g/dL), and 0.119 g/dL in Group III (IQR = 0.089 to 0.134 g/dL). Measures between each subsequent group were all statistically different (p < 0.001). CONCLUSIONS The use of common alcohol-based hand sanitizer may cause false-positive readings with a standard hospital breathalyzer when the operator uses the hand sanitizer correctly. The breathalyzer readings are further elevated if more sanitizer is used or if it is not allowed to dry appropriately.
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Affiliation(s)
| | | | | | - Peter Witucki
- the Department of Emergency Medicine; UC San Diego Health System; San Diego; CA
| | - Todd T. Simmons
- the Department of Emergency Medicine; UC San Diego Health System; San Diego; CA
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Hautemanière A, Cunat L, Ahmed-Lecheheb D, Hajjard F, Gerardin F, Morele Y, Hartemann P. Assessment of exposure to ethanol vapors released during use of Alcohol-Based Hand Rubs by healthcare workers. J Infect Public Health 2012; 6:16-26. [PMID: 23290089 DOI: 10.1016/j.jiph.2012.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite the increasing use of Alcohol-Based Hand Rub solutions, few studies have quantified the concentrations of inhaled ethanol. OBJECTIVE The aim of this study was to assess ethanol exposure during hygienic and surgical hand disinfection practices. METHOD Ethanol concentrations were measured at the nose level of a wooden dummy and human volunteers. Two systems were used in parallel to determine short-term ethanol vapor exposures: activated charcoal tubes followed by gas chromatography analysis and direct reading on a photoionization detector (PID). Exposure was assessed for 4 different sequences (N=10) reproducing hand rubs for simple surgery, nursing care, intensive care and surgical scrub. RESULTS The ethanol concentrations measured were of a similar order between the dummy and volunteers. The concentrations obtained by PID were higher than the gas chromatography values for the simple care (45%) and nursing care (27%) sequences and reflected specific exposure peaks of ethanol, whereas ethanol concentrations were continuously high for intensive care (440 mg m(-3)) or surgical scrub (650 mg m(-3)). CONCLUSION Ethanol concentrations were similar for these two exposure assessment methods and demonstrated a relationship between handled doses and inhaled doses. However, the ethanol vapors released during hand disinfection were safe for the healthcare workers.
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Ahmed-Lecheheb D, Cunat L, Hartemann P, Hautemanière A. Dermal and pulmonary absorption of ethanol from alcohol-based hand rub. J Hosp Infect 2012; 81:31-5. [PMID: 22445089 DOI: 10.1016/j.jhin.2012.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among HCWs after hygienic hand disinfection. METHODS Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift. Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in expired air. RESULTS Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of 28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h shift, and urine tests were negative in all participants. CONCLUSION Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was detected but was below toxic levels.
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Affiliation(s)
- D Ahmed-Lecheheb
- Department of Environment and Public Health, Faculty of Medicine, Nancy University, Nancy, France.
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Stewardson A, Allegranzi B, Sax H, Kilpatrick C, Pittet D. Back to the future: rising to the Semmelweis challenge in hand hygiene. Future Microbiol 2011; 6:855-76. [PMID: 21861619 DOI: 10.2217/fmb.11.66] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hand hygiene is the single most important intervention for reducing healthcare associated infections and preventing the spread of antimicrobial resistance. This sentence begins most publications regarding hand hygiene in the medical literature. But why - as we mark 150 years since the publication of Ignaz Semmelweis' landmark monograph on the subject - do we continue to repeat it? One might be tempted to regard it as a truism. However, while tremendous progress has certainly been made in this field, a significant amount of work is yet to be done in both strengthening the evidence regarding the impact of hand hygiene and maximizing its implementation. Hand hygiene cannot yet be taken for granted. This article summarizes historical perspectives, dynamics of microbial colonization and efficacy of hand cleansing methods and agents, elements and impacts of successful hand hygiene promotion, as well as scale-up and sustainability. We also explore hand hygiene myths and current challenges such as monitoring, behavior change, patient participation and research priorities.
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Affiliation(s)
- Andrew Stewardson
- Infection Control Program & World Health Organization Collaborating Centre on Patient Safety (Infection Control & Practice Improvement), University of Geneva Hospitals, Switzerland
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Nandrup-Bus I. Comparative studies of hand disinfection and handwashing procedures as tested by pupils in intervention programs. Am J Infect Control 2011; 39:450-5. [PMID: 21802616 DOI: 10.1016/j.ajic.2010.10.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study was to determine the effect of mandatory, scheduled hand disinfection (HD) on actual absenteeism because of infectious illness in elementary school pupils in Denmark. METHODS A 3-month intervention study between 2 schools was performed on 656 pupils ages 5 to 15 years. The pupils at the intervention school (IS; n = 318) were required to disinfect their hands 3 times during school hours. Those at the control school (CS; n = 338) continued their usual handwashing (HW) practices, but they had been IS regarding mandatory HW the previous year. All absences because of illness were recorded, and data were analyzed statistically. RESULTS Comparison between the IS and itself (CS in 2007) demonstrated a significant difference (P = .018) in reducing absenteeism because of infectious illness, both for girls (P = .011) and boys (P = .029). The CS (IS in 2007) did not show any difference between 2007 and 2008 (P = .86). CONCLUSION Intervention with mandatory HW may have a lasting pedagogical effect in reducing absenteeism because of infectious illness when exposed to role models. HD could be effective in reducing absenteeism because of infectious illness and a well-placed supplement to HW.
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Abstract
Alcohol-based hand sanitizers have become widely available because of widespread usage in schools, hospitals, and workplaces and by consumers. We report what we believe is the first unintentional ingestion in a small child producing significant intoxication. A 4-year-old 14-kg girl was brought to the emergency department with altered mental status after a history of ingesting an alcohol-based hand sanitizer. Physical examination revealed an obtunded child with periods of hypoventilation and a hematoma in the central portion of her forehead from a fall at home that occurred after the ingestion. Abnormal vital signs included a heart rate of 139 beats/min and temperature of 96.3 degrees F, decreasing to 93.6 degrees F. Abnormal laboratory values consisted of potassium of 2.6 mEq/L and a serum alcohol of 243 mg/dL. A computed tomography scan of her brain without contrast showed no acute intracranial abnormality. A urine drug screen for common drugs of abuse was reported as negative. The child was intubated, placed on mechanical ventilation, and admitted for medical care. She recovered over the next day without sequelae. As with other potentially toxic products, we would recommend caution and direct supervision of use when this product is available to young children.
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Religion and culture: potential undercurrents influencing hand hygiene promotion in health care. Am J Infect Control 2009; 37:28-34. [PMID: 18834738 PMCID: PMC7115273 DOI: 10.1016/j.ajic.2008.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/08/2022]
Abstract
Background Health care–associated infections affect hundreds of millions of patients worldwide each year. The World Health Organization's (WHO) First Global Patient Safety Challenge, “Clean Care is Safer Care,” is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in different health care settings worldwide. Methods An extensive literature search was conducted and experts and religious authorities were consulted to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible solutions, and suggest areas for future research. Results Religious faith and culture can strongly influence hand hygiene behavior in health care workers and potentially affect compliance with best practices. Interesting data were retrieved on specific indications for hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of “visibly dirty” hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some religions. Conclusions The impact of religious faith and cultural specificities must be taken into consideration when implementing a multimodal strategy to promote hand hygiene on a global scale.
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Wigmore J. The Purell® Defence: Can the use of Alcohol-Containing Hand Sanitizers Cause an Elevated Breath or Blood Alcohol Concentration? CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 2009. [DOI: 10.1080/00085030.2009.10757603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lachenmeier DW. Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity. J Occup Med Toxicol 2008; 3:26. [PMID: 19014531 PMCID: PMC2596158 DOI: 10.1186/1745-6673-3-26] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/13/2008] [Indexed: 01/01/2023] Open
Abstract
Ethanol is widely used in all kinds of products with direct exposure to the human skin (e.g. medicinal products like hand disinfectants in occupational settings, cosmetics like hairsprays or mouthwashes, pharmaceutical preparations, and many household products). Contradictory evidence about the safety of such topical applications of the alcohol can be found in the scientific literature, yet an up-to-date risk assessment of ethanol application on the skin and inside the oral cavity is currently lacking.The first and foremost concerns of topical ethanol applications for public health are its carcinogenic effects, as there is unambiguous evidence for the carcinogenicity of ethanol orally consumed in the form of alcoholic beverages. So far there is a lack of evidence to associate topical ethanol use with an increased risk of skin cancer. Limited and conflicting epidemiological evidence is available on the link between the use of ethanol in the oral cavity in the form of mouthwashes or mouthrinses and oral cancer. Some studies pointed to an increased risk of oral cancer due to locally produced acetaldehyde, operating via a similar mechanism to that found after alcoholic beverage ingestion.In addition, topically applied ethanol acts as a skin penetration enhancer and may facilitate the transdermal absorption of xenobiotics (e.g. carcinogenic contaminants in cosmetic formulations). Ethanol use is associated with skin irritation or contact dermatitis, especially in humans with an aldehyde dehydrogenase (ALDH) deficiency.After regular application of ethanol on the skin (e.g. in the form of hand disinfectants) relatively low but measurable blood concentrations of ethanol and its metabolite acetaldehyde may occur, which are, however, below acute toxic levels. Only in children, especially through lacerated skin, can percutaneous toxicity occur.As there might be industry bias in many studies about the safety of topical ethanol applications, as well as a general lack of scientific research on the long-term effects, there is a requirement for independent studies on this topic. The research focus should be set on the chronic toxic effects of ethanol and acetaldehyde at the point of impact, with special regard to children and individuals with genetic deficiencies in ethanol metabolism.
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Affiliation(s)
- Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Strasse 3, D-76187 Karlsruhe, Germany.
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Bush K, Mah MW, Meyers G, Armstrong P, Stoesz J, Strople S. Going Dotty: a practical guide for installing new hand hygiene products. Am J Infect Control 2007; 35:690-3. [PMID: 18063135 DOI: 10.1016/j.ajic.2007.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 01/02/2007] [Accepted: 01/03/2007] [Indexed: 11/19/2022]
Abstract
This report distills our experiences coordinating the installation of a new commercial line of hand hygiene products in a large, integrated health care region in Western Canada into a practical guide that can benefit infection control professionals. Some key considerations while managing such a large hand hygiene products installation are stakeholder collaboration, management of occupational hand dermatitis, housekeeping support, and communication.
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Affiliation(s)
- Kathryn Bush
- Infection Prevention and Control Program, Calgary Health Region, Calgary, AB, Canada.
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Brown TL, Gamon S, Tester P, Martin R, Hosking K, Bowkett GC, Gerostamoulos D, Grayson ML. Can alcohol-based hand-rub solutions cause you to lose your driver's license? Comparative cutaneous absorption of various alcohols. Antimicrob Agents Chemother 2006; 51:1107-8. [PMID: 17194820 PMCID: PMC1803104 DOI: 10.1128/aac.01320-06] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We assessed cutaneous ethanol (ETOH) and isopropanol (ISOP) absorption after intensive (30 times per h) use of alcohol-based hand-rub solutions by healthcare workers (HCWs). ETOH was detectable in the breath of 6/20 HCWs (0.001 to 0.0025%) at 1 to 2 min postexposure and in the serum of 2/20 HCWs at 5 to 7 min postexposure. Serum ISOP levels were unrecordable at all time points.
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Affiliation(s)
- T L Brown
- Infectious Diseases Department, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia
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Miller MA, Rosin A, Levsky ME, Patel MM, Gregory TJD, Crystal CS. Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study. Am J Emerg Med 2006; 24:815-7. [PMID: 17098103 DOI: 10.1016/j.ajem.2006.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Revised: 05/01/2006] [Accepted: 05/07/2006] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Ethanol-based hand sanitizers (EBHSs) are used in most health care facilities in the United States. Infection control personnel advocate the use of generous quantities of EBHS before and after contact with patients. Although it is assumed that little systemic absorption of ethanol occurs during EBHS use, many alcohols are absorbed to varying degrees via the transdermal route. Ethanol intoxication by employees in the medical workplace is a potentially serious finding, and it is of forensic and medical-legal importance to elucidate the effects of frequent use of EBHS upon serum blood ethanol levels (BELs). To investigate the effect of frequent use of EBHS upon serum blood ethanol concentrations, we prospectively studied 5 volunteers undergoing frequent application of EBHS. METHODS Enrolled subjects applied 5 mL of the product (62% denatured ethyl alcohol manufactured by Kimberley-Clark, Roswell, GA) to both hands and rubbed until dry. This activity was repeated 50 times over 4 hours. Participants had their blood drawn before as well as after completing the study. Each participant was without alcohol exposure during the 12 hours preceding the study. RESULTS Five volunteers were enrolled. All had an initial blood ethanol level of less than 5 mg/dL. All 5 participants completed the 4-hour study. There were no noted adverse reactions during the study. Blood ethanol level upon completion of the 50 applications of EBHS was less than 5 mg/dL in all 5 study participants. CONCLUSION The results of this study demonstrate that use of ethanol-based hand sanitizers, when frequently used in accordance with labeling, do not raise serum blood ethanol levels.
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Affiliation(s)
- Michael A Miller
- Department of Emergency Medicine, C.R. Darnall Army Medical Center, Hood, TX 76544, USA.
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