Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans

Axel Kramer¹ , Harald Below¹ , Nora Bieber¹ , Guenter Kampf¹^,2 , Cyril D Toma³ , Nils-Olaf Huebner¹ and Ojan Assadian³^,4

¹Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University, Walther-Rathenau-Str. 49a, 17489 Greifswald, Germany

²BODE Chemie GmbH & Co. KG, Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany

³Prince Court Medical Centre, 39 Jalan Kia Peng, 50450 Kuala Lumpur, Malaysia

⁴Department of Hygiene and Clinical Microbiology, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria

author email corresponding author email

BMC Infectious Diseases 2007, 7:117doi:10.1186/1471-2334-7-117


Published:	11 October 2007

Abstract

Background

Despite 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.

Methods

Twelve 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.

Results

The 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).

Conclusion

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.