Practice Lesson of the week

Alcohol hand rubs: hygiene and hazard

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39274.583472.AE (Published 29 November 2007) Cite this as: BMJ 2007;335:1154
  1. John R H Archer, specialist registrar in general internal medicine and clinical pharmacology1,
  2. David M Wood, acting consultant in clinical toxicology1,
  3. Zoe Tizzard, specialist in poisons information1,
  4. Alison L Jones, professor of medicine and toxicology2,
  5. Paul I Dargan, consultant physician and clinical toxicologist, director1
  1. 1Guy's and St Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London SE14 5ER
  2. 2University of Newcastle, Newcastle, NSW 2300, Australia
  1. Correspondence to: J R H Archerjrh_archer{at}yahoo.com
  • Accepted 6 June 2007

Young or confused people and those dependent on alcohol are at risk from ingestion of alcohol hand rubs

Hospital acquired infections are common and increase morbidity, mortality, and length of stay.1 2 The benefit of hand washing has been highlighted,3 and studies have shown that alcohol hand rub is significantly better than soap in reducing hand contamination.4 5 6 7 In 2004, NHS trusts were advised to introduce “near patient” alcohol based hand rubs (for example, attached beside beds and at entrances to wards) by April 2005.8

With the widespread introduction of these hand rubs, risk assessments were made for the possibility of fire and ingestion. Although alcohol hand rub is flammable, no incidents involving fire have occurred. The risk of ingestion was thought possible in children and confused patients, but little advice was given on reducing this risk.8 Frequent dermal application of alcohol based hand rub has been shown not to raise blood ethanol levels.9 However, no further risk assessment has examined unintentional or intentional ingestion of alcohol rubs.

We report a case of considerable toxicity associated with the deliberate ingestion of alcohol based hand rub, together with data from our poisons unit showing an increase in inquiries related to alcohol rubs.

Case report

A patient known to have a history of alcohol dependency presented with withdrawal symptoms, having not consumed alcohol for 24 hours. On examination the patient …

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