Original contribution
Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study

https://doi.org/10.1016/j.ajem.2006.05.006Get rights and content

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.

Introduction

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 [1]. This translates to the use of these products 10 to 25 times per hour, depending upon the task being performed. 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 [2]. Because dermal absorption of alcohols has been demonstrated in a previous study, and ethanol intoxication by employees in the medical workplace is a potentially serious finding, 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 studied 5 volunteers undergoing frequent application of EBHS.

Section snippets

Study design

This was a prospective, nonblinded study. The institutional review board at our institution approved the study.

Study protocol

Participants were the investigators and associate investigators of the study. All are employees in the emergency department at the study institution. Enrolled subjects applied 5 mL of the product (62% denatured ethyl alcohol manufactured by Kimberley-Clark) to both hands and rubbed until dry. This activity was repeated 50 times over 4 hours. Participants had their blood drawn before as

Results

A total of 5 volunteers were enrolled. All had an initial BEL 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.

Discussion

Ethanol is the most frequently abused intoxicant in the United States [3]. The proliferation of work-related drug testing programs, integration of EBHS into health care facilities, and the widespread abuse of ethanol make it imperative to define what, if any, contribution the use of ethanol-based hand sanitizers have on the BEL of users of such products. Medical review officers (MROs) may be asked to review an employee's claim that he or she was not using ethanol, and the MRO must use the best

Limitations

This study tested the ability of EBHS to elevate BEL in healthy, adult males. Although the findings likely apply to other human populations, this cannot be proven from our data. Furthermore, we dealt only with EBHS being used as intended. This study does not rule out BEL elevation by EBHS that has been misused in some manner, such as through ingestion or application to mucous membranes. An important remaining question is whether EBHS may contribute to or cause disulfiram-alcohol reactions in

Conclusion

The results of this study demonstrate that use of ethanol-based hand sanitizers, when frequently used in accordance with labeling, does not raise serum blood ethanol levels.

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