title: Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University, Walther-Rathenau-Str. 49a, 17489 Greifswald, Germany. kramer@uni-greifswald.de
authors.forename: Axel
authors.initials: A
authors.lastname: Kramer
authors.forename: Harald
authors.initials: H
authors.lastname: Below
authors.forename: Nora
authors.initials: N
authors.lastname: Bieber
authors.forename: Guenter
authors.initials: G
authors.lastname: Kampf
authors.forename: Cyril D
authors.initials: CD
authors.lastname: Toma
authors.forename: Nils-Olaf
authors.initials: NO
authors.lastname: Huebner
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
mesh_terms: D000042:Absorption; D000079:Acetaldehyde / Q000097:blood; D000279:Administration, Cutaneous; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000097:blood / Q000737:chemistry*; D004203:Disinfection; D000431:Ethanol / Q000008:administration & dosage / Q000097:blood / Q000737:chemistry*; D005260:Female; D006225:Hand; D006235:Hand Disinfection; D006801:Humans; D008297:Male; D012867:Skin
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol; D000079:Acetaldehyde