title: Safety assessment for ethanol-based topical antiseptic use by health care workers: Evaluation of developmental toxicity potential.
abstract: Ethanol-based topical antiseptic hand rubs, commonly referred to as alcohol-based hand sanitizers (ABHS), are routinely used as the standard of care to reduce the presence of viable bacteria on the skin and are an important element of infection control procedures in the healthcare industry. There are no reported indications of safety concerns associated with the use of these products in the workplace. However, the prevalence of such alcohol-based products in healthcare facilities and safety questions raised by the U.S. FDA led us to assess the potential for developmental toxicity under relevant product-use scenarios. Estimates from a physiologically based pharmacokinetic modeling approach suggest that occupational use of alcohol-based topical antiseptics in the healthcare industry can generate low, detectable concentrations of ethanol in blood. This unintended systemic dose probably reflects contributions from both dermal absorption and inhalation of volatilized product. The resulting internal dose is low, even under hypothetical, worst case intensive use assumptions. A significant margin of exposure (MOE) exists compared to demonstrated effect levels for developmental toxicity under worst case use scenarios, and the MOE is even more significant for typical anticipated occupational use patterns. The estimated internal doses of ethanol from topical application of alcohol-based hand sanitizers are also in the range of those associated with consumption of non-alcoholic beverages (i.e., non-alcoholic beer, flavored water, and orange juice), which are considered safe for consumers. Additionally, the estimated internal doses associated with expected exposure scenarios are below or in the range of the expected internal doses associated with the current occupational exposure limit for ethanol set by the Occupational Safety and Health Administration. These results support the conclusion that there is no significant risk of developmental or reproductive toxicity from repeated occupational exposures and high frequency use of ABHSs or surgical scrubs. Overall, the data support the conclusion that alcohol-based hand sanitizer products are safe for their intended use in hand hygiene as a critical infection prevention strategy in healthcare settings.
authors.affiliation: Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: maierma@ucmail.uc.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Maier
authors.affiliation: Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jerald L
authors.initials: JL
authors.lastname: Ovesen
authors.affiliation: Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Casey L
authors.initials: CL
authors.lastname: Allen
authors.affiliation: RG York and Associates LLC, Manlius, NY, USA.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: York
authors.affiliation: Toxicology Excellence For Risk Assessment, Cincinnati, OH, USA.
authors.forename: Bernard K
authors.initials: BK
authors.lastname: Gadagbui
authors.affiliation: Summit Toxicology LLP, Cleveland, OH, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Kirman
authors.affiliation: Summit Toxicology, LLP, Richland, WA, USA.
authors.forename: Torka
authors.initials: T
authors.lastname: Poet
authors.affiliation: GOJO Industries, Inc., Akron, OH, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Quiñones-Rivera
mesh_terms: D000280:Administration, Inhalation; D000287:Administration, Topical; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D000431:Ethanol / Q000009:adverse effects*; D000882:Haplorhini; D006282:Health Personnel; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects*; D051381:Rats; D018570:Risk Assessment; D012449:Safety; D012869:Skin Absorption / Q000502:physiology
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol
keywords: Blood alcohol concentration; Dermal exposure; Developmental toxicity; Dose–response; Ethanol; Hand sanitizers; Healthcare workers; Margin of exposure; Safety assessment