title: Breath alcohol of anesthesiologists using alcohol hand gel and the "five moments for hand hygiene" in routine practice.
abstract: OBJECTIVE
  Appropriate hand hygiene reduces hospital-acquired infections. Anesthesiologists work in environments with numerous hand hygiene opportunities (HHOs). In a prospective observational study, we investigated the potential for an anesthesiologist to return a positive alcohol breath test during routine practice when using alcohol hand gel.
  
  
  METHODS
  We observed ten volunteer anesthesiologists over four hours while they implemented the World Health Organization (WHO) "five moments for hand hygiene" using our hospital's adopted standard 70% ethanol hand gel. We measured the expired alcohol concentration at shift start and every fifteen minutes thereafter with a fuel cell breathalyzer calibrated to measure the percentage of blood alcohol concentration (BAC). Blood alcohol specimens (analyzed with gas chromatography) were collected at shift start and, when possible, immediately after a participant's first positive breathalyzer test.
  
  
  RESULTS
  Of the 130 breathalyzer tests obtained, there were eight (6.2%) positive breath alcohol results from six of the ten participants, all within two minutes of a HHO. The highest value breathalyzer BAC recorded was 0.064%, with an overall mean (SD) of 0.023 (0.017)%. Five (62.5%) of the positive breathalyzer tests returned to zero in less than seven minutes. All of three blood specimens obtained immediately after a positive breathalyzer reading tested negative for alcohol.
  
  
  CONCLUSIONS
  Anesthesia practitioners using alcohol hand gel in a manner that conforms with recommended hand hygiene can test positive for alcohol on a breathalyzer assay. Positive tests probably arose from inhalation of alcohol vapour into the respiratory dead space following gel application. If workplace breath testing for alcohol is implemented, it should be completed more than 15 min after applying alcohol hand gel. Positive results should be verified with a BAC test.
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Auckland City Hospital, 2 Park Road, Auckland, New Zealand. helenl@adhb.govt.nz.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Lindsay
authors.affiliation: Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Hannam
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Auckland City Hospital, 2 Park Road, Auckland, New Zealand.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bradfield
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Auckland City Hospital, 2 Park Road, Auckland, New Zealand.|Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000378:metabolism* / Q000627:therapeutic use; D000067401:Blood Alcohol Content; D001944:Breath Tests; D002849:Chromatography, Gas; D000431:Ethanol / Q000378:metabolism* / Q000627:therapeutic use; D005260:Female; D005782:Gels / Q000378:metabolism; D006225:Hand; D063373:Hand Hygiene / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D000891:Anti-Infective Agents, Local; D000067401:Blood Alcohol Content; D005782:Gels; D000431:Ethanol