Today, different formulations with variable concentrations of these alcohols are used with the aim to reduce both the transient and resident flora on hands in order to prevent transmission of nosocomial pathogens in hospitals [ 1 ]. The antimicrobial efficacy of ethanol is dependent on its concentration. Both, the CDC-guideline for hand hygiene [ 3 ], and the recently published WHO guideline on hand hygiene in healthcare [ 15 ] clearly favour the use of alcohol-based hand rubs in hospitals because other alternatives like antimicrobial soaps have significant disadvantages such as a lower efficacy [ 1 , 16 ], a decreased dermal tolerance [ 1 , 17 ], higher potential for impaired efficacy due to an incorrect performance of the procedure [ 18 ], the necessity of a wash basin, and the longer time spent for the procedure [ 19 ].
However, 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. Generally, it is stated that ethanol is absorbed by human skin in a quantity described as "toxicologically negligible". Yet, this opinion is based on earlier studies, in which the concentration of ethanol in serum was not investigated [ 20 — 24 ], or contradictory results were presented.
Two investigators reported that no rise of ethanol concentrations in human serum were detectable, even when excessive ethanol exposure occurred using dressings soaked with ml ethanol for 3 h [ 25 , 26 ]. Yet, this experimental design does not allow drawing valid conclusions for hand hygiene procedures.
In light of the recent WHO recommendations [ 15 ] the possibility of ethanol absorption from skin in man is not of trivial nature. Some cultures and religions particularly Islam, categorically prohibit the use of alcohol and regard its use as a sin 'haram' [ 27 ].
Ethanol is the principal alcohol found in all alcoholic beverages. In Islam, all intoxicants are haram whether they are in liquid, solid or in any other form regardless of its quantity. Although never investigated, for Muslims alcohol skin absorption and its smell might arguably constitute a perceptive barrier for the use of alcohol-based hand rubs and concerns have been expressed about the potential systemic diffusion of alcohol or its metabolites following dermal absorption or airborne inhalation related to the use of alcohol-based hand rub formulations.
As a result, the adoption of alcohol-based formulations as the gold standard for hand hygiene may be unsuitable or inappropriate for some healthcare workers, either because of their reluctance to have contact with alcohol, or because of their concern about alcohol absorption by route of the skin.
Currently available scientific data, elucidating this issue are limited or inconclusive. The aim of this study was therefore to assess if absorption of ethanol does occurs using three different alcohol-based hand rubs for hygienic and surgical hand disinfection, and if so, whether its quantity is minimal or below toxic levels for humans. Hand rubs were applied in a room sized 37 m 3 with two open windows and an open door.
No controlled air exchange occurred during applications. Between applications of hand rubs, volunteers were placed in a second room in which the use of alcohol-based hand rubs was not permitted. Blood samples were collected in a third room.
All hand rubs were tested on the same 12 volunteers 6 male, 6 female. Inclusion criteria were a minimum age of 18 years and the ability to perform a standardized application according to EN [ 28 ]. Exclusion criteria were defined as follows: visible skin lesions on hands or arms, skin disease, alimentary intake of ethanol in any form within 24 h before the beginning of an experiment, diabetes mellitus, pregnancy or lactation, and participation in a clinical trial 30 days prior to start of this study.
Written consent was obtained from all volunteers. Hygienic hand disinfection is performed after a proven or anticipated contamination of hands [ 3 ]. This number is certainly variable depending on the nature of clinical activity, the clinical setting, or the impact of training programs [ 6 ]. The risk of contamination of the hands of healthcare workers and the susceptibility of patients for acquiring a healthcare-associated infections is, for example, much lower in a psychiatric setting than in intensive care units.
Under practical conditions the procedure of hand disinfection averages between 6 — 24 s and normally does not reach the recommended 30 s [ 6 ]. The exposure of a healthcare worker to ethanol in a "real life" situation can therefore only be estimated based on the number of hygienic hand disinfections which is likely to be on average 5—6 minutes per healthcare worker and shift [ 29 ]. It can be assumed that surgical healthcare workers perform an average of 4 surgical hand disinfections per day.
The contact time of ethanol with human skin will be approximately 3 minutes per surgical hand disinfection for most preparations [ 30 ]. Therefore the exposure to ethanol is likely to be on average 12 minutes per healthcare worker per shift. Immediately prior to the initiation of the experiments, the hands were washed with non-medicated neutral pH soap and dried thoroughly.
For hygienic and surgical hand disinfection each hand rub was tested individually on one of three consecutive days of evaluation. For each application 4 mL of a hand rub were applied in the test room to both hands and rubbed in for 30 s according to the standard rub-in procedure described in the European norm EN [ 28 ].
After a waiting time of 1 minute outside the test room, the procedure was repeated. A total of 20 hygienic hand disinfections were performed, resulting in a total exposure time with each hand rub of 10 minutes over a period of 30 minutes. Surgical hand disinfection experiments started 7 days after the hygienic hand disinfection experiments. Four mL of the hand rub were applied to the hands and rubbed on hands and forearms. This procedure was repeated five times with the aim to keep hands and forearms covered with the hand rub for the recommended application time of 3 minutes [ 31 ].
After a waiting time of 5 minutes outside the test room the procedure was repeated. A total of 10 surgical hand disinfections were performed resulting in a total exposure time with each hand rub of 30 minutes over a period of 80 minutes. At the end of each test day a dermatological protective hand cream was applied to the treated skin areas. Prior to sampling, the skin was disinfected with an alcohol-free skin antiseptic alcohol-free povidone-iodine, 1 minute.
In order to determine the ethanol concentration before the first application of a day baseline and 2. Only for hand rub C, an additional sample was taken minutes after the last surgical hand disinfection. The measurement quantification of ethanol and acetaldehyde concentrations in peripheral blood was performed using gas chromatography in a modification of the method described by Roemhild et al. Then, 2. Nitrogen 5. In each case, calibration was performed according to the method of the external standard, with three calibration points.
The latter were used if the sample concentration did not fall within the calibration level e. These calibration standards were produced by weight of the contents of original substances followed by dilution on calibration level.
The content of the self-made standards were cross checked with those of commercially standards by gas chromatographic measurements. Characteristic analytical data for the procedure used in the determination of acetaldehyde is 0. The WHO's recommendation for ethanol is a maximum of mg per day. Hence, for values below the detection limits, for ethanol a concentration of 0.
The amount of absorbed ethanol was determined for each volunteer, each hand rub and mode of application. In order to control for the difference of ethanol absorption between males and females the formula described by Wittmann et al.
The proportion of absorbed ethanol was determined for each hand rub and type of application as the ratio of the median absorbed amount and the amount of ethanol initially applied. Continuous variables were analyzed to evaluate normality of distribution. Based on the null hypothesis of no differences in the median ethanol or acetaldehyde concentrations between baseline and post-application, P-values were calculated using the Wilcoxon rank sum test.
In The median ethanol concentration was 0. The highest baseline ethanol concentration was 1. For acetaldehyde, 5. The median acetaldehyde concentration was 0. The highest baseline acetaldehyde concentration was 1. During 20 hygienic hand disinfections within a period of 30 minutes and a total contact time of 10 minutes, volunteers were exposed to a total of 80 mL of hand rub corresponding to an ethanol exposure of After the last application, the median ethanol concentration in peripheral blood increased gradually and peaked after 30 minutes for all hand rubs Table 1.
The highest median concentration found with hand rub A was After 30 minutes, ethanol concentration gradually decreased for all hand rubs. There was, however, a difference in the absorption kinetics between the tested hand rubs. Figure 1. The amount of absorbed ethanol was mg with hand rub A, mg with hand rub B, and mg with hand rub C.
Based on the total amount of applied ethanol with each hand rub, the proportion of absorbed ethanol was 2. During 10 surgical hand disinfections within a period of 80 minutes and a contact time of 30 minutes, volunteers were exposed to a total of mL of hand rub corresponding to a total ethanol exposure of The highest median ethanol concentration was found with two hand rubs 30 minutes after the last application, but with hand rub C 20 minutes thereafter Table 2.
The maximum observed median ethanol concentration was Figure 2. Based on the total amount of applied ethanol with each hand rub, the proportion of absorbed ethanol was 0. The highest median acetaldehyde concentrations after 20 hygienic hand disinfections were 0. After 30 to 60 minutes, however, levels of acetaldehyde decreased gradually Figures 3 and 4. Alcohol abuse is a significant medical and social problem.
At sufficiently high doses, ethanol, the active ingredient of alcoholic beverages, and others can cause both short-term such as inebriation and long-term such as cirrhosis of the liver toxic effects in humans. Thus, concern has been raised about the possible health consequences of using ethanol for alcoholic hand rubs.
Since the intrinsic toxic effects of ethanol require its entry into the bloodstream, we evaluated ethanol blood concentrations using 3 different ethanol-based hand rubs. However, individual baseline ethanol concentrations ranged from non-detectable concentrations to a maximum of 1. This is not unexpected since ethanol is produced through fermentation by fungi and other intestinal microorganisms, and is found at low levels in the blood and exhalation of individuals otherwise abstinent [ 35 ].
The individual blood levels determined in our study at baseline vary to some extent due to individual factors influencing the production, absorption and metabolism of ethanol such as activity of alcohol dehydrogenase, alimentation and gender [ 36 , 37 ]. We were able to demonstrate that following excessive hygienic or surgical hand disinfection only 0. This excessive exposure, however, will rarely occur in clinical practice. Albeit that, we were compelled to chose this particular experimental design since the literature does not offer data on exact absorption rates after hand disinfection.
Our findings are important to have confidence in the safe use of ethanol-based hand rubs. If a surgeon carries out three surgical hand disinfection with hand rub A containing the highest concentration of ethanol over 6 hours one hand disinfection every two hours using e. According to our results, approximately 0.
Assuming 70 kg body weight and PainSci commentary on Hansen ? This page is one of thousands in the PainScience. It is not a general article : it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible. Also, y'know what's really thin and sensitive? The mucous membranes inside your nose.
Punishing them with a solution that 40 percent alcohol by volume is a bad idea, as it can quickly desiccate them. Watch the above video if you dare. Do you want to be like those guys? If so, stop and change everything about yourself right now so that never happens. You pour in a shot of your liquor of choice, the machine turns it into a vapor, and you inhale it.
Insufflated alcohol goes into your bloodstream much faster than drinking. Also, the amount of food you have eaten doesn't affect its potency because, again, it bypasses your digestive system. It advertised a calorie-free drinking experience and promised no hangovers. It was all bullshit calories still get in your system, regardless of how you ingest the alcohol.
But the AWOL was just one way to inhale alcohol. Among other methods, dry ice seems to be the most common. There's also this interesting pump-system. At least the AWOL could ensure that a shot was taken slowly, over the course of 20 minutes, and it specifically said that no one should do more than two shots in a hour period. The DIY folks, with no such warning labels, can easily cross the line into alcohol poisoning.
Can you absorb booze through the mucous membranes in your mouth without swallowing? According to the blog Science 20 , "there are drugs bigger than ethanol molecules that are administered sublingually. You have to hold booze in your mouth, a little at a time, for a long time.
If you were using a high-proof liquor, that would burn a lot. Definitely not worth it. Ever drank an ass-load of booze? I hope you haven't done it like this. It's called butt-chugging, and it's sad that it's common enough to have a nickname.
It is, essentially, an alcohol enema. It's rather popular with the not-yet college scene because you won't have any liquor on your breath. Or so they think. Actually, because the alcohol goes into your blood stream, the vapor comes out in your breath just the same. Sorry, kids. The appeal, for a practice that involves lying flat on your back, knees in the air, with a funnel shoved up your ass?
The mucous membranes up your poop-chute are extremely porous, allowing for rapid absorption. I got drunk so fast! Oops, I'm dead.
0コメント