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Kramer A, Arvand M, Christiansen B, Dancer S, Eggers M, Exner M, Müller D, Mutters NT, Schwebke I, Pittet D. Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany. Antimicrob Resist Infect Control 2022; 11:93. [PMID: 35794648 PMCID: PMC9257567 DOI: 10.1186/s13756-022-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. AIM A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. RESULTS EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure < 500 ppm does not significantly contribute to the cancer risk. Mutagenic effects were observed only at doses within the toxic range in animal studies. While reprotoxicity is linked with abuse of alcoholic beverages, there is no epidemiological evidence for this from EBHR use in healthcare facilities or from products containing ethanol in non-healthcare settings. CONCLUSION The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (< 0.5% v/v), such as apple juice or kefir. There is no risk of carcinogenicity, mutagenicity or reprotoxicity from repeated use of EBHR. Hence, the WHO Task Force strongly recommend retaining ethanol as an essential constituent in hand rubs for healthcare.
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Affiliation(s)
- Axel Kramer
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany. .,WHO Task Force Alcohol-Based Hand Rub, Zürich, Switzerland. .,Institute of Hygiene and Environmental Medicine University Medicine Greifswald, Walther-Rathenau-Straße 38, 17475, Greifswald, Germany.
| | - Mardjan Arvand
- Division Hospital Hygiene, Infection Prevention and Control, Robert-Koch Institute, Berlin, Germany
| | - Bärbel Christiansen
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Department of Hospital Hygiene, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stephanie Dancer
- Department of Microbiology, University Hospital Hairmyres, Glasgow, UK.,School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Maren Eggers
- Labor Prof. Dr. G. Enders MVZ GbR, Stuttgart, Germany
| | - Martin Exner
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Dieter Müller
- Department of Occupational Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Nico T Mutters
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Ingeborg Schwebke
- German Association for the Control of Virus Diseases (DVV e. V.), Berlin, Germany
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva, Hospitals and Faculty of Medicine, Geneva, Switzerland
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Dewey HM, Jones JM, Keating MR, Budhathoki-Uprety J. Increased Use of Disinfectants During the COVID-19 Pandemic and Its Potential Impacts on Health and Safety. ACS CHEMICAL HEALTH & SAFETY 2021. [DOI: 10.1021/acs.chas.1c00026] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hannah M. Dewey
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Jaron M. Jones
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Mike R. Keating
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Januka Budhathoki-Uprety
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
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Abstract
Isopropyl alcohol and ethyl alcohol have been used as low-level disinfectants in healthcare settings for many years. Recent studies have found that ethyl alcohol inhibits protein synthesis in Escherichia coli by direct effects on ribosomes and RNA polymerase and that 60%-70% solutions have in vitro efficacy against murine norovirus, Ebola virus, and several coronaviruses. Alcohol prep pads or towelettes containing isopropyl or ethyl alcohol and water have been used primarily for disinfection of small noncritical items due to a concern regarding their rapid evaporation rates and associated short contact times. Sterile alcohol solutions are used mostly for disinfection of compounding pharmacies and controlled areas. One new Environmental Protection Agency (EPA)-registered cleaner/disinfectant formulation differs from other alcohol-based disinfectants by virtue of having a 30-second contact time for multiple pathogens and a toxicity rating of category IV. Multiple disinfectants containing ethyl alcohol and/or isopropyl alcohol combined with other active agents such as quaternary ammonium or phenolic compounds are widely used for disinfecting environmental surfaces in healthcare facilities. Infect Control Hosp Epidemiol 2018;39:323-328.
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