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Dinis-Oliveira RJ. "Not everything that can be counted counts" in ethanol toxicological results: an antemortem and postmortem technical interpretation focusing on driving under the influence. Forensic Sci Res 2024; 9:owae023. [PMID: 39006154 PMCID: PMC11240237 DOI: 10.1093/fsr/owae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/29/2024] [Indexed: 07/16/2024] Open
Abstract
Ethanol blood analysis is the most common request in forensic toxicology, and some studies point to positive results in approximately one-third of all unnatural deaths. However, distinguishing sober deaths from drunk deaths is not as simple as it may seem. This technical, clinical, and forensic interpretation is proposed to interpret the ethanol toxicological results, discussing several artefacts and pitfalls that must be considered, namely focusing on driving under the influence. This work is presented with a practical and objective approach, aiming to alleviate the complexities associated with clinical, physiological, pathophysiological, and toxicological aspects to enhance comprehension, practicality, and applicability of its content, especially to courts. Particularly the physical integrity of the body, the postmortem interval, putrefactive signs, anatomic place of blood collection, alternative samples such as vitreous humour and urine, the possibility of postmortem redistribution, the inclusion of preservatives in containers, and optimal temperature conditions of shipment are among some of the aspects to pay attention. Although several biomarkers related to postmortem microbial ethanol production have been proposed, their translation into forensic routine is slow to be implemented due to the uncertainties of their application and analytical difficulties. Specifically, in the interpretation of ethanol toxicological results, "not everything that can be counted counts and not everything that counts can be counted" (attributed to Albert Einstein).
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Research Unit on Applied Molecular Biosciences, Translational Toxicology Research Laboratory, University Institute of Health Sciences 1H-TOXRUN, IUCS-CESPU, Gandra, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- FOREN - Forensic Science Experts, Lisbon, Portugal
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2
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Nusantoro AP, Kuntaman K, Perdanakusuma DS. Management of wounds in diabetes by administering allicin and quercetin in emulsion form as wound medicine in diabetic rat models. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2024; 0:jcim-2023-0177. [PMID: 38308387 DOI: 10.1515/jcim-2023-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
Wounds in diabetes is a complex problem that requires effective treatment at a high cost. Adjuvant therapy from natural bioactive elements can be an alternative to overcome problems in diabetic wound healing disorders. Allicin and quercetin are natural bioactive substances contained in several fruit or vegetable plants that have various pharmacological effects. The purpose of this study was to determine the effect of allicin and quercetin in emulsion form as wound medicine in helping the wound healing process. Diabetic wistar rats with wounds on their backs measuring 1 × 1 cm were divided into four treatment groups which were given wound medicine once a day for seven days according to their distribution. The wound healing process was evaluated on the third and seventh day. Data were observed and analyzed using appropriate statistical tools. Measurement of wound healing indicators was carried out by examining wound contraction and histopathological examination showing that the treatment group given the allicin and quercetin formula experienced an improvement compared to the treatment group without allicin and quercetin. Allicin and quercetin increase the percentage of wound contraction, increase the density of blood vessels and the epithelialization process in the wound so that the wound healing process becomes faster. In conclusion, allicin and quercetin can be effective adjuvant therapies in helping wound healing in diabetes. Wound medication in the form of an emulsion is an effective choice, because it can maintain the stability of the allicin and quercetin content and can make the wound environment moist.
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Affiliation(s)
- Agik Priyo Nusantoro
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Nursing, Faculty of Health Science, Universitas Kusuma Husada, Surakarta, Indonesia
| | - Kuntaman Kuntaman
- Department of Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David Sontani Perdanakusuma
- Department of Reconstructive and Aesthetic Plastic Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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3
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Wilson R, Hu Z, O'Brien C, Meer E, Agarwal A, Murray T. A Review of Materials and Medications with Religious or Dietary Significance in the Interventional Radiology Suite. J Vasc Interv Radiol 2023; 34:1717-1721. [PMID: 37406772 DOI: 10.1016/j.jvir.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
A holistic approach to patient-centered care should include cultural and religious considerations. Certain cultural groups have beliefs that may restrict the use of particular animal-derived products and chemicals. A working knowledge of ingredients commonly used in the interventional suite with religious and cultural connotations may be helpful. This review article highlights medications and medical devices with cultural or religiously sensitive ingredients used in interventional radiology departments and provides a framework for addressing this common scenario.
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Affiliation(s)
- Roger Wilson
- Department of Radiology, St Paul's Hospital, Vancouver, Canada; Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Zoe Hu
- Schooland School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Cormac O'Brien
- Department of Radiology, St Paul's Hospital, Vancouver, Canada; Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Emtenan Meer
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | | | - Timothy Murray
- Department of Radiology, St Paul's Hospital, Vancouver, Canada; Department of Radiology, University of British Columbia, Vancouver, Canada
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4
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Lopez-Gigosos RM, Mariscal-Lopez E, Gutierrez-Bedmar M, Mariscal A. Effect of Long-Term Use of Alcohol-Containing Handwashing Gels on the Biofilm-Forming Capacity of Staphylococcus epidermidis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5037. [PMID: 36981945 PMCID: PMC10049709 DOI: 10.3390/ijerph20065037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
The spread of coronavirus disease 2019 (COVID-19) has promoted the use of hand sanitizers among the general population as recommended by health authorities. Alcohols, which are used in many hand sanitizers, have been shown to promotes the formation of biofilms by certain bacteria and to increase bacterial resistance to disinfection. We investigated the effect of continued use of alcohol-based gel hand sanitizer on biofilm formation by the Staphylococcus epidermidis resident strain isolated from the hands of health science students. Hand microbes were counted before and after handwashing, and the ability to produce biofilms was investigated. We found that 179 (84.8%) strains of S. epidermidis isolated from hands had the ability to form biofilm (biofilm-positive strains) in an alcohol-free culture medium. Furthermore, the presence of alcohol in the culture medium induced biofilm formation in 13 (40.6%) of the biofilm-negative strains and increased biofilm production in 111 (76.6%) strains, which were classified as low-grade biofilm-producing. Based on our findings, there is no clear evidence that the continued use of alcohol-based gels results in the selection of strains with the capacity to form biofilms. However, other disinfectant formulations that are more commonly used in clinical settings, such as alcohol-based hand-rub solutions, should be tested for their long-term effects.
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Affiliation(s)
- Rosa M. Lopez-Gigosos
- Department of Preventive Medicine and Public Health, Malaga University, 29016 Málaga, Spain; (R.M.L.-G.); (M.G.-B.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29590 Málaga, Spain
| | - Eloisa Mariscal-Lopez
- Department of Preventive Medicine and Public Health, Malaga University, 29016 Málaga, Spain; (R.M.L.-G.); (M.G.-B.)
- Hospital Costa del Sol, 29603 Marbella, Spain
| | - Mario Gutierrez-Bedmar
- Department of Preventive Medicine and Public Health, Malaga University, 29016 Málaga, Spain; (R.M.L.-G.); (M.G.-B.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29590 Málaga, Spain
- CIBERCV Cardiovascular Diseases, Carlos III Health Institute, 28029 Madrid, Spain
| | - Alberto Mariscal
- Department of Preventive Medicine and Public Health, Malaga University, 29016 Málaga, Spain; (R.M.L.-G.); (M.G.-B.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29590 Málaga, Spain
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Horiguchi A, Numazawa S. Development of a risk assessment method for the detailed consideration of the effects of liquid toxic substance leakage incidents on the human body: ethanol as a model substance. J Toxicol Sci 2023; 49:37-47. [PMID: 38191200 DOI: 10.2131/jts.49.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
To ensure safety in chemical plants handling a wide variety of liquid and gaseous hazardous substances, it is necessary to carry out highly accurate risk assessments and take appropriate measures. In this study, a risk assessment method was developed for the problem of the leakage of liquid hazardous substances. The risk assessment of toxic liquid leaks must consider the exposure of workers to the liquid and toxic gases produced by vaporization. The absorption and subsequent metabolism of hazardous substances in the body via multiple pathways after exposure to liquids and gases was calculated using a pharmacokinetic model. Estimation of exposure concentrations of toxic gases volatilized from leaked liquids was reproduced by computational fluid dynamics simulation. In this study, ethanol was selected as the hazardous substance and the risk of hazardous liquid leakage was assessed. The results of the analysis, which considered liquid and gas exposure under the conditions of the assumed scenario, showed that the maximum blood concentration of ethanol was 1640 µmol/L, which is sufficiently low compared to the concentration of 10,900 µmol/L at which acute toxic effects become apparent. These results suggest that work can be carried out safely under the conditions of the assumed scenario. The risk assessment methodology for liquid spills in this study confirms that risk assessment is possible under multiple scenarios, including individual differences, activity conditions, and the use of protective equipment.
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Affiliation(s)
- Akio Horiguchi
- Department of Toxicology, Showa University Graduate School of Pharmacy
- Science Innovation Center, Mitsubishi Chemical Corporation
| | - Satoshi Numazawa
- Department of Toxicology, Showa University Graduate School of Pharmacy
- Showa University Pharmacological Research Center
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Kramer A, Benkhai H, Jäkel C, Zwicker P. Ethanol is indispensable for virucidal hand antisepsis and without toxic risks in daily use. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc02. [PMID: 36875333 PMCID: PMC9978451 DOI: 10.3205/dgkh000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007 due to controversial opinions on the risk assessment. Because of this critical situation, 2022 a memorandum was published to verify whether the use of ethanol for hand antisepsis poses any hazard. On the basis of the memorandum a toxicological evaluation of ethanol-based hand rubs is given.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | | | - Christian Jäkel
- Kanzlei Dr. Jaekel, Medical law - Pharmaceuticals law - Medical devices law, Lübben (Spreewald), Germany
| | - Paula Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
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VishnuRadhan R, Thresyamma DD, Eldho TI, Dhiman R, Bhavan SG. On the emergence of a health-pollutant-climate nexus in the wake of a global pandemic. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:85619-85631. [PMID: 34523098 PMCID: PMC8439646 DOI: 10.1007/s11356-021-16392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
COVID-19 has wreaked havoc throughout the planet within a short time frame, inducing substantial morbidity and mortality in the global population. The primary procedures commonly used to manage the pandemic can produce various environmental pollutants, primarily contaminants of emerging concern such as plastics, chemical disinfectants, and pharmaceutical waste. There is a huge influx of various environmental pollutants due to the pandemic effect. We, therefore, introduce the term "envirodemics" depicting the exacerbated surge in the amount of pandemic-induced pollutants. The general toxicity pattern of common chemical ingredients in widely used disinfectants shows negative impacts on the environment. We have identified some of the significant imprints of the pandemic on localizing the Sustainable Development Goals-environment interaction and their implications on achieving the goals in terms of environmental benefits. Climate change impacts are now widespread and have a profound effect on pollutant fluxes and distribution. The climate change signatures will impact the pandemic-induced enhanced fluxes of pollutants in the global waters, such as their transport and transformation. In this study, possible interactions and emerging pathways involving an emerging climate-health-pollutant nexus are discussed. The nexus is further elaborated by considering plastic as an example of an emerging pollutant that is produced in huge quantities as a by-product of COVID management and disaster risk reduction. Additionally, regulatory implications and future perspectives concerning the unleashed nexus are also discussed. We hope that this communication shall call for incisive investigations in the less explored realm concerning the health-pollutant-climate nexus.
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Affiliation(s)
- Renjith VishnuRadhan
- Department of Civil Engineering, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra, 400076, India.
| | - Divya David Thresyamma
- Arctic Ocean Atmospheric Studies, National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Goa, 403804, Vasco da Gama, India
| | - T I Eldho
- Department of Civil Engineering, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra, 400076, India
| | - Ravinder Dhiman
- Centre for Geo Informatics, Jamsetji Tata School of Disaster Studies, Tata Institute of Social Sciences, Maharashtra, 400088, Mumbai, India
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Raza ZA, Shahzad Q, Rehman A, Taqi M, Ayub A. Biosurfactants in the sustainable eradication of SARS COV-2 from the environmental surfaces. 3 Biotech 2022; 12:273. [PMID: 36101547 PMCID: PMC9464425 DOI: 10.1007/s13205-022-03320-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/19/2022] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 outbreak has brought the world, at least, to one consensus that cleanliness is unavoidable under all circumstances. Hands are the main body part to interact with the environment and thus are prone to receive, initiate and propagate the chain of infection. Hand hygiene has, therefore, been most emphasized by experts to interrupt the spread of infection. Various harsh chemicals like synthetic surfactants and alcoholic preparations have been in practice to eradicate and disinfect the germs. This choice may be unsafe and cause a subsequent chain of adversities. Thereby, biosurfactants have been proposed as sustainable, non-toxic and safe surface cleaners cum disinfectants under a wide range of physiological and environmental conditions. The amphiphilic micellar behavior of biosurfactants makes them promising candidates as hygienic surface cleaners and therapeutic carriers. We overview the possibilities of using biosurfactants in different ways against microbial pathogens, in general, and the SARS COV-2, in specific.
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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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Han AA, Buerger AN, Allen H, Vincent M, Thornton SA, Unice K, Maier A, Quiñones-Rivera A. Assessment of Ethanol Exposure from Hand Sanitizer Use and Potential for Developmental Toxicity in Nursing Infants. J Appl Toxicol 2022; 42:1424-1442. [PMID: 34991177 PMCID: PMC9543418 DOI: 10.1002/jat.4284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022]
Abstract
Ingestion of ethanol during pregnancy is known to have detrimental effects on the fetus. Although the potential developmental effects of maternal ethanol intake during lactation are less well characterized, public health guidelines recommend avoidance of alcohol or, if alcohol is consumed, to allow for 1–2 h to pass before nursing. A proposal to classify ethanol as potentially harmful to breast‐fed children warrants an investigation of the potential adverse neurodevelopmental effects of low‐dose ethanol exposure during lactation. There currently are no studies that have examined neurodevelopmental outcomes from lactational exposure to ethanol from the use of topical products that contain ethanol, such as alcohol‐based hand sanitizers (ABHS). Furthermore, the epidemiological literature of lactational ethanol exposures from maternal alcohol consumption is limited in design, provides equivocal evidence of neurological effects in infants, and is insufficient to characterize a dose–response relationship for developmental effects. Toxicological studies that observed neurodevelopmental effects in pups from ethanol via lactation did so at exceedingly high doses that also caused maternal toxicity. In this investigation, blood ethanol concentrations (BECs) of breastfeeding women following typical‐to‐intense ABHS use were computationally predicted and compared to health benchmarks to quantify the risk for developmental outcomes. Margins of 2.2 to 1000 exist between BECs associated with ABHS use compared to BECs associated with neurotoxicity adverse effect levels in the toxicology literature or oral ethanol intake per public health guidelines. Neurodevelopmental effects are not likely to occur in infants due to ABHS use by breastfeeding women, even when ABHSs are used at intense frequencies. Adverse neurodevelopmental effects of ethanol exposure are supported by toxicological studies; ethanol as a potential “lactation hazard” needs evaluation. A lactation hazard may not be applicable for all ethanol‐containing products, such as hand sanitizers. Furthermore, internal dose assessments of hand sanitizer use are lacking. Computationally modeled blood ethanol concentrations following hand sanitizer use are lower than concentrations associated with toxicological and guideline benchmarks. Therefore, there is low potential for the use of ethanol‐containing hand sanitizers to be a lactation hazard.
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11
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Kweon H, Choi JW, Yoon SY. Analysis of Consumer Exposure Cases for Alcohol-Based Disinfectant and Hand Sanitizer Use against Coronavirus Disease 2019 (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010100. [PMID: 35010360 PMCID: PMC8750816 DOI: 10.3390/ijerph19010100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 05/11/2023]
Abstract
The development and distribution of vaccines and treatments as well as the use of disinfectants and hand sanitizers to cope with coronavirus disease 2019 (COVID-19) infection has increased rapidly. As the use of disinfectants and hand sanitizers increased, the number of unintended exposures to these substances also increased. A total of 8016 cases of toxic exposure to disinfectants and hand sanitizers were reported to the American Association of Poison Control Centers (AAPCC) from 1 January 2017 to 30 May 2021. The cases have been characterized by substance, sex, patient age, exposure reason and site, treatments received, and outcomes. The number of exposures correlates closely to the rise of COVID-19 cases, rising significantly in March 2020. About half of the total cases involved children less than 10 years old and 97% of those exposures per year were unintentional. In addition, the most common exposure site was the patient's own residence. Over-exposure to disinfectants and hand sanitizers can cause symptoms such as burning and irritation of the eyes, nose, and throat, coughing, chest tightness, headache, choking, and, in severe cases, death.
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Affiliation(s)
- Hyukmin Kweon
- Civil and Environmental Engineering, University of California, Los Angeles, CA 90095, USA;
- BenSci Inc., 4822 Elmwood Ave, Los Angeles, CA 90004, USA
- Environmental Health Center, Soonchunhyang University Hospital, Gumi 39371, Korea;
| | - Jae-Won Choi
- Environmental Health Center, Soonchunhyang University Hospital, Gumi 39371, Korea;
| | - Seong-Yong Yoon
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Gumi 39371, Korea
- Correspondence: ; Tel.: +82-54-468-9428
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12
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Saha T, Khadka P, Das SC. Alcohol-based hand sanitizer - composition, proper use and precautions. Germs 2021; 11:408-417. [PMID: 34722363 DOI: 10.18683/germs.2021.1278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 12/23/2022]
Abstract
During the COVID-19 pandemic, the use of alcohol-based hand sanitizers (ABHS) increased worldwide among the public as well as the health care workers in pursuit to prevent the spread of SARS-CoV-2, the causative virus of COVID-19. Hand hygiene is one of the primary preventive measures to prevent the spread of harmful germs. Although ABHS are effective hand hygiene products and help reduce the transmission of pathogenic microorganisms, appropriate use of such products is necessary to ensure the maximum killing of pathogens and to prevent hazards associated with ABHS. The effectiveness of ABHS against different microorganisms, including SARS-CoV-2 is also documented, but proper knowledge on hand hygiene techniques, selection of appropriate hand sanitizer product, and safe handling of ABHS are required to avoid their adverse effects such as allergies, skin irritation, lung injury, fire hazards, and toxicities. The effectiveness of ABHS is dependent on several factors including its appropriate usage, manufacturing methods, the choice of active agents, and the appropriateness of the agent on the target pathogen. This article highlights the importance of proper usage, handling, and appropriate ABHS selection for maximum efficacy against intended pathogens and safe use of ABHS. User awareness can help promote the appropriate usage of ABHS and prevent its hazards, which ultimately can help in preventing the transmission of pathogenic microorganisms.
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Affiliation(s)
- Tushar Saha
- MPharm, University of Otago School of Pharmacy, Adams Building, 18 Frederick Street, Dunedin 9016, New Zealand
| | - Prakash Khadka
- PhD, University of Otago School of Pharmacy, Adams Building, 18 Frederick Street, Dunedin 9016, New Zealand
| | - Shyamal C Das
- PhD, University of Otago School of Pharmacy, Adams Building, 18 Frederick Street, Dunedin 9016, New Zealand
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13
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van den Berg RB, de Poot S, Swart EL, Crul M. Assessment of occupational exposure to nebulized isopropyl alcohol as disinfectant during aseptic compounding of parenteral cytotoxic drugs in cleanrooms. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:361-368. [PMID: 34185621 DOI: 10.1080/15459624.2021.1933505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pharmacy technicians are exposed to volatile organic compounds, like the disinfectant isopropyl alcohol (IPA), during the process of aseptic compounding of parenteral cytotoxic drugs. The occupational exposure to nebulized IPA during aseptic compounding has not been investigated. The aim of this study was to investigate the exposure to IPA during aseptic compounding of parenteral cytotoxic drugs and to assess compliance with legal and regulatory limits. As a secondary endpoint, the difference between two disinfection methods was compared regarding the exposure to IPA. The exposure to IPA was measured during five working shifts of 8 hr and one shift of 4 hr. The concentration IPA was measured by using a six-gas monitor. Total daily exposure was calculated as 8-hr Time Weighted Average (TWA) air concentration in mg/m3 and compared with an Occupational Exposure Limit (OEL) value of 500 mg/m3 and incidental peak exposure of 5,000 mg/m3. To assess whether the 8-hr TWA air concentration meets the legal and regulatory limits the Similar Exposure Groups (SEG) compliance test was used. A paired sample t-test was conducted to assess difference in exposure between two disinfection methods. The average 8-hr TWA exposure to IPA during the six measurements varied from 2.6 mg/m3 to 43.9 mg/m3 and the highest momentary concentration measured was 860 mg/m3. The result of the SEG compliance test was 3.392 (Ur value) and was greater than the Ut value of 2.187 which means the exposure to IPA is in compliance with the OEL value. No significant difference in exposure was shown between two disinfection methods (p = 0.49). In conclusion, exposure to IPA during aseptic compounding of parenteral cytotoxic drugs showed compliance to the OEL values with no significant difference in exposure between two disinfection methods.
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Affiliation(s)
- Roland B van den Berg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stan de Poot
- Department of Occupational Health & Safety, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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14
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A Roadmap for Navigating Occupational Exposures for Surgeons: A Special Consideration for the Pregnant Surgeon. Plast Reconstr Surg 2021; 147:513-523. [PMID: 33235051 DOI: 10.1097/prs.0000000000007581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
SUMMARY Surgeons are exposed to occupational hazards daily. Risks include chemical, biological, and physical hazards that place providers at risk of serious harm. Departmental policies or written guides to help pregnant surgeons navigate the hospital are lacking. In response to the scarcity in the literature, the authors have summarized current guidelines and recommendations to aid surgeons in making an informed decision. In addition, the authors present a brief narrative of the impact of these exposures during pregnancy and methods of transmission and, where relevant, include specialties that are at risk of these exposures.
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15
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Khaliq O, Mkhize PZ, Moodley JM. Raising awareness about the unintended consequences of hand sanitiser in children. S Afr Fam Pract (2004) 2021; 63:e1-e3. [PMID: 34212752 PMCID: PMC8378183 DOI: 10.4102/safp.v63i1.5278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 11/24/2022] Open
Abstract
The use of hand sanitisers is common practice to prevent the spread of coronavirus disease 2019 (COVID-19). However, the safety thereof requires consideration as this may be hazardous in children. Recent studies have shown that the misuse and increased unsupervised availability of alcohol-based hand sanitisers may result in adverse events in children such as skin irritation, dryness, cracking and peeling. Unintentional or intentional ingestion of hand sanitisers in children under the age of 12 years may occur because of the colour, smell and flavour added to it. Consumption of alcohol in children may result in hypoglycaemia, apnoea and acidosis. This allows the invasion of other bacterial and viral infections. Children may also rub their eyes with sanitised hands and cause ocular injury. Therefore, the use of hand sanitisers in general needs to be revised in both children and adults. Other interventions on lowering the risk of adverse events because of misuse of hand sanitiser should be practised more often. These include promoting washing of hands over sanitisers where possible, training children on how to use hand sanitisers and creating awareness of the dangers if ingested or in contact with the eyes.
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Affiliation(s)
- Olive Khaliq
- Department of Obstetrics and Gynecology, Women's Health and HIV Research Group, Nelson Mandela School of Medicine, Faculty of Clinical Medicine, University of KwaZulu-Natal, Durban.
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16
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Phillips T, Schulte JM, Smith EA, Roth B, Kleinschmidt KC. COVID-19 and contamination: impact on exposures to alcohol-based hand sanitizers reported to Texas Poison Control Centers, 2020. Clin Toxicol (Phila) 2021; 59:926-931. [DOI: 10.1080/15563650.2021.1887491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Todd Phillips
- North Texas Poison Control Center, Parkland Health & Hospital System, Dallas, TX, USA
- Toxicology Division, Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Joann M. Schulte
- North Texas Poison Control Center, Parkland Health & Hospital System, Dallas, TX, USA
- Dallas County Health & Human Services, Dallas, TX, USA
| | - Eric Anthony Smith
- North Texas Poison Control Center, Parkland Health & Hospital System, Dallas, TX, USA
- Toxicology Division, Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brett Roth
- North Texas Poison Control Center, Parkland Health & Hospital System, Dallas, TX, USA
- Toxicology Division, Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kurt C. Kleinschmidt
- North Texas Poison Control Center, Parkland Health & Hospital System, Dallas, TX, USA
- Toxicology Division, Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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17
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Raventós J, Sabate R. Air Curtains Equipped With Hydroalcoholic Aerosol Sprayers for Massive COVID-19 Disinfection. Front Public Health 2021; 8:582782. [PMID: 33585380 PMCID: PMC7876380 DOI: 10.3389/fpubh.2020.582782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Judit Raventós
- Service of Psychiatry, Psychology and Psychosomatic Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Raimon Sabate
- Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), Barcelona, Spain
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18
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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19
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Kampf G, Exner M, Schwebke I, Gebel J. Ethanol is indispensable and safe as a biocidal active substance for hand disinfection. J Hosp Infect 2020; 108:205-206. [PMID: 33220347 DOI: 10.1016/j.jhin.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- G Kampf
- University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany.
| | - M Exner
- University Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | | | - J Gebel
- University Bonn, Institute for Hygiene and Public Health, Bonn, Germany
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20
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Mahmood A, Eqan M, Pervez S, Alghamdi HA, Tabinda AB, Yasar A, Brindhadevi K, Pugazhendhi A. COVID-19 and frequent use of hand sanitizers; human health and environmental hazards by exposure pathways. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 742:140561. [PMID: 32623176 PMCID: PMC7320712 DOI: 10.1016/j.scitotenv.2020.140561] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 04/13/2023]
Abstract
Till date no medication or vaccine is available to cope with the COVID-19 infection and infection rate is increasing drastically across the globe. Only preventive measures and healthy life style with efficient immune system have been suggested by WHO to fight and stay safe from COVID-19. WHO recommended alcohol based hand sanitizers for frequent hand hygiene, which are mainly made up from ethanol, isopropyl alcohols, hydrogen peroxides in different combinations. These preparations may become toxic to human health and environment when misused. These chemicals have known toxic and hazardous impact on environment when released by evaporation. In early five months of 2020, American Association of Poison Control Center reported 9504 alcoholic hand sanitizer exposure cases in children under the age of 12 years and recognized that even a small amount of alcohol can cause alcohol poisoning in children that is responsible for confusion, vomiting and drowsiness, and in severe cases, respiratory arrest and death. Furthermore, frequent usage of said hand sanitizers has reported increased chance of antimicrobial resistance and chance of other viral diseases. Current review is designed with main objective to highlight the toxic and serious health risks to human health and environment by frequent using hand hygiene products with alcohols based formulations.
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Affiliation(s)
- Adeel Mahmood
- Department of Environmental Sciences, GC Women University Sialkot, Pakistan
| | - Maryam Eqan
- Department of Environmental Sciences, GC Women University Sialkot, Pakistan
| | - Saher Pervez
- Department of Environmental Sciences, GC Women University Sialkot, Pakistan
| | - Huda Ahmed Alghamdi
- Department of Biology, College of Sciences, King Khalid University, Abha, Saudi Arabia
| | - Amtul Bari Tabinda
- Sustainable Development Study Centre, Government College University, Lahore, Pakistan
| | - Abdullah Yasar
- Sustainable Development Study Centre, Government College University, Lahore, Pakistan
| | - Kathirvel Brindhadevi
- Innovative Green Product Synthesis and Renewable Environment Development Research Group, Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Viet Nam
| | - Arivalagan Pugazhendhi
- Innovative Green Product Synthesis and Renewable Environment Development Research Group, Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Viet Nam.
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21
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Abstract
Infection preventive practice of using disinfectants against SARS-CoV-2 has become the new normal due to the COVID-19 pandemic. Although disinfectants may not be applied directly to the human body, it remains at high risk of exposure including close skin contact on disinfected surfaces or during handling. This dermal contact, on a regular basis, can induce hazardous skin reactions like irritation, inflammation, and burning in severe conditions. Disinfectants are germicide chemicals that can penetrate the skin and create skin reactions that are usually regarded as irritant and allergic contact dermatitis. More importantly, disinfectants can react with skin components (proteins and lipids) to facilitate their skin penetration and disrupt the skin barrier function. Whereas the antimicrobial actions of disinfectants are well understood, much less is known regarding their dermatologic reactions, including but not limited to irritation and hypersensitivity. We reviewed the skin reactions created by those disinfectants against SARS-CoV-2 approved by the European Chemical Agency and the US Environmental Protection Agency.
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Affiliation(s)
- Choon Fu Goh
- Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | - Long Chiau Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei Darussalam.
| | - Li Ching Wong
- Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
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22
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Dear K, Grayson L, Nixon R. Potential methanol toxicity and the importance of using a standardised alcohol-based hand rub formulation in the era of COVID-19. Antimicrob Resist Infect Control 2020; 9:129. [PMID: 32771064 PMCID: PMC7414286 DOI: 10.1186/s13756-020-00788-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/21/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Hand sanitisers are urgently needed in the time of COVID-19, and as a result of shortages, some people have resorted to making their own formulations, including the repurposing of distilleries. We wish to highlight the importance of those producing hand sanitisers to avoid methylated spirits containing methanol and to follow WHO recommended formulations. METHODS We explore and discuss reports of methanol toxicity through ingestion and transdermal absorption. We discuss the WHO formulations and explain the rationale behind the chosen ingredients. SHORT CONCLUSION We advise those producing hand sanitisers to follow WHO recommended formulations, and advise those producing hand sanitisers using methylated spirits, to avoid formulations which contain methanol.
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Affiliation(s)
- K Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Melbourne, Australia
| | - L Grayson
- University of Melbourne, Parkville, Victoria, Australia
| | - R Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Melbourne, Australia.
- Australia and University of Melbourne, Parkville, Victoria, Australia.
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23
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Atolani O, Baker MT, Adeyemi OS, Olanrewaju IR, Hamid AA, Ameen OM, Oguntoye SO, Usman LA. COVID-19: Critical discussion on the applications and implications of chemicals in sanitizers and disinfectants. EXCLI JOURNAL 2020; 19:785-799. [PMID: 32636732 PMCID: PMC7332783 DOI: 10.17179/excli2020-1386] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Olubunmi Atolani
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | | | - Oluyomi Stephen Adeyemi
- Department of Biochemistry, Medicinal Biochemistry, Infectious Diseases, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran 251101, Kwara State, Nigeria
| | | | | | - Oloduowo M. Ameen
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | | | - Lamidi A. Usman
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
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24
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Hu S, Anand P, Laughter M, Maymone MBC, Dellavalle RP. Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders. J Am Acad Dermatol 2020; 86:868-877. [PMID: 32360717 DOI: 10.1016/j.jaad.2020.04.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Holistic dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease. Understanding the interplay between modifiable lifestyle factors and patients' dermatologic health will help physicians better inform patients on self-care methods to mitigate the burden of their skin disease(s). OBJECTIVE To review the current scientific literature on the relationship between modifiable lifestyle factors and the dermatologic outcome of skin disorders. METHODS A systematic literature search on PubMed, Cochrane, and Web of Science was conducted to identify research articles examining the relationship between dermatology and 6 major categories of modifiable lifestyle factors: diet, sleep, exercise, stress, alcohol, and smoking. RESULTS A substantial amount of evidence supports the relationship between modifiable lifestyle factors and dermatologic outcomes. There were the most studies on diet, stress, alcohol, and smoking, but all lifestyle factors were supported by some degree of scientific evidence. CONCLUSION All modifiable lifestyle factors explored in this review play a critical role in modulating the onset and progression of skin disease. We anticipate more research studies in the future and an increasing integration of holistic dermatology into patient care.
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Affiliation(s)
- Sophia Hu
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Pratibha Anand
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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25
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Atolani O, Baker MT, Adeyemi OS, Olanrewaju IR, Hamid AA, Ameen OM, Oguntoye SO, Usman LA. COVID-19: Critical discussion on the applications and implications of chemicals in sanitizers and disinfectants. EXCLI JOURNAL 2020. [PMID: 32636732 DOI: 10.17179/2fexcli2020-1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Olubunmi Atolani
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | | | - Oluyomi Stephen Adeyemi
- Department of Biochemistry, Medicinal Biochemistry, Infectious Diseases, Nanomedicine & Toxicology Laboratory, Landmark University, PMB 1001, Omu-Aran 251101, Kwara State, Nigeria
| | | | | | - Oloduowo M Ameen
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - Stephen O Oguntoye
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - Lamidi A Usman
- Department of Chemistry, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
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26
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Gupta R, Badhe Y, Rai B, Mitragotri S. Molecular mechanism of the skin permeation enhancing effect of ethanol: a molecular dynamics study. RSC Adv 2020; 10:12234-12248. [PMID: 35497613 PMCID: PMC9050718 DOI: 10.1039/d0ra01692f] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/16/2020] [Indexed: 02/01/2023] Open
Abstract
Ethanol is widely used in various pharmaceutical and cosmetic formulations in order to enhance skin penetration of active ingredients. While it is well known that ethanol partitions into the skin and enhances the permeation of both polar and nonpolar molecules, the exact mechanisms by which it enhances skin permeability are not fully understood. Several mechanisms have been proposed including lipid extraction from the stratum corneum (SC), fluidisation of SC lipid bilayer, alteration of SC protein conformation and enhancement of the drug solubility in the SC lipids. In this study, we performed molecular dynamics (MD) simulations of SC lipid bilayers comprised of an equimolar mixture of ceramides, cholesterol and free fatty acid in the presence of aqueous mixtures of ethanol. Various unrestrained MD simulations were performed in the presence of aqueous ethanol solution at molar ratios (x) ranging from x = 0 to x = 1. It was found that ethanol enhances bilayer permeability by dual actions (a) extraction of the skin lipids and (b) enhancing the mobility of lipid chains. Ethanol's permeation enhancing effect arises from its superior ability to form hydrogen bonds with headgroup atoms of skin lipids. Further, the free energy of extraction of ceramides (CER) and fatty acids (FFA) from the lipid bilayer was studied using umbrella sampling simulations. The free energy of extraction of CER was found to be much higher compared to FFA for all ethanol concentrations which shows that CER are difficult to extract as compared to FFA. Finally, the permeation of benzoic acid drug molecules through the skin lipid bilayer is shown in presence of ethanol molecules. It was found that ethanol selectively targets the FFA of the skin lipid bilayer and extracts it out of the lipid bilayer within few microseconds. Further, ethanol penetrates inside the lipid layer and creates the channels from which drug molecules can easily cross the lipid layer. Our observations (both in unrestrained and umbrella sampling simulations) are consistent with the experimental findings reported in the literature. The simulation methodology could be used for design and testing of permeation enhancers (acting on skin SC lipid lamella) for topical and transdermal drug delivery applications. Concentration dependent action of mechanism of ethanol on skin SC lipid barrier.![]()
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Affiliation(s)
- Rakesh Gupta
- Physical Science Research Area
- Tata Research Development and Design Centre
- TCS Research
- Tata Consultancy Services
- Pune – 411013
| | - Yogesh Badhe
- Physical Science Research Area
- Tata Research Development and Design Centre
- TCS Research
- Tata Consultancy Services
- Pune – 411013
| | - Beena Rai
- Physical Science Research Area
- Tata Research Development and Design Centre
- TCS Research
- Tata Consultancy Services
- Pune – 411013
| | - Samir Mitragotri
- School of Engineering and Applied Sciences
- Wyss Institute
- Harvard University
- USA
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27
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Ng WK, Shaban RZ, van de Mortel T. Hand hygiene beliefs and behaviours about alcohol-based hand rub use: Questionnaire development, piloting and validation. Infect Dis Health 2019; 25:43-49. [PMID: 31727595 DOI: 10.1016/j.idh.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors. METHODS Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias. RESULTS The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale. CONCLUSIONS A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.
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Affiliation(s)
- Wai Khuan Ng
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Thea van de Mortel
- School of Nursing and Midwifery, Griffith University, Clinical Sciences 2 Building (G16), Parklands Drive, Southport, Qld, 4215, Australia.
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28
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Prediction of human drug-induced liver injury (DILI) in relation to oral doses and blood concentrations. Arch Toxicol 2019; 93:1609-1637. [PMID: 31250071 DOI: 10.1007/s00204-019-02492-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
Drug-induced liver injury (DILI) cannot be accurately predicted by animal models. In addition, currently available in vitro methods do not allow for the estimation of hepatotoxic doses or the determination of an acceptable daily intake (ADI). To overcome this limitation, an in vitro/in silico method was established that predicts the risk of human DILI in relation to oral doses and blood concentrations. This method can be used to estimate DILI risk if the maximal blood concentration (Cmax) of the test compound is known. Moreover, an ADI can be estimated even for compounds without information on blood concentrations. To systematically optimize the in vitro system, two novel test performance metrics were introduced, the toxicity separation index (TSI) which quantifies how well a test differentiates between hepatotoxic and non-hepatotoxic compounds, and the toxicity estimation index (TEI) which measures how well hepatotoxic blood concentrations in vivo can be estimated. In vitro test performance was optimized for a training set of 28 compounds, based on TSI and TEI, demonstrating that (1) concentrations where cytotoxicity first becomes evident in vitro (EC10) yielded better metrics than higher toxicity thresholds (EC50); (2) compound incubation for 48 h was better than 24 h, with no further improvement of TSI after 7 days incubation; (3) metrics were moderately improved by adding gene expression to the test battery; (4) evaluation of pharmacokinetic parameters demonstrated that total blood compound concentrations and the 95%-population-based percentile of Cmax were best suited to estimate human toxicity. With a support vector machine-based classifier, using EC10 and Cmax as variables, the cross-validated sensitivity, specificity and accuracy for hepatotoxicity prediction were 100, 88 and 93%, respectively. Concentrations in the culture medium allowed extrapolation to blood concentrations in vivo that are associated with a specific probability of hepatotoxicity and the corresponding oral doses were obtained by reverse modeling. Application of this in vitro/in silico method to the rat hepatotoxicant pulegone resulted in an ADI that was similar to values previously established based on animal experiments. In conclusion, the proposed method links oral doses and blood concentrations of test compounds to the probability of hepatotoxicity.
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29
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Li JN, Nijhawan RI, Srivastava D. Cutaneous Surgery in Patients Who Are Pregnant or Breastfeeding. Dermatol Clin 2019; 37:307-317. [PMID: 31084725 DOI: 10.1016/j.det.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dermatologic surgery in pregnant/postpartum patients requires deliberate consideration. Although surgery can be safely performed during any trimester, the second trimester and immediate postpartum period is optimal. Surgery should not be delayed for melanoma/high-risk skin cancers. Perioperative positioning, analgesic, antiseptic, and antibiotic selection should be deliberate to avoid risk to the patient/fetus/infant. The left lateral tilt position reduces aortocaval compression syndrome. Lidocaine and epinephrine can be used safely. Alcohol and chlorhexidine are considered safe. Antibiotics commonly used in skin surgery are safe in pregnancy and lactation. Acetaminophen is first line for pain management. Nonsteroidal antiinflammatory drugs should be avoided.
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Affiliation(s)
- Jeffrey N Li
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA.
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Harrison BL, Ogara C, Gladstone M, Carrol ED, Dusabe-Richards J, Medina-Lara A, Ditai J, Weeks AD. "We have to clean ourselves to ensure that our children are healthy and beautiful": findings from a qualitative assessment of a hand hygiene poster in rural Uganda. BMC Public Health 2019; 19:1. [PMID: 30606151 PMCID: PMC6318918 DOI: 10.1186/s12889-018-6343-3] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal sepsis is a major cause of mortality worldwide, with most deaths occurring in low-income countries. The World Health Organisation (WHO) ‘5 Moments for Hand Hygiene’ poster has been used to reduce hospital-acquired infections, but there is no similar tool to prevent community-acquired newborn infections in low-resource settings. This assessment, part of the BabyGel Pilot study, evaluated the acceptability of the ‘Newborn Moments for Hand Hygiene in the Home’ poster. This was an educational tool which aimed to remind mothers in rural Uganda to clean their hands to prevent neonatal infection. Methods The BabyGel pilot was a cluster randomised trial that assessed the post-partum use of alcohol-based hand rub (ABHR) to prevent neonatal infections in Mbale, Uganda. Fifty-five women in 5 village clusters received the ABHR and used it from birth to 3 months postnatally, with use guided by the new poster. Following the study, 5 focus group discussions (FGDs) were conducted consisting of 6–8 purposively sampled participants from intervention villages. FGDs were audio-recorded, transcribed then translated into English. Transcripts were inductively coded using ATLAS.ti® and qualitatively analysed using thematic content analysis. Results Most mothers reported that they understood the message in the poster (“The picture shows me you must use these drugs to keep your baby healthy”) and that they could adhere to the moments from the poster. Some participants used the information from the poster to encourage other caregivers to use the ABHR (“after explaining to them, they liked it”). Other potential moments for hand hygiene were introduced by participants, such as after tending to domestic animals and gardening. Conclusion The poster was well-received, and participants reported compliance with the moments for hand hygiene (although the full body wipe of the baby has since been removed). The poster will be adapted into a sticker format on the ABHR bottle. More focus could be put into an education tool for other caregivers who wish to hold the baby. Overall, the study demonstrated the acceptability of an adapted version of the WHO Moments for Hand Hygiene poster in the introduction of an intervention in the community. Trial registration ISRCTN67852437, registered 02/03/2015. Trial funding Medical Research Council/ Wellcome Trust/ DfID (Global Health Trials Scheme).
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Affiliation(s)
- B L Harrison
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - C Ogara
- Sanyu Africa Research Institute (SAfRI), Mbale, Uganda
| | - M Gladstone
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E D Carrol
- Institute of Infection and Global Health, University of Liverpool, Mbale, Uganda
| | | | | | - J Ditai
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Sanyu Africa Research Institute (SAfRI), Mbale, Uganda.,Busitema University Faculty of Health Sciences, Tororo, Uganda
| | - A D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Wai Khuan N, Shaban RZ, van de Mortel T. The influence of religious and cultural beliefs on hand hygiene behaviour in the United Arab Emirates. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ditai J, Mudoola M, Gladstone M, Abeso J, Dusabe-Richards J, Adengo M, Olupot-Olupot P, Carrol ED, Storr J, Medina-Lara A, Faragher B, Weeks AD. Preventing neonatal sepsis in rural Uganda: a cross-over study comparing the tolerance and acceptability of three alcohol-based hand rub formulations. BMC Public Health 2018; 18:1279. [PMID: 30458740 PMCID: PMC6245533 DOI: 10.1186/s12889-018-6201-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neonatal sepsis causes 0.5 million deaths annually, mostly in low resource settings. Babies born in African rural homes without running water or toilet facilities are especially vulnerable. Alcohol-based hand rub (ABHR) may be used by mothers and carers as an alternative to hand washing with soap to prevent neonatal infection. However, no definite study has established the preferred formulation of hand rub for the mothers. This study aimed to assess the effects of addition of bitterants and perfume towards the acceptability of the alcohol-based hand rubs by the mothers in their homes after childbirth. METHODS This was a 3-way blinded cross-over study design. Mothers with children aged ≤3 months were recruited from immunisation clinics at 3 local health facilities in rural eastern Uganda and received 3-different ABHR formulations (in the order plain, bitterant and perfumed) packed in 100 ml bottles. Each ABHR was used for 5 consecutive days followed by a 2-day 'washout' period (evaluation period). Overall satisfaction with each hand rub was evaluated at the end of each week using a 7-point Likert scale. RESULTS A total of 43 women were recruited, whose ages ranged from 16 to 45 years (mean 26.2 years old). None of the participants normally used a hand protective lotion/cream. The three formulations were used for a mean of 5 (range 3-7) days. A significantly greater volume of the "bitterant" and "perfumed" formulations (mean 91 and 83 ml respectively) were used in comparison to the "plain" formulation (mean 64 ml). Overall satisfaction was high with all the hand rubs, but the perfumed formulation had a significantly higher overall satisfaction score [mean 6.7, range 4-7] compared with the plain [6.4, 3-7] and bitterant [6.2, 2-7] formulations. CONCLUSIONS All the 3 ABHR formulations were well accepted with little to choose between them. The ABHR with added perfume scored highest on overall satisfaction and was used significantly more often than plain ABHR. ABHR with bitterant additive did, however, score highly and may be a preferable choice to those with concern over alcohol misuse. TRIAL REGISTRATION ISRCTN67852437 , prospectively registered on 18/03/2018.
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Affiliation(s)
- J. Ditai
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
| | - M. Mudoola
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - M. Gladstone
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
| | - J. Abeso
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - J. Dusabe-Richards
- Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - M. Adengo
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - P. Olupot-Olupot
- Mbale Regional Referral Hospital Clinical Research Unit, Mbale, Uganda
- Busitema University, Faculty of Health Sciences, P.o Box 1460, Mbale, Uganda
| | - E. D. Carrol
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE UK
| | - J. Storr
- WHO Consultant, Geneva, Switzerland
- S3 Global, London, UK
| | - A. Medina-Lara
- Health Economics Group, University of Exeter, Exeter, UK
| | - B. Faragher
- Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - A. D. Weeks
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
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Salomone A, Bozzo A, Di Corcia D, Gerace E, Vincenti M. Occupational Exposure to Alcohol-Based Hand Sanitizers: The Diagnostic Role of Alcohol Biomarkers in Hair. J Anal Toxicol 2018; 42:157-162. [PMID: 29206963 DOI: 10.1093/jat/bkx094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 11/16/2017] [Indexed: 01/19/2023] Open
Abstract
Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) in hair are effective direct biomarkers of ethanol ingestion, whose analytical determination can be used to discriminate between chronic and occasional ethanol intake. Ethanol is a compound widely used in some workplaces (e.g., clinics, hospitals) and is present in considerable amounts in mouthwash for oral cleaning, medications, cosmetic products, hydro-alcoholic disinfectants and antiseptics for hands. This study examined the ethyl alcohol exposure derived from hand disinfectants (in gel form) by simulating the typical occupational situation of medical-health workers (healthcare workers, nurses, surgeons, etc.) who frequently wash their hands with antiseptic sanitizer. Two types of hand disinfectants with 62% w/w of ethanol content were daily applied to the hands of a teetotaler for 20 times a day, for 4 consecutive weeks, thus simulating a typical workplace situation and a cumulative dermal exposure to ethanol of ~1,100 g. Different matrices (head, chest and beard hair, urine) were regularly sampled and analyzed using a ultra high-performance liquid chromatography tandem massspectrometry validated method for EtG and a (HS)SPME-GC-MS validated technique for FAEEs. The data obtained showed that a significant dermal absorption and/or inhalation of ethanol occurred, and that the use of detergents produce urinary EtG concentrations both higher than the cut-offs normally used for clinical and forensic analyses (either 100 and 500 ng/mL, depending on the context). The concentrations of the ethanol metabolites in the keratin matrices were, respectively, below the cut-off of 7 pg/mg for EtG and below 0.5 ng/mg for FAAEs (0.35 ng/mg for ethyl palmitate). In conclusion, the regular use of alcohol-based hand sanitizers can affect the concentration of urinary EtG and lead to positive analytical results, particularly when specimens are obtained shortly after sustained use of ethanol-containing hand sanitizer. On the other hand, direct biomarkers of alcohol abuse in the keratin matrix are capable of distinguishing between ethanol consumption and incidental exposures.
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Affiliation(s)
- A Salomone
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - A Bozzo
- Dipartimento di Chimica, Università degli Studi di Torino, via P. Giuria 7, 10125 Turin, Italy
| | - D Di Corcia
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - E Gerace
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy
| | - M Vincenti
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043 Orbassano, Turin, Italy.,Dipartimento di Chimica, Università degli Studi di Torino, via P. Giuria 7, 10125 Turin, Italy
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Strawsine E, Lutmer B. The Effect of Alcohol-Based Hand Sanitizer Vapors on Evidential Breath Alcohol Test Results. J Forensic Sci 2017; 63:1284-1290. [PMID: 29143333 DOI: 10.1111/1556-4029.13691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/26/2022]
Abstract
This study was undertaken to determine if the application of alcohol-based hand sanitizers (ABHSs) to the hands of a breath test operator will affect the results obtained on evidential breath alcohol instruments (EBTs). This study obtained breath samples on three different EBTs immediately after application of either gel or foam ABHS to the operator's hands. A small, but significant, number of initial analyses (13 of 130, 10%) resulted in positive breath alcohol concentrations, while 41 samples (31.5%) resulted in a status code. These status codes were caused by ethanol vapors either in the room air or their inhalation by the subject, thereby causing a mouth alcohol effect. Replicate subject samples did not yield any consecutive positive numeric results. As ABHS application can cause a transitory mouth alcohol effect via inhalation of ABHS vapors, EBT operators should forego the use of ABHS in the 15 min preceding subject testing.
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Affiliation(s)
- Ellen Strawsine
- Breath Alcohol Program, Missouri Department of Health and Senior Services, Poplar Bluff, MO, 63901
| | - Brian Lutmer
- Breath Alcohol Program, Missouri Department of Health and Senior Services, Poplar Bluff, MO, 63901
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Paula H, Hübner NO, Assadian O, Bransmöller K, Baguhl R, Löffler H, Kramer A. Effect of hand lotion on the effectiveness of hygienic hand antisepsis: Implications for practicing hand hygiene. Am J Infect Control 2017; 45:835-838. [PMID: 28768592 DOI: 10.1016/j.ajic.2017.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub. METHODS The effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor. RESULTS The effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion. CONCLUSIONS Hand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.
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Affiliation(s)
- Helga Paula
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria.
| | - Nils-Olaf Hübner
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Ojan Assadian
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria; Institute for Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom
| | - Katja Bransmöller
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Romy Baguhl
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Harald Löffler
- SLK-Kliniken GmbH, Am Gesundbrunnen 20-26, Heilbronn, Germany
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
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MacLean RR, Valentine GW, Jatlow PI, Sofuoglu M. Inhalation of Alcohol Vapor: Measurement and Implications. Alcohol Clin Exp Res 2017; 41:238-250. [PMID: 28054395 DOI: 10.1111/acer.13291] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 02/06/2023]
Abstract
Decades of alcohol research have established the health risks and pharmacodynamic profile of oral alcohol consumption. Despite isolated periods of public health concern, comparatively less research has evaluated exposure to alcohol vapor. Inhaled alcohol initially bypasses first-pass metabolism and rapidly reaches the arterial circulation and the brain, suggesting that this route of administration may be associated with pharmacological effects that increase the risk of addiction. However, detailed reviews assessing the possible effects of inhaled alcohol in humans are lacking. A comprehensive, systematic literature review was conducted using Google Scholar and PubMed to examine manuscripts studying exposure to inhaled alcohol and measurement of biomarkers (biochemical or functional) associated with alcohol consumption in human participants. Twenty-one publications reported on alcohol inhalation. Fourteen studies examined inhalation of alcohol vapor associated with occupational exposure (e.g., hand sanitizer) in a variety of settings (e.g., naturalistic, laboratory). Six publications measured inhalation of alcohol in a controlled laboratory chamber, and 1 evaluated direct inhalation of an e-cigarette with ethanol-containing "e-liquid." Some studies have reported that inhalation of alcohol vapor results in measurable biomarkers of acute alcohol exposure, most notably ethyl glucuronide. Despite the lack of significantly elevated blood alcohol concentrations, the behavioral consequences and subjective effects associated with repeated use of devices capable of delivering alcohol vapor are yet to be determined. No studies have focused on vulnerable populations, such as adolescents or individuals with alcohol use disorder, who may be most at risk of problems associated with alcohol inhalation.
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Affiliation(s)
- Robert Ross MacLean
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gerald W Valentine
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Peter I Jatlow
- Laboratory Medicine, Yale University, West Haven, Connecticut
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
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Gessner S, Below E, Diedrich S, Wegner C, Gessner W, Kohlmann T, Heidecke CD, Bockholdt B, Kramer A, Assadian O, Below H. Ethanol and ethyl glucuronide urine concentrations after ethanol-based hand antisepsis with and without permitted alcohol consumption. Am J Infect Control 2016; 44:999-1003. [PMID: 27079243 DOI: 10.1016/j.ajic.2016.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 02/20/2016] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND During hand antisepsis, health care workers (HCWs) are exposed to alcohol by dermal contact and by inhalation. Concerns have been raised that high alcohol absorptions may adversely affect HCWs, particularly certain vulnerable individuals such as pregnant women or individuals with genetic deficiencies of aldehyde dehydrogenase. METHODS We investigated the kinetics of HCWs' urinary concentrations of ethanol and its metabolite ethyl glucuronide (EtG) during clinical work with and without previous consumption of alcoholic beverages by HCWs. RESULTS The median ethanol concentration was 0.7 mg/L (interquartile range [IQR], 0.5-1.9 mg/L; maximum, 9.2 mg/L) during abstinence and 12.2 mg/L (IQR, 1.5-139.6 mg/L; maximum, 1,020.1 mg/L) during alcohol consumption. During abstinence, EtG reached concentrations of up to 958 ng/mL. When alcohol consumption was permitted, the median EtG concentration of all samples was 2,593 ng/mL (IQR, 890.8-3,576 ng/mL; maximum, 5,043 ng/mL). Although alcohol consumption was strongly correlated with both EtG and ethanol in urine, no significant correlation for the frequency of alcoholic hand antisepsis was observed in the linear mixed models. CONCLUSIONS The use of ethanol-based handrub induces measurable ethanol and EtG concentrations in urine. Compared with consumption of alcoholic beverages or use of consumer products containing ethanol, the amount of ethanol absorption resulting from handrub applications is negligible. In practice, there is no evidence of any harmful effect of using ethanol-based handrubs as much as it is clinically necessary.
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Affiliation(s)
- Stephan Gessner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Elke Below
- Institute of Forensic Science, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Diedrich
- Department of Surgery, Clinic of General, Visceral, Vascular and Thoracic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christian Wegner
- Department for Information Technology Systems, University Medicine Greifswald, Greifswald, Germany
| | - Wiebke Gessner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- Department of Surgery, Clinic of General, Visceral, Vascular and Thoracic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Britta Bockholdt
- Department for Information Technology Systems, University Medicine Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ojan Assadian
- Institute for Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Harald Below
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Pires D, Bellissimo-Rodrigues F, Pittet D. Ethanol-based handrubs: Safe for patients and health care workers. Am J Infect Control 2016; 44:858-9. [PMID: 27091229 DOI: 10.1016/j.ajic.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Daniela Pires
- Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernando Bellissimo-Rodrigues
- Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Didier Pittet
- Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Al-Marabeh S, Khalil E, Khanfar M, Al-Bakri AG, Alzweiri M. A prodrug approach to enhance azelaic acid percutaneous availability. Pharm Dev Technol 2016; 22:578-586. [PMID: 27346659 DOI: 10.1080/10837450.2016.1200614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Azelaic acid is a dicarboxylic acid compound used in treatment of acne vulgaris. However, high concentration (ca 20%) is needed to guarantee the drug availability in the skin. The latter increases the incidence of side effects such as local irritation. The prodrug strategy to enhance azelaic acid diffusion through skin was not reported before. Thus, a lipophilic prodrug of azelaic acid (diethyl azelate [DEA]) was synthesized and investigated to improve percutaneous availability of azelaic acid, with a subsequent full physical, chemical, and biological characterization. Expectedly, DEA exhibited a significant increase in diffusion compared to azelaic acid through silicone membrane. In contrast, the diffusion results through human stratum corneum (SC) displayed weaker permeation for DEA with expected retention in the SC. Therefore, a desorption study of DEA from SC was conducted to examine the reservoir behavior in SC. Results showed an evidence of sustained release behavior of DEA from SC. Consequently, enhancement of keratolytic effect is expected due to azelaic acid produced from enzymatic conversion of DEA released from SC.
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Affiliation(s)
- Sara Al-Marabeh
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Enam Khalil
- b Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Mohammad Khanfar
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Amal G Al-Bakri
- b Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Muhammed Alzweiri
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan.,c Faculty of Pharmacy , Al-Zaytoonah Private University of Jordan , Amman , Jordan
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Breath alcohol of anesthesiologists using alcohol hand gel and the “five moments for hand hygiene” in routine practice. Can J Anaesth 2016; 63:938-44. [DOI: 10.1007/s12630-016-0666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/12/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022] Open
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety assessment for ethanol-based topical antiseptic use by health care workers: Evaluation of developmental toxicity potential. Regul Toxicol Pharmacol 2015. [PMID: 26212636 DOI: 10.1016/j.yrtph.2015.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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.
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Klymenko I, Kampf G. Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and ways of elimination. GMS HYGIENE AND INFECTION CONTROL 2015; 10:Doc01. [PMID: 25699224 PMCID: PMC4332274 DOI: 10.3205/dgkh000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training.
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Affiliation(s)
- Iryna Klymenko
- Organization and Economy Department, P.L. Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Günter Kampf
- Bode Science Center, Bode Chemie GmbH, Hamburg, Germany ; Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany
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Dohmen PM, Markou T, Ingemansson R, Rotering H, Hartman JM, van Valen R, Brunott M, Segers P. Use of incisional negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery: clinical evidence and consensus recommendations. Med Sci Monit 2014; 20:1814-25. [PMID: 25280449 PMCID: PMC4199398 DOI: 10.12659/msm.891169] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery.
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Affiliation(s)
- Pascal M Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Thanasie Markou
- Department of Cardiothoracic Surgery, Isala Klinieken Zwolle, Zwolle, Netherlands
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery, University Hospital of Lund, Lund, Sweden
| | - Heinrich Rotering
- Department of Cardiothoracic Surgery, University Clinic Münster, Münster, Germany
| | - Jean M Hartman
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - Richard van Valen
- Department of Cardiothoracic Surgery, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Maaike Brunott
- Department of Cardiothoracic Surgery, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
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Gross ER, Zambelli VO, Small BA, Ferreira JCB, Chen CH, Mochly-Rosen D. A personalized medicine approach for Asian Americans with the aldehyde dehydrogenase 2*2 variant. Annu Rev Pharmacol Toxicol 2014; 55:107-27. [PMID: 25292432 DOI: 10.1146/annurev-pharmtox-010814-124915] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Asian Americans are one of the fastest-growing populations in the United States. A relatively large subset of this population carries a unique loss-of-function point mutation in aldehyde dehydrogenase 2 (ALDH2), ALDH2*2. Found in approximately 560 million people of East Asian descent, ALDH2*2 reduces enzymatic activity by approximately 60% to 80% in heterozygotes. Furthermore, this variant is associated with a higher risk for several diseases affecting many organ systems, including a particularly high incidence relative to the general population of esophageal cancer, myocardial infarction, and osteoporosis. In this review, we discuss the pathophysiology associated with the ALDH2*2 variant, describe why this variant needs to be considered when selecting drug treatments, and suggest a personalized medicine approach for Asian American carriers of this variant. We also discuss future clinical and translational perspectives regarding ALDH2*2 research.
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Affiliation(s)
- Eric R Gross
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California 94305
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Beeinflussung der Alkoholabstinenzkontrolle durch Händedesinfektion. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ulmer M, Lademann J, Patzelt A, Knorr F, Kramer A, Koburger T, Assadian O, Daeschlein G, Lange-Asschenfeldt B. New strategies for preoperative skin antisepsis. Skin Pharmacol Physiol 2014; 27:283-92. [PMID: 24969555 DOI: 10.1159/000357387] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/15/2013] [Indexed: 11/19/2022]
Abstract
During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.
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Affiliation(s)
- Miriam Ulmer
- Center for Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Harnoss JC, Brune L, Ansorg J, Heidecke CD, Assadian O, Kramer A. Practice of skin protection and skin care among German surgeons and influence on the efficacy of surgical hand disinfection and surgical glove perforation. BMC Infect Dis 2014; 14:315. [PMID: 24912541 PMCID: PMC4229856 DOI: 10.1186/1471-2334-14-315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 05/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Surgical hand rub and healthy skin are basic requirements to prevent surgical site infections. Nevertheless, there is little knowledge about the current practice of skin protection and/or skin care products (SP/SC) using among surgeons as well as a lack of data pertaining to the influence of SP/SC on the antimicrobial efficacy of surgical hand rub. Methods A 10 weeks-survey among German surgeons as well as an experimental crossover study involving 26 participants were conducted. The immediate and sustainable efficacy (IE/SE) of surgical hand rub and participants’ hand moisture were measured after an 8-day usage of SP/SC, as well as the influence on micro-perforations on surgical gloves. Results The questionnaire was available to 16,000 German surgeons. Thereof, 1,771 surgeons accessed the questionnaire, representing a total participation rate of 11%. As 19% (n = 338) of questionnaires were incomplete, a total of 1,433 completed questionnaires were available for further analysis. More than 75% of the participants stated not to use any SP/SC, yet, almost 50% suffered from skin irritation or discomfort. Only 5% used SP/SC at the beginning of their shift. 10% refused to use SP/SC because of concerns that SP/SC may reduce the antimicrobial efficacy of surgical hand rub. After usage of SP/SC over 8-days, skin moisture was significantly higher (P < 0.001), whereas no significant influence on the antimicrobial efficacy of surgical hand rub was observed (IE: P = 0.135; SP: P = 0.681). Micro-perforations were detected in 8/52 surgical gloves (15%), with no statistical significant difference between SP/SC users (n = 2/26; 8%) and non-users (n = 6/26; 23%; P = 0.249). Conclusions Following the results of this largest questionnaire base survey among German surgeons on skin care, there is a need to educate and inform surgeons on the correct application and the concept of SP/SC strategies. In the present study, the combination of selected SP/SC products and one alcohol-based hand rub formulation did not show a negative interaction with surgical hand rub or surgical glove perforation. However, it is advisable to ascertain the compatibility of SP/SC products with the used hand disinfectant prior to purchase.
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Affiliation(s)
| | | | | | | | - Ojan Assadian
- Clinical Institute for Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
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Lin W, Patil PM. Facial dog attack injuries. Indian J Surg 2013; 77:55-8. [PMID: 25829713 DOI: 10.1007/s12262-013-0964-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022] Open
Abstract
The exposed position of the face makes it vulnerable to dog bite injuries. This fact combined with the short stature of children makes them a high-risk group for such attacks. In contrast to wounds inflicted by assaults and accidents, dog bite wounds are deep puncture type wounds compounded by the presence of pathologic bacteria from the saliva of the attacking dog. This, combined with the presence of crushed, devitalized tissue makes these wounds highly susceptible to infection. Key to successful management of such wounds are meticulous cleansing of the wound, careful debridement, primary repair, appropriate antibiotic therapy, and rabies and tetanus immunization where indicated. This review presents an overview of the epidemiology, presentation, management of such emergencies, and the recent advances in the care of such patients.
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Affiliation(s)
- Wei Lin
- Department of Burn and Plastic Surgery, Yantai Economic and Technological Development Zone Hospital, Yantai, China
| | - Pavan Manohar Patil
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Plot 32 and 34, Sharda University, Greater Noida, Uttar Pradesh 201308 India
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