en
Scientific article
Review
Open access
English

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

Publication date2022-07-06
First online date2022-07-06
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.

eng
Keywords
  • Absorption
  • Biocidal product regulation
  • Ethanol based hand rub
  • Hand antisepsis
  • Inactivation
  • Memorandum
  • Non-enveloped viruses
  • Patient safety
  • Risk–benefit-assessment
  • WHO
  • Worker safety
  • 2-Propanol
  • Animals
  • Anti-Infective Agents, Local / pharmacology
  • Antisepsis
  • Berlin
  • Ethanol / pharmacology
  • Germany
  • Hand Disinfection / methods
  • Hand Hygiene
  • Hospitals
  • Patient Safety
  • World Health Organization
Citation (ISO format)
KRAMER, Axel et al. 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. In: Antimicrobial resistance and infection control, 2022, vol. 11, p. 93. doi: 10.1186/s13756-022-01134-7
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Article (Published version)
Identifiers
ISSN of the journal2047-2994
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9downloads

Technical informations

Creation08/29/2022 12:05:00 PM
First validation08/29/2022 12:05:00 PM
Update time03/16/2023 10:49:51 AM
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