Bedeutung der Händedesinfektion beim Nachweis der Alkoholabstinenz

When healthcare workers lose their driving license after careless consumption of alcohol it may be necessary to prove alcohol abstinence. This is mostly done by measuring ethyl glucuronide (EtG), e. g. in urine. A concentration > 0.1 mg/L indicates alcohol consumption within the last 3 to 4 days. A healthcare worker in patient care will on average use an alcohol-based hand rub 25 times per shift. Usage is likely to be higher in areas with a higher risk for infection, e. g. in neonatology intensive care units, hematological oncology or wards for organ transplantations. Using 1 mL of a hand rub based on 62 % ethanol every 5 minutes for 10 hours over 3 days resulted in a mean EtG concentration of 0.278 mg/L. At the same time the ethyl sulfate (EtS) concentration remained < 0.1 mg/L. Other studies revealed after hand disinfection maximum EtG-values in urine of 0.062, 0.114 and 0.713 mg/L. Even subjects not using an alcohol-based hand rub have been described to have EtG-values in urine of up to 0.6 mg/L when they only stayed for a while in an area where hand disinfection was performed. When EtG is measured using commercially available immunoassays a false positive result may occur after use of propanol-based hand rubs due to a cross reactivity of 2-propyl glucuronide (69-84 %) and 1-propyl glucuronide (4-9 %). Using hand rubs in patient care as indicated may therefore result in EtG-values which are regarded as evidence for alcohol consumption although no alcohol was consumed. When positive EtG results are evaluated for a healthcare worker who used hand rubs as recommended in patient care, one should consider this possibility of explanation.