Lindsay Helen A, Hannam Jacqueline A, Bradfield Charles N, Mitchell Simon J
Department of Anaesthesia & Perioperative Medicine, Auckland City Hospital, 2 Park Road, Auckland, New Zealand.
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Can J Anaesth. 2016 Aug;63(8):938-44. doi: 10.1007/s12630-016-0666-2. Epub 2016 May 3.
Appropriate hand hygiene reduces hospital-acquired infections. Anesthesiologists work in environments with numerous hand hygiene opportunities (HHOs). In a prospective observational study, we investigated the potential for an anesthesiologist to return a positive alcohol breath test during routine practice when using alcohol hand gel.
We observed ten volunteer anesthesiologists over four hours while they implemented the World Health Organization (WHO) "five moments for hand hygiene" using our hospital's adopted standard 70% ethanol hand gel. We measured the expired alcohol concentration at shift start and every fifteen minutes thereafter with a fuel cell breathalyzer calibrated to measure the percentage of blood alcohol concentration (BAC). Blood alcohol specimens (analyzed with gas chromatography) were collected at shift start and, when possible, immediately after a participant's first positive breathalyzer test.
Of the 130 breathalyzer tests obtained, there were eight (6.2%) positive breath alcohol results from six of the ten participants, all within two minutes of a HHO. The highest value breathalyzer BAC recorded was 0.064%, with an overall mean (SD) of 0.023 (0.017)%. Five (62.5%) of the positive breathalyzer tests returned to zero in less than seven minutes. All of three blood specimens obtained immediately after a positive breathalyzer reading tested negative for alcohol.
Anesthesia practitioners using alcohol hand gel in a manner that conforms with recommended hand hygiene can test positive for alcohol on a breathalyzer assay. Positive tests probably arose from inhalation of alcohol vapour into the respiratory dead space following gel application. If workplace breath testing for alcohol is implemented, it should be completed more than 15 min after applying alcohol hand gel. Positive results should be verified with a BAC test.
适当的手部卫生可减少医院获得性感染。麻醉医生工作的环境中有大量手部卫生时机（HHOs）。在一项前瞻性观察研究中，我们调查了麻醉医生在日常工作中使用酒精洗手液时呼出酒精检测呈阳性的可能性。
我们观察了10名志愿麻醉医生4小时，他们使用我院采用的标准70%乙醇洗手液执行世界卫生组织（WHO）的“手部卫生五个时刻”。在轮班开始时以及此后每隔15分钟，我们使用经校准以测量血液酒精浓度（BAC）百分比的燃料电池呼气酒精含量测定仪测量呼出酒精浓度。在轮班开始时以及在参与者首次呼出酒精检测呈阳性后尽可能立即采集血液酒精样本（用气相色谱法分析）。
在获得的130次呼出酒精含量测定仪检测中，10名参与者中有6人出现了8次（6.2%）呼出酒精阳性结果，均在手部卫生时机后两分钟内。记录的呼出酒精含量测定仪最高BAC值为0.064%，总体平均（标准差）为0.023（0.017）%。5次（62.5%）呼出酒精检测呈阳性的结果在不到7分钟内恢复到零。在呼出酒精检测呈阳性读数后立即采集的3份血液样本全部检测酒精呈阴性。
以符合推荐的手部卫生方式使用酒精洗手液的麻醉从业者呼出酒精检测可能呈阳性。阳性检测结果可能是由于涂抹洗手液后酒精蒸气吸入呼吸道无效腔所致。如果实施工作场所酒精呼气检测，应在涂抹酒精洗手液15分钟后进行。阳性结果应用BAC检测进行验证。
