Grashoff Philine, Mutters Nico Tom, Kramer Axel, Ilschner Carola, Rausch Marvin, Gebel Jürgen
Institute of Hygiene and Public Health, University Clinic, Bonn, Germany.
Verbund für Angewandte Hygiene, Bonn, Germany.
GMS Hyg Infect Control. 2025 May 2;20:Doc17. doi: 10.3205/dgkh000546. eCollection 2025.
The number of active agents used in hand antiseptics (HA) in Germany was analyzed using the disinfectant lists of the Association for Applied Hygiene (VAH) for the years 2004, 2012 and 2022 to evaluate the development regarding the use of unnecessary or critical active agents in alcohol-based hand rubs (ABHR).
While 20 different active agents were used in the HAs (97 listed HAs) in 2004, only 14 were used in 2012 (201 listed HAs) and 15 in 2022 (332 listed HAs). Benzoic acid, clorocesol, chlorophene, octenidine dihydrochloride, peracetic acid, polihexanide and triclosan are no longer used as additives to ABHR. At the same time, the number of active ingredients per product fell.In the period from 2002 to 2022, there was an increase in ABHR, so that in 2022, only four HAs did not contain alcohol: three were based on PVP iodine and one was based on quaternary ammonium compounds.While 2-propanol still dominated as the first-named active ingredient in 2004 and 2022, in 2022 mainly ABHR with ethanol as the first-named active ingredient were certified. The percentage share of ethanol in ABHR, measured against all VAH-listed HA and as the main active ingredient, increased by 43.4% between 2004 and 2022. At the same time, there has been a 33.2% decrease in ABHR of 2-propanol as active ingredient.
There are probably two reasons for the decrease in the total number of active ingredients used. The addition of antiseptic agents to ABHR does not increase their residual effectiveness. In addition, the antimicrobial antiseptics added to ABHR are less well tolerated than alcohols. Consequently, for ethical reasons it makes sense not to add these antimicrobials to the formulas. The increase of ethanol-based hand rubs (EBHR) suggests that these are preferred by users. One explanation may be that, unlike ethanol, 1-propanol can have an irritating effect on both healthy and atopic skin.
Ethanol must be retained as an active ingredient for ABHR for the following reasons: ethanol is the only active ingredient that can be used for HA with comprehensive efficacy against non-enveloped viruses; both propanols are less physiological for the human organism than ethanol; ethanol is better tolerated by the skin than 1-propanol; and an adverse effect on the skin microbiome has been ruled out for ethanol. This must be considered when discussing the possible biocide classification of ethanol as CMR, especially because such a classification has absolutely no scientific basis.
利用应用卫生协会（VAH）2004年、2012年和2022年的消毒剂清单，分析德国手部消毒剂（HA）中使用的活性成分数量，以评估含酒精洗手液（ABHR）中不必要或关键活性成分的使用发展情况。
2004年，在手部消毒剂（97种列出的手部消毒剂）中使用了20种不同的活性成分，2012年（201种列出的手部消毒剂）仅使用了14种，2022年（332种列出的手部消毒剂）使用了15种。苯甲酸、氯甲酚、氯苯酚、二盐酸奥替尼啶、过氧乙酸、聚己缩胍和三氯生不再用作含酒精洗手液的添加剂。同时，每种产品的活性成分数量减少。在2002年至2022年期间，含酒精洗手液的数量有所增加，因此在2022年，只有四种手部消毒剂不含酒精：三种基于聚乙烯吡咯烷酮碘，一种基于季铵化合物。虽然2004年和2022年2-丙醇仍作为首要活性成分占主导地位，但在2022年，主要是以乙醇作为首要活性成分的含酒精洗手液获得认证。在2004年至2022年期间，相对于所有VAH列出的手部消毒剂并作为主要活性成分，含酒精洗手液中乙醇的百分比份额增加了43.4%。同时，作为活性成分的2-丙醇的含酒精洗手液数量减少了33.2%。
使用的活性成分总数减少可能有两个原因。向含酒精洗手液中添加防腐剂不会提高其残留有效性。此外，添加到含酒精洗手液中的抗菌防腐剂的耐受性不如酒精。因此，出于伦理原因，不在配方中添加这些抗菌剂是有意义的。基于乙醇的洗手液（EBHR）的增加表明这些是用户的首选。一种解释可能是，与乙醇不同，1-丙醇对健康皮肤和特应性皮肤都可能有刺激作用。
出于以下原因，乙醇必须保留为含酒精洗手液的活性成分：乙醇是唯一可用于对非包膜病毒具有全面功效的手部消毒剂的活性成分；两种丙醇对人体生物体的生理适应性都不如乙醇；乙醇比1-丙醇对皮肤的耐受性更好；并且已排除乙醇对皮肤微生物群的不利影响。在讨论乙醇可能被归类为具有致癌、致突变或生殖毒性（CMR）的杀生剂时必须考虑到这一点，特别是因为这样的分类完全没有科学依据。
