Ethyl Glucuronide, Ethyl Sulfate and Acetone as Biomarkers for Alcohol Based Hand Sanitizers Chronic Exposure in Health Care Workers

Document Type : Original Article


1 Department of Forensic Medicine & Clinical Toxicology,Faculty of Medicine, Zagazig university, Zagazig, Egypt.

2 Department of Community, Environmental and Occupational medicine Department. Faculty of Medicine, Zagazig university, Zagazig, Egypt.



 Introduction: health care workers (HCWs) are exposed to alcohols during hand antisepsis by both dermal contact and inhalation. This study aimed to assess the ethanol and isopropanol (ISOP) absorption in HCWs due to alcohol based hand sanitizers (ABHSs) use in real work conditions and to characterize the highest measurable concentrations of ethyl glucuronide (EtG) and ethyl sulfate (EtS) that could be produced by ABHSs use in order to recommend appropriate threshold concentrations specific enough to eliminate the possibility of false positive results due to incidental exposures to ethanol in Egypt. 
Subject and Methods: ethanol and ISOP absorption were assessed in 74 HCWs using ABHSs during regular 8-hours working shift through measuring urinary concentrations of ethanol and its metabolites ethyl glucuronide (EtG) and ethyl sulfate (EtS) before the ABHSs use and for the following 24 hours as well as blood ISOP and its metabolite acetone were measured before ABHSs use and at the end of 8-hours shift. 
Results: the highest maximum median urinary ethanol (8.75 mg/L), EtG (538.93 ng/mL) and EtS (62 ng/mL) as well as blood ISOP (4.9 mg/L) and acetone (6.32 mg/L) concentrations were recorded in group III (excessive ABHSs use), all these parameters returned to base line within 24 hours. Parameters were correlated to frequency, quantity of ABHSs used. EtG was correlated positively to the concentration of ethanol in ABHSs. 
Conclusion: ABHSs use generated measurable levels of ethanol, EtG and EtS in urine as well as ISOP and acetone in blood. their concentrations decrease to baseline levels within 24 hours (not accumulated). EtG cut off of 1000 ng/ml and EtS cut off 100ng/ml seemed to be more promising in identification of incidental alcohol use in HCWs. Measuring EtS with EtG might be useful in incidental ethanol exposure.