Safety of hand disinfectants: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

DIAO Sha ^1,2,3 , LI Shengwu ⁴ , YANG Jiao ⁴ , LUO Jiefeng ^1,2,3,5 , LIU Weijia ⁴ , ZENG Linan ^1,2,3 ,  PENG Lijuan ⁴ , ZHANG Lingli ^1,2,3

1. Department of Pharmacy, West China Second University Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Evidence-Based Pharmacy Center, West China Second University Hospital of Sichuan University, Chengdu 610041, P. R. China;
3. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P. R. China;
4. Purchase Department, West China Second University Hospital of Sichuan University, Chengdu 610041, P. R. China;
5. West China School of Pharmacy, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

PENG Lijuan, Email: zhanglingli@scu.edu.cn

Keywords：

Hand disinfectant; Adverse effect; Systematic review

DOI：

10.7507/1672-2531.202112065

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the safety of hand disinfectants. Methods PubMed, EMbase, The Cochrane Library, INAHTA, WanFang Data, CNKI and VIP databases were electronically searched to collect studies on the safety of hand disinfectants from inception to February 1^st, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies; then, a systematic review was conducted. Results A total of 50 studies were included. The reported adverse events were eye and nasal mucosal irritation, hand adverse events with skin itching, rash, erythema, edema and so on. A total of 29 brands such as 3M Avagard and 26 ingredients such as ethanol were reported to be related to the above adverse events. Hand disinfectants containing glycerin, silicone oil, vitamin B, plant extracts and other emollients could reduce the incidence of adverse events. Conclusion Current evidence shows that hand disinfectants containing emollients and free from ethanol, chlorhexidine and other ingredients are related to fewer adverse events. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： DIAO Sha, LI Shengwu, YANG Jiao, LUO Jiefeng, LIU Weijia, ZENG Linan, PENG Lijuan, ZHANG Lingli. Safety of hand disinfectants: a systematic review. Chinese Journal of Evidence-Based Medicine, 2022, 22(6): 676-683. doi: 10.7507/1672-2531.202112065 Copy

1.	WHO. WHO hand hygiene strategy feasible and sustainable for health-care settings around the world. Geneva: WHO, 2013.
2.	國家衛生健康委員會. 中華人民共和國衛生行業標準: 醫務人員手衛生規范. Available at: http://www.nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e/files/6a3e2bf3d82b4ee8a718dbfc3cde8338.pdf.
3.	Jing J, Pei YT, Bose R, et al. Hand sanitizers: a review on formulation aspects, adverse effects, and regulations. Int J Environ Res Public Health, 2020, 17(9): 3326.
4.	Breidablik HJ, Lysebo DE, Johannessen L, et al. Ozonized water as an alternative to alcohol-based hand disinfection. J Hosp Infect, 2019, 102(4): 419-424.
5.	Bosker HM, Politiek K, Urgert MC, et al. Occupational allergic contact dermatitis caused by 1-propanol in a hand disinfectant. Contact Dermatitis, 2017, 76(4): 241-243.
6.	Galli-Novak E, Wilfinger D, Takacs S, et al. Occupational contact dermatitis caused by isopropanol-containing disinfectant based on a genetic defect. Contact Dermatitis, 2019, 80(5): 316-318.
7.	徐書霞. 詩潔應用于高海拔地區醫護人員手部消毒的觀察與研究. 中國實用護理雜志, 2004, 20(22): 53-53.
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45.	周玉, 余國輝. 幾種凝膠型手消毒劑的綜合效果評價. 中國消毒學雜志, 2015, 32(6): 623-625.
46.	謝秀花. 一種快速手消毒劑消毒效果臨床評價. 國際醫藥衛生導報, 2004, (22): 139-140.
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1. WHO. WHO hand hygiene strategy feasible and sustainable for health-care settings around the world. Geneva: WHO, 2013.
2. 國家衛生健康委員會. 中華人民共和國衛生行業標準: 醫務人員手衛生規范. Available at: http://www.nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e/files/6a3e2bf3d82b4ee8a718dbfc3cde8338.pdf.
3. Jing J, Pei YT, Bose R, et al. Hand sanitizers: a review on formulation aspects, adverse effects, and regulations. Int J Environ Res Public Health, 2020, 17(9): 3326.
4. Breidablik HJ, Lysebo DE, Johannessen L, et al. Ozonized water as an alternative to alcohol-based hand disinfection. J Hosp Infect, 2019, 102(4): 419-424.
5. Bosker HM, Politiek K, Urgert MC, et al. Occupational allergic contact dermatitis caused by 1-propanol in a hand disinfectant. Contact Dermatitis, 2017, 76(4): 241-243.
6. Galli-Novak E, Wilfinger D, Takacs S, et al. Occupational contact dermatitis caused by isopropanol-containing disinfectant based on a genetic defect. Contact Dermatitis, 2019, 80(5): 316-318.
7. 徐書霞. 詩潔應用于高海拔地區醫護人員手部消毒的觀察與研究. 中國實用護理雜志, 2004, 20(22): 53-53.
8. 李柄輝, 訾豪, 李路遙, 等. 醫學領域一次研究和二次研究的方法學質量(偏倚風險)評價工具. 醫學新知, 2021, 31(1): 51-58.
9. Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: https://xueshu.baidu.com/usercenter/paper/show?paperid=d8c0c42f0d0500f35cde52367829b137.
10. JBI. JBI's critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers. Available at: https://xueshu.baidu.com/usercenter/paper/show?paperid=daaac12d7533cf945159b5f9bb176017.
11. Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
12. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
13. 孫志紅, 陳煥英, 鄭桂芳. 無醇雙胍手消毒液在醫院CSSD應用效果觀察. 中國消毒學雜志, 2019, 36(5): 338-339,342.
14. 吳芳芳, 劉耀, 孫愛華, 等. 血液科醫務人員速干手消毒劑使用依從性及消毒效果觀察. 環球中醫藥, 2013, 6(S2): 184-185.
15. 徐傳國, 苗溫, 王瑞. 5種消毒劑對采血車采血護士手消毒效果觀察. 中國輸血雜志, 2011, 24(8): 704.
16. Cimiotti JP, Marmur ES, Nesin M, et al. Adverse reactions associated with an alcohol-based hand antiseptic among nurses in a neonatal intensive care unit. Am J Infect Control, 2003, 31(1): 43-48.
17. Weight CJ, Lee MC, Palmer JS. Avagard hand antisepsis vs. traditional scrub in 3600 pediatric urologic procedures. Urology, 2010, 76(1): 15-17.
18. Palmer JS. Use of Avagard in pediatric urologic procedures. Urology, 2006, 68(3): 655-657.
19. Houben E, De Paepe K, Rogiers V. Skin condition associated with intensive use of alcoholic gels for hand disinfection: a combination of biophysical and sensorial data. Contact Dermatitis, 2006, 54(5): 261-267.
20. Lourith N, Pungprom S, Kanlayavattanakul M. Formulation and efficacy evaluation of the safe and efficient moisturizing snow mushroom hand sanitizer. J Cosmet Dermatol, 2021, 20(2): 554-560.
21. 楊蘋蘋. 不同消毒方法對采血護士手衛生消毒效果評價. 中國傷殘醫學, 2013, 21(12): 343-343.
22. Cargill DI, Roche ED, Van Der Kar CA, et al. Development of a health care personnel handwash with 6-hour persistence. Am J Infect Control, 2011, 39(3): 226-234.
23. Hosler J, Mcdyer D. Effects of the micro dine TM protocol on facility acquired clostridium difficile infections and employee absenteeism 2010 presidential poster. Am J Gastroenterol, 2010, 105(Suppl 1): S403.
24. Slotosch CM, Kampf G, L?ffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermatitis, 2007, 57(4): 235-241.
25. Pedersen LK, Held E, Johansen JD, et al. Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection. Br J Dermatol, 2005, 153(6): 1142-1146.
26. 陳玉珍, 肖服興. 異丙醇復合物洗手液對手消毒的效果監測. 現代臨床護理, 2004, (4): 35-36.
27. Kampf G, Muscatiello M. Dermal tolerance of Sterillium, a propanol-based hand rub. J Hosp Infect, 2003, 55(4): 295-298.
28. Lübbe J, Ruffieux C, van Melle G, et al. Irritancy of the skin disinfectant n-propanol. Contact Dermatitis, 2001, 45(4): 226-231.
29. Grove GL, Zerweck CR, Heilman JM, et al. Methods for evaluating changes in skin condition due to the effects of antimicrobial hand cleansers: two studies comparing a new waterless chlorhexidine gluconate/ethanol-emollient antiseptic preparation with a conventional water-applied product. Am J Infect Control, 2001, 29(6): 361-369.
30. Bendig JW. Surgical hand disinfection: comparison of 4% chlorhexidine detergent solution and 2% triclosan detergent solution. J Hosp Infect, 1990, 15(2): 143-148.
31. Murie JA, Macpherson SG. Chlorhexidine in methanol for the preoperative cleansing of surgeons' hands: a clinical trial. Scott Med J, 1980, 25(4): 309-311.
32. 趙偉, 李蘇婭. 免洗手億人安(R)消毒劑與肥皂洗手效果的臨床評價. 特別健康, 2018, (18): 108.
33. Kampiatu P, Cozean J. A controlled, crossover study of a persistent antiseptic to reduce hospital-acquired infection. Afr J Infect Dis, 2015, 9(1): 6-9.
34. 王峰娟. 4種消毒方法對流動采血車采血護士手消毒效果觀察. 中國消毒學雜志, 2013, 30(8): 788-789.
35. 李荷花, 王苗鳳, 馬玲平. 一種快速手消毒劑現場消毒效果觀察. 中國消毒學雜志, 2013, 30(2): 108-109.
36. 馮飛燕, 陶寅, 戚均超. 三種不同方法對采血者手消毒效果評價. 中國消毒學雜志, 2012, 29(9): 834-835.
37. 曾俊, 官曉慶, 李永紅. 愛護佳外科無水洗手液在術前手消毒中的應用效果觀察. 中華醫院感染學雜志, 2007, 17(3): 296-296.
38. 王紅麗, 岳雪堂. 潤興牌手消毒劑消毒效果監測. 中國社區醫師(綜合版), 2007, (16): 137-138.
39. Pietsch H. Hand antiseptics: rubs versus scrubs, alcoholic solutions versus alcoholic gels. J Hosp Infect, 2001, 48(Suppl A): S33-S36.
40. Moadab A, Rupley KF, Wadhams P. Effectiveness of a nonrinse, alcohol-free antiseptic hand wash. J Am Podiatr Med Assoc, 2001, 91(6): 288-293.
41. Nicoletti G, Boghossian V, Borland R. Hygienic hand disinfection: a comparative study with chlorhexidine detergents and soap. J Hosp Infect, 1990, 15(4): 323-337.
42. Tanaka K, Kumon K, Hirata T, et al. Evaluation of rapid drying hand disinfectant preparations in the intensive care unit. Crit Care Med, 1988, 16(5): 540-542.
43. 顧麗娟. 復合季銨鹽新型手部消毒劑使用效果. 現代醫藥衛生, 2016, 32(4): 629-631.
44. 卿美英, 黃蓉, 黃莉, 等. 4%葡萄糖酸洗必泰外科洗手液與其他消毒液手部皮膚消毒效果的比較觀察. 當代護士(下旬刊), 2016, (4): 94-96,97.
45. 周玉, 余國輝. 幾種凝膠型手消毒劑的綜合效果評價. 中國消毒學雜志, 2015, 32(6): 623-625.
46. 謝秀花. 一種快速手消毒劑消毒效果臨床評價. 國際醫藥衛生導報, 2004, (22): 139-140.
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