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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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

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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.
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44.	卿美英, 黄蓉, 黄莉, 等. 4%葡萄糖酸洗必泰外科洗手液与其他消毒液手部皮肤消毒效果的比较观察. 当代护士(下旬刊), 2016, (4): 94-96,97.
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1. WHO. WHO hand hygiene strategy feasible and sustainable for health-care settings around the world. Geneva: WHO, 2013.
2. 国家卫生健康委员会. 中华人民共和国卫生行业标准: 医务人员手卫生规范. 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. 徐书霞. 诗洁应用于高海拔地区医护人员手部消毒的观察与研究. 中国实用护理杂志, 2004, 20(22): 53-53.
8. 李柄辉, 訾豪, 李路遥, 等. 医学领域一次研究和二次研究的方法学质量(偏倚风险)评价工具. 医学新知, 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, Savović 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. 孙志红, 陈焕英, 郑桂芳. 无醇双胍手消毒液在医院CSSD应用效果观察. 中国消毒学杂志, 2019, 36(5): 338-339,342.
14. 吴芳芳, 刘耀, 孙爱华, 等. 血液科医务人员速干手消毒剂使用依从性及消毒效果观察. 环球中医药, 2013, 6(S2): 184-185.
15. 徐传国, 苗温, 王瑞. 5种消毒剂对采血车采血护士手消毒效果观察. 中国输血杂志, 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. 杨苹苹. 不同消毒方法对采血护士手卫生消毒效果评价. 中国伤残医学, 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, Löffler 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. 陈玉珍, 肖服兴. 异丙醇复合物洗手液对手消毒的效果监测. 现代临床护理, 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. 赵伟, 李苏娅. 免洗手亿人安(R)消毒剂与肥皂洗手效果的临床评价. 特别健康, 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种消毒方法对流动采血车采血护士手消毒效果观察. 中国消毒学杂志, 2013, 30(8): 788-789.
35. 李荷花, 王苗凤, 马玲平. 一种快速手消毒剂现场消毒效果观察. 中国消毒学杂志, 2013, 30(2): 108-109.
36. 冯飞燕, 陶寅, 戚均超. 三种不同方法对采血者手消毒效果评价. 中国消毒学杂志, 2012, 29(9): 834-835.
37. 曾俊, 官晓庆, 李永红. 爱护佳外科无水洗手液在术前手消毒中的应用效果观察. 中华医院感染学杂志, 2007, 17(3): 296-296.
38. 王红丽, 岳雪堂. 润兴牌手消毒剂消毒效果监测. 中国社区医师(综合版), 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. 顾丽娟. 复合季铵盐新型手部消毒剂使用效果. 现代医药卫生, 2016, 32(4): 629-631.
44. 卿美英, 黄蓉, 黄莉, 等. 4%葡萄糖酸洗必泰外科洗手液与其他消毒液手部皮肤消毒效果的比较观察. 当代护士(下旬刊), 2016, (4): 94-96,97.
45. 周玉, 余国辉. 几种凝胶型手消毒剂的综合效果评价. 中国消毒学杂志, 2015, 32(6): 623-625.
46. 谢秀花. 一种快速手消毒剂消毒效果临床评价. 国际医药卫生导报, 2004, (22): 139-140.
47. 谢丹, 章晓玲, 辛琳. 碘伏擦手与免洗手消毒液用于外科手术人员皮肤消毒效果比较. 中国药业, 2013, 22(A01): 2.
48. Olson LK, Morse DJ, Duley C, et al. Prospective, randomized in vivo comparison of a dual-active waterless antiseptic versus two alcohol-only waterless antiseptics for surgical hand antisepsis. Am J Infect Control, 2012, 40(2): 155-159.
49. 孙亚君. 3种快速手消毒液效果观察. 中华医院感染学杂志, 2011, 21(12): 2384-2384.
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