Breathalyzer machines are commonly used in the ED to help clinicians and law enforcement officials determine the degree to which patients are intoxicated with alcohol, with the legal limit being 0.080 g/dL. Most commercially available hand sanitizers contain ethyl alcohol, but studies suggest that these products don’t significantly elevate blood alcohol levels in individuals who have applied them to themselves, even when applied excessively. What remains unclear, however, is whether applying hand-sanitizer mixtures to people measuring breathalyzer levels could falsely elevate breathalyzer results of patients whose alcohol level is being measured. There is reason to suspect that it might because alcohol is volatile and, thus, may distort breathalyzer readings.

“Patients who are improperly assumed to be intoxicated may be held longer than necessary in the ED, resulting in crowding and longer wait times for other patients.”

Hand Sanitizer’s Effect on Breathalyzers

In a study published in Academic Emergency Medicine, my colleagues and I sought to determine if applying alcohol-based hand sanitizer on the hands of people holding a breathalyzer affected readings of others. The initial breathalyzer readings of all study participants were 0.000 g/dL. We found that some common alcohol-based hand sanitizers may affect breathalyzer readings when used improperly, presumably by vaporization of the hand sanitizer on the part of the person holding the breathalyzer. This in turn affected the readings in patients who had not ingested alcohol.

The breathalyzer readings were further elevated if more sanitizer was used or if it wasn’t allowed to dry appropriately. According to the results, the median breathalyzer reading was 0.119 g/dL in the group who used two pumps (3 mL) without allowing the hands to dry—a reading above the legal limit (view study abstract).

Important Implications on Hand Sanitizer Use

The results from our study raise a few concerns. It’s critical that breathalyzer machines provide precise alcohol level results because they may affect clinicians’ ability to properly assess patients, even in those people who haven’t ingested alcohol. In addition, patients who are improperly assumed to be intoxicated may be held longer than necessary in the ED, resulting in crowding and longer wait times for other patients. Another potential concern outside the hospital is that many states use breathalyzers to administer preliminary breath tests. Accuracy is critical because law enforcement officials may rely on these readings to establish probable cause for a driving-under-the-influence arrest.

Given the importance of both clinical and legal determinations of alcohol use, healthcare workers and others who rely on breathalyzers to make judgments about the alcohol levels of others should be careful not to use hand sanitizer immediately before operating these machines. ED personnel should also be sure to use hand sanitizer according to the manufacturer’s recommendations and dry their hands thoroughly. In future analyses, it’s hoped that studies will look into whether use of gloves diminishes the effect of ethanol-based hand sanitizer on breathalyzer readings.

 

References

Ali SS, Wilson MP, Castillo EM, et al. Common hand sanitizer may distort readings of breathalyzer tests in the absence of acute intoxication. Acad Emerg Med. 2013 [Epub ahead of print].

Brown TL, Gamon S, Tester P, et al. Can alcohol-based hand-rub solutions cause you to lose your driver’s license? Comparative cutaneous absorption of various alcohols. Antimicrob Agents Chemother. 2007; 51:1107-1108.

Miller MA, Rosin A, Crystal C. Alcohol-based hand sanitizer: can frequent use cause an elevated blood alcohol level? Am J Infect Control. 2006; 34:150-151.

Miller MA, Rosin A, Levsky ME, Patel MM, et al. Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study. Am J Emerg Med. 2006; 24:815-817.

Bessonneau V, Clement M, Thomas O. Can intensive use of alcohol-based hand rubs lead to passive alcoholization? Int J Environ Res Public Health. 2010;7:3038-3050.

Gormley NJ, Bronstein NC, Rasimas JJ, et al. The rising incidence of intentional ingestion of ethanol-containing hand sanitizers. Crit Care Med. 2012;40:290-294.

Chaloupka FJ, Grossman M, Saffer H. The effects of price on alcohol consumption on alcohol related problems. Alcohol Res Health. 2002;26:22-33.

Hilburn J, Hammond BS, Fendler EJ, Groziak PA. Use of alcohol-based hand sanitizers as an infection control strategy in an acute care facility. Am J Infect Control. 2003;31:109-116.