Harald Below

Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans

BackgroundDespite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical hand disinfection using three different alcohol-based hand-rubs, and to quantify absorption levels in humans.MethodsTwelve volunteers applied three hand-rubs containing 95% (hand-rub A), 85% (hand-rub B) and 55% ethanol (hand-rub C; all w/w). For hygienic hand disinfection, 4 mL were applied 20 times for 30 s, with 1 minute break between applications. For surgical hand disinfection, 20 mL of each hand rub was applied to hands and arms up to the level of the elbow 10 times for 3 minutes, with a break of 5 minutes between applications. Blood concentrations of ethanol and acetaldehyde were determined immediately prior and up to 90 minutes after application using head space gas chromatography.ResultsThe median of absorbed ethanol after hygienic hand disinfection was 1365 mg (A), 630 mg (B), and 358 mg (C). The proportion of absorbed ethanol was 2.3% (A), 1.1% (B), and 0.9% (C). After surgical hand disinfection, the median of absorbed ethanol was 1067 mg (A), 1542 mg (B), and 477 mg (C). The proportion of absorbed ethanol was 0.7% (A), 1.1% (B), and 0.5% (C). The highest median acetaldehyde concentration after 20 hygienic hand disinfections was 0.57 mg/L (hand-rub C, after 30 min), after 10 surgical hand disinfections 3.99 mg/L (hand-rub A, after 20 minutes).ConclusionThe overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based hand-rubs is safe.

Investigating the Mutagenicity of a Cold Argon-Plasma Jet in an HET-MN Model.

Objective So-called cold physical plasmas for biomedical applications generate reactive oxygen and nitrogen species and the latter can trigger DNA damage at high concentrations. Therefore, the mutagenic risks of a certified atmospheric pressure argon plasma jet (kINPen MED) and its predecessor model (kINPen 09) were assessed. Methods Inner egg membranes of fertilized chicken eggs received a single treatment with either the kINPen 09 (1.5, 2.0, or 2.5 min) or the kINPen MED (3, 4, 5, or 10 min). After three days of incubation, blood smears (panoptic May-Grünwald-Giemsa stain) were performed, and 1000 erythrocytes per egg were evaluated for the presence of polychromatic and normochromic nuclear staining as well as nuclear aberrations and binucleated cells (hen’s egg test for micronuclei induction, HET-MN). At the same time, the embryo mortality was documented. For each experiment, positive controls (cyclophosphamide and methotrexate) and negative controls (NaCl-solution, argon gas) were included. Additionally, the antioxidant potential of the blood plasma was assessed by ascorbic acid oxidation assay after treatment. Results For both plasma sources, there was no evidence of genotoxicity, although at the longest plasma exposure time of 10 min the mortality of the embryos exceeded 40%. The antioxidant potential in the egg’s blood plasma was not significantly reduced immediately (p = 0.32) or 1 h (p = 0.19) post exposure to cold plasma. Conclusion The longest plasma treatment time with the kINPen MED was 5–10 fold above the recommended limit for treatment of chronic wounds in clinics. We did not find mutagenic effects for any plasma treatment time using the either kINPen 09 or kINPen MED. The data provided with the current study seem to confirm the lack of a genotoxic potential suggesting that a veterinary or clinical application of these argon plasma jets does not pose mutagenic risks.

Jodidurie bei Schulkindern in Deutschland 1999 im Normbereich

ZusammenfassungHintergrund: Verbesserte Gesetzgebung (1989, 1993) und forcierte Aufklärungsarbeit führten zum Ansteigen der Jodversorgung der deutschen Bevölkerung, wie jüngere regionale Untersuchungen zeigten. Kinder und Jugendliche profitierten als Erste davon. Strumaprävalenz und Schilddrüsengröße sanken signifikant bzw. normalisierten sich. Aktuelle deutschlandweite Untersuchungen zur alimentären Jodversorgung, gemessen an der Jodidurie, fehlen. Nach WHO-Empfehlung sind Sechs- bis Zwölfjährige die geeignetste Indikatorgruppe hierfür. Probanden und Methodik: Wir untersuchten im Frühjahr 1999 die Urinjodidausscheidung (Cer-Arsenit-Methode) bei insgesamt 3065 sechs- bis zwölfjährigen gesunden Schülern an 128 Standorten Deutschlands, verteilt über alle Bundesländer. Ergebnisse: Die mediane Jodidausscheidung in der Gesamtstichprobe betrug 148 μg/l. Die WHO empfiehlt einen Optimalbereich von 100–200 μg/l. Signifikante Unterschiede zwischen Geschlecht, Alter, Bundesland, den Regionen Deutschland Nord, Mitte und Süd, den neuen und alten Bundesländern gab es nicht. Entsprechend den Forderungen von WHO/UNICEF/ICCIDD hatten 73% der Schüler eine suffiziente Jodidurie (>100 μg/l). 20% wiesen einen milden (50–99 μg/l), 6% einen moderaten (20–49 μg/l) und 1% einen schweren (< 20 μg/l) Jodmangel auf. 8% schiedenmehr als 300 μg Jodid/l aus. Schlussfolgerungen: Die Ursache für das Überwinden des Jodmangels in Deutschland liegt in der hohen Akzeptanz von Jodsalz im Lebensmittel herstellenden Handwerk, der Gastronomie (70–95%) und der Lebensmittelindustrie, wobei die Quote von 40% bei Letztgenannten noch nicht ausreichend ist.AbstractBackground: Recent regional investigations have shown that the abolition of the requirement to declaire iodine in foodstuffs and the greater emphasis on information about goitre prevention led to an increase in urinary iodine excretion in Germany. There was also a decrease in thyroid size and goitre prevalence in children. No up to date results for the whole of Germany are available. Probands and Methods: In 1999 we examined the urinary iodine excretion in the spontaneous morning urine of 3,065 healthy 6- to 12-year-old school children in 128 places from all over Germany. The iodine was measured by the Cer-arsenit method. Results: The median iodine excretion amounted to 148 μg/l. There were no significant differences between age groups, sexes or regions. 73% had no iodine deficiency (> 100 μg/l). In 20% the deficiency was slight (50–99 μg/l), in 6% moderate (20–49 μg/l) and in 1% there was a severe iodine deficiency (< 20 μG/l). 8% excreted > 300 μg iodine per liter urine. Conclusion: According to the WHO guidelines, there is no longer a iodine deficiency in Germany – at least among children prior to puberty.

Smoking as a risk factor for thyroid volume progression and incident goiter in a region with improved iodine supply.

OBJECTIVE The role of smoking in the pathogenesis of thyroid enlargement is currently under debate. It has been hypothesized that the effect of smoking on increased thyroid volume is larger in regions with than in regions without iodine deficiency. The aim of this paper was to investigate the association of smoking with thyroid volume progression and incident goiter for different age-strata in a region with improved iodine supply. DESIGN AND METHODS The population-based Study of Health in Pomerania compromised 3300 subjects with complete 5-year examination follow-up. Data from 2484 participants without known history of thyroid disorder or thyroid medication were analyzed. Thyroid size was evaluated by ultrasound. Determinants of thyroid volume progression and incident goiter, i.e., newly occurred goiter between baseline and follow-up, were analyzed by linear and logistic regression respectively. RESULTS Participants aged 20-39 years who were current smokers at baseline and at follow-up had a lower risk of incident goiter (odds ratio: 0.33; 95% confidence interval (CI): 0.15; 0.71; P=0.005). In this subpopulation, age was inversely related to thyroid volume progression. In subjects aged 60-79 years, smoking at baseline and follow-up was a risk factor for thyroid volume progression (beta: 3.37; 95% CI: 0.84; 5.89; P=0.009). After exclusion of individuals who had actual goiter in ultrasound at baseline, this association disappeared. CONCLUSION We conclude that the inverse association between smoking and goiter in young adults and the lacking association of smoking with goiter and thyroid volume progression in adult non-goitrous subjects indicate that smoking has a declining impact on thyroid growth in the study region. Our findings mirror the improved iodine supply of Northeast Germany.

Association of socioeconomic status with iodine supply and thyroid disorders in northeast Germany.

OBJECTIVES Studies on the potential association of socioeconomic status with iodine supply and the risk for thyroid disorders from developed countries are sparse. Socioeconomic status, however, may particularly impact the efficiency of iodine prophylaxis programs, which are based on the voluntary principle. This study aims to investigate whether the socioeconomic status is cross-sectionally and longitudinally related to low urinary excretion or thyroid disorders in the population of northeast Germany. METHODS Data of the population-based Study of Health in Pomerania were used. The study population comprised 4056 adults for cross-sectional and 2860 adults for longitudinal analyses. Assessment of socioeconomic status comprised different scales of education, income, employment, and occupation. Thyroid-related outcomes included urinary iodine excretion, serum thyrotropin, and sonographically defined goiter and nodules. Statistical analyses were adjusted for confounders. RESULTS Some of the socioeconomic variables were associated with thyroid-related characteristics in cross-sectional analyses. For example, there was an overall tendency for groups with higher education and higher income to have larger thyroid volumes and an increased risk of goiter. However, most of these associations did not attain statistical significance after correcting the target p-value for multiple testing. Longitudinal analyses did not demonstrate consistent results. CONCLUSIONS Socioeconomic status neither substantially influences iodine supply nor does it have a major impact on the prevalence and incidence of thyroid deficiency-related disorders in the adult population of northeast Germany, indicating a good efficacy of the German iodine fortification program in all socioeconomic groups.

Dermal and pulmonary absorption of propan-1-ol and propan-2-ol from hand rubs.

BACKGROUND It has been shown that nontoxic concentrations of ethanol are absorbed after hand hygiene using ethanol-based hand rubs. This study investigated whether absorption of propan-1-ol and propan-2-ol from commercially available hand rubs results in measurable concentrations after use. METHODS The pulmonary and dermal absorption of propanol during hand rubs was investigated. Rubs contained 70% (w/w) propan-1-ol, 63.14% (w/w) propan-2-ol, or 45% (w/w) propan-2-ol in combination with 30% (w/w) propan-1-ol. RESULTS Peak median blood levels were 9.15 mg/L for propan-1-ol and 5.3 mg/L for propan-2-ol after hygienic hand rubs and 18.0 mg/L and 10.0 mg/L, respectively, after surgical hand rubs. Under actual surgical conditions, the highest median blood levels were 4.08 mg/L for propan-1-ol and 2.56 mg/L for propan-2-ol. The same procedure performed with prevention of pulmonary exposure through the use of a gas-tight mask resulted in peak median blood levels of 1.16 mg/L of propan-1-ol and 1.74 mg/L of propan-2-ol. CONCLUSION Only minimal amounts of propanols are absorbed through the use of hand rubs. Based on our experimental data, the risk of chronic systemic toxic effects caused by hand rubs is likely negligible. However, our study did not evaluate the consequences of long-term daily and frequent use of hygienic hand rubs.

Five-Year Change in Morphological and Functional Alterations of the Thyroid Gland: The Study of Health in Pomerania

BACKGROUND While cross-sectional data on thyroid epidemiology are common, few longitudinal data on the incidence and progression of thyroid disorders exist. The aim of this study was to analyze the 5-year change and the incidence of morphological and functional alterations of the thyroid gland in a previously iodine-deficient area. METHODS We used 5-year follow-up data based on 2941 participants (20-79 years) of the population-based Study of Health in Pomerania. The thyroid structure and size were measured by ultrasonography. Thyroid function and serum autoantibodies to thyroperoxidase (anti-TPO-Ab) were evaluated. RESULTS During follow-up, the median iodine/creatinine ratio decreased slightly from 134.2 to 130.4 μg/g. The mean thyroid volume was nonsignificantly increased by 0.73 mL [confidence interval (CI) -1.68-3.41 mL]. The incidence rate of goiter was 34.0 [CI 30.7-37.7] per 1000 person-years (py), the incident rate of nodules was 16.6 [CI 14.5-19.1] per 1000 py. Median serum thyrotropin levels increased slightly (0.10 [CI -0.10-0.34 mIU/L]). The incidence of positive anti-TPO-Ab was 3.4 [CI 2.6-4.7] per 1000 py. For all thyroid parameters, the regression rates were higher than the incidence rates. CONCLUSIONS After iodine fortification became effective in this previously iodine-deficient region, there is a negative net balance between occurring and reverting goiter and nodules. Along with balanced incidences of hyper- and hypothyroid dysfunction and the low incidence of autoimmune-related findings, these findings indicate that the current iodine status is sufficient to prevent iodine deficiency-related disorders in the adult population of the study region.

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4))

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air. Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b.

Decontamination of room air and adjoining wall surfaces by nebulizing hydrogen peroxide.

Aim: In 2010, the ASP GLOSAIRTM 400 was introduced in Germany for nebulizing hydrogen peroxide (H2O2). Since there were no results of practical experience, the new method was to be checked under practical conditions for its effectiveness in decontaminating air in rooms, infested with mold after water damage and, at the same time, under experimentally controlled conditions, test surfaces, contaminated with Aspergillus brasiliensis. Method: After the nebulizer was used in two rooms with a massive mold infestation, the air colony count was determined (MAS-100® Zinsser Analytik) and, at the same time, the mold infestation in samples of wall plaster. As part of this controlled study, test surfaces contaminated with Aspergillus brasiliensis were positioned vertically and horizontally in a test room. The effectiveness of the nebulization (5–6% H2O2 for 2 hours) was tested on these surfaces according to EN 13697. Results: In a massive mold infestation resulting from water damage (worst case), an approximately 9-fold decrease in the mold content and an approximately 13-fold decrease in the number of colony-forming units (sum of the bacteria + fungi) could be detected in the room air immediately after the nebulizing was finished. Even in samples of wall and joint plaster, the molds were reduced, although to a distinctly lesser extent. By indoor nebulization of 5–6% H2O2, A. brasiliensis was reduced >4 log on vertical and horizontal surfaces. Discussion: In rooms with a massive mold infestation, the ASP GLOSAIRTM 400 system is suitable for attaining a clear reduction in the fungal and bacterial room air load, lasting for a week. On vertical and horizontal surfaces, contaminated experimentally with A. brasiliensis, a reduction of >4 lg is achieved. As a load of 104 to 105 fungal spores is unlikely to occur on pre-cleaned surfaces, the GLOSAIRTM 400 can be considered a suitable complementary process for the substantial reduction of fungal contamination.

Can physical stress be measured in urine using the parameter antioxidative potential

Although regular exercise is known to promote health, it is also well known that competetive sports can lead to an increase of free radical production, and thus to a drop in antioxidative potential. Thus, the present study examined the effect of competetive sports on the antioxidative potential (AOP). Using chemoluminescence, the AOP was measured in the spontaneous urine of leisure and semi-professional athletes during a training camp. Further, the parameters creatinin and uric acid were measured. It was shown that physical stress led to a drop in the antioxidant potential of up to approximately 50%. To compensate for this decline, special antioxidant food is recommended.