Short Communication: Is Ethanol-Based Hand Sanitizer Involved in Acute Pancreatitis after Excessive Disinfection?-An Evaluation with the Use of PBPK Model

Abstract

An occupational physician reported to the French Health Products Safety Agency (Afssaps) a case of adverse effect of acute pancreatitis (AP) in a teaching nurse, after multiple demonstrations with ethanol-based hand sanitizers (EBHSs) used in a classroom with defective mechanical ventilation. It was suggested by the occupational physician that the exposure to ethanol may have produced a significant blood ethanol concentration and subsequently the AP. In order to verify if the confinement situation due to defective mechanical ventilation could increase the systemic exposure to ethanol via inhalation route, a physiologically based pharmacokinetic (PBPK) modeling was used to predict ethanol blood levels. Under the worst case scenario, the simulation by PBPK modeling showed that the maximum blood ethanol concentration which can be predicted of 5.9 mg/l is of the same order of magnitude to endogenous ethanol concentration (mean = 1.1 mg/L; median = 0.4 mg/L; range = 0-35 mg/L) in nondrinker humans (Al-Awadhi et al., 2004). The present study does not support the likelihood that EBHS leads to an increase in systemic ethanol concentration high enough to provoke an acute pancreatitis.

Figure 1

Schematic representation of the ethanol physiologically based pharmacokinetic model (PBPK) proposed by Pastino et al. [3].

Figure 2

(a) Atmospheric ethanol concentration (day 1). By using the AIHA software, the ethanol atmospheric emission was calculated as follows: 30 rubbing hands (RH) at time 0 h, 30 RH at 3 h and 30 RH at 6 h resulting in a mean ethanol atmospheric concentration of 408 mg/m³ (time 0–3 h), 768 mg/m³ (time 3–6 h), and 1108 mg/m³ (time 6–8 h). (b) Atmospheric ethanol concentration (day 2). By using the AIHA software, the ethanol atmospheric emission was calculated as follows: 30 rubbing hands (RH) at time 0 h, 30 RH at 3 h, and 30 RH at 6 h resulting in a mean ethanol atmospheric concentration of 924 mg/m³ (time 0–3 h), 1224 mg/m³ (time 3–6 h), and 1518 mg/m³ (time 6–8 h).