The cat is out of the bag and research from The University of Florida, and published in the March 2011 Journal of Analytical Toxicology confirms what I already knew. To be a good doctor or nurse in the hospital these days following diligent handwashing hygiene, you have to be drunk. In an evidence based world, anyone seeking out a role in health care will be required to undergo forced alcohol tolerance training.
These findings are going to change how hospitals perform their physician credentialing and how states license their physicians as well as offer up a new defense opportunity angle for Lindsay Lohan. I'm going to have to start answering yes when asked if I have a drug or alcohol problem. Because it turns out to be a good evidence based doctor or nurse these days, we have to take care of patients while drunk.
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How say you Happy? What's the premise of the research? University of Florida research began their evidence based quest to prove the relationship between hand sanitizer and urinary alcohol levels by forcing willing participants to cleanse their hands every five minutes over a ten hour period for three consecutive days.
They argue this is equivalent to good handwashing technique for a routine daily nursing experience. That works out to 120 daily episodes of exposure to hand sanitizer (Purell™) in a normal nursing shift.
They wished to test alcohol absorption from the frequent use of hand sanitizer in the expected working world of health care professionals. One can check blood alcohol levels (here's the highest blood alcohol concentration ever), by breathlizer (here's that famous picture of man arrested for drunk driving while wearing a breathalyzer costume making him the funniest criminal arrest of the year) or by urine.
Many alcoholic beverages contain ethyl alcohol, the same alcohol used in many hand sanitizers. Does our body absorb this alcohol through the skin in measurable amounts? That's what these researchers decided to find out.
In the case of urine testing for positive alcohol exposure, several metabolites can be tested including ethyl glucuronide (EtG) and ethyl sulfate (EtS). Ethyl glucuronide is most commonly used in testing exposure to alcohol in the work place or court system. While blood and breathalyzer testing only tests for the acute exposure to alcohol, urine testing of these metabolites can be used to search for longer term alcohol exposure as the metabolites remain long after the acute alcohol exposure has ended. It's the same concept as testing one for cotinine after smoking, a compound that can be detected for up to a month or more in the urine long after the nicotine has been metabolized.
How did our germ free participants do? Nearly all participants had levels of alcohol metabolites consistent with drinking moderate amounts of alcohol. That means Lindsay Lohan or the disruptive physician accused of being drunk by an angry Night Nurse RN, MSN, M'M, PRN may have an alibi. They were just being a diligent germ free doctor and trying to protect their patients from VRSA.
The researchers, however, did clarify their findings by suggesting that ehtyl sulfate levels did not rise significantly in hand sanitizer exposure as they did with alcohol beverage consumption, and in fact, this test may be much more important in clarifying positive urine testing from beverage versus hand sanitizer exposure than the more commonly used ethyl glucuronide.
Regardless of whether the doctors and nurses get drunk during their lunch break or during the normal daily exposure to hand sanitizer, I think the take home message remains. If you want to practice good evidence based medicine, your going to have to be drunk to do so.
Which means, in this new era of CMS physician pay for performance PQRI madness where we measure compliance instead of outcomes, I formally submit to CMS that we start a program of measuring alcohol levels in all physicians and nurses to verify that we are in fact all practicing drunk.
One other thing. For you ER nurses and doctors, instead of calling the hospitalist to admit an alcohol withdrawal patient that is too weak to go home, just slather on a full body hand sanitizer bath and send them on their way. The more the merrier.
Who's with me?
- You can watch the University of Florida video about their hand sanitizer study.
- Read the University of Florida press release about the study.
