后大流行时期的生活174——手卫生·其五【免洗洗手液】
洗手液的分类
洗手液与肥皂的区别
洗手液的潜在健康风险
市面上的洗手液根据主要有效成分一般分为醇类和非醇类两种，其中醇类的有效成分主要是乙醇和异丙醇，非醇类的有效成分则有碘化合物、季铵盐化合物、酚类、过氧化物、含氯化合物等。这和我们常见各种消毒剂成分并没有很大区别，在一些情况下直接使用消毒溶液临时替代洗手液也是可行的(不过消毒液的蒸发效果会使得其洗手效果变差)。主要使用方式则为凝胶、液体和泡沫。每种类型都有其自身的特点，但总体上来说凝胶由于可操作性方面的便利，使得其接受度更高。
在实际应用中，市场上广泛存在的是醇类洗手液，特别是乙醇洗手液。根据美国CDC的相关研究，浓度在60%~80%的乙醇是一种非常有效的灭活剂，可以灭活几乎所有亲脂性病毒（例如流感病毒、疱疹病毒）和许多亲水性病毒（例如脊髓灰质）[1]。而在世界卫生组织的相关建议中，乙醇洗手液也可以非常有效地应对前些年新出现的各种病毒，比如寨卡病毒（Zika）、埃博拉病毒（Ebola）和中东呼吸综合征病毒（MERS）[2]。在应对新型冠状病毒时，40%~80%的乙醇可以在5秒内达成对新冠病毒的灭活，从而降低我们的感染风险。
二、洗手液与肥皂的区别
三、洗手液的潜在健康风险
[1]Centers for Disease Control and Prevention. Infection Control. Disinfection & Sterilization Guidelines. Guidelines Library. Chemical Disinfectants: Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008. Available from: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html[Accessed 17 Feb 2021]
[2]Siddharta A, Pfaender S, Vielle NJ, Dijkman R, Friesland M, Becker B, Yang J, Engelmann M, Todt D, Windisch MP, Brill FH, Steinmann J, Steinmann J, Becker S, Alves MP, Pietschmann T, Eickmann M, Thiel V, Steinmann E. Virucidal Activity of World Health Organization-Recommended Formulations Against Enveloped Viruses, Including Zika, Ebola, and Emerging Coronaviruses. J Infect Dis. 2017 Mar 15;215(6):902-906. doi: 10.1093/infdis/jix046. PMID: 28453839; PMCID: PMC5407053.
[3]Tuladhar E, Hazeleger WC, Koopmans M, Zwietering MH, Duizer E, Beumer RR. Reducing viral contamination from finger pads: handwashing is more effective than alcohol-based hand disinfectants. J Hosp Infect. 2015 Jul;90(3):226-34. doi: 10.1016/j.jhin.2015.02.019. Epub 2015 Apr 10. PMID: 25936671.
[4]Foddai AC, Grant IR, Dean M. Efficacy of Instant Hand Sanitizers against Foodborne Pathogens Compared with Hand Washing with Soap and Water in Food Preparation Settings: A Systematic Review. J Food Prot. 2016 Jun;79(6):1040-54. doi: 10.4315/0362-028X.JFP-15-492. PMID: 27296611.
[5]Lachenmeier DW. Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity. J Occup Med Toxicol. 2008;3(1):1–6. 10.1186/1745-6673-3-26
[6]ones AW, Rajs J. Appreciable blood-ethanol concentration after washing abraised and lacerated skin with surgical spirit. J Anal Toxicol. 1997;21(7):587–8. 10.1093/jat/21.7.587
[7]Zaman F, Pervez A, Abreo K. Isopropyl alcohol intoxication: a diagnostic challenge. Am J Kidney Dis. 2002;40(3):e12–1. 10.1053/ajkd.2002.34938
[8]Emadi A, Coberly L. Intoxication of a hospitalized patient with an isopropanol-based hand sanitizer. N Engl J Med. 2007;356(5):530–1. 10.1056/NEJMc063237
[9]Mahmood A, Eqan M, Pervez S, Alghamdi HA, Tabinda AB, Yasar A, Brindhadevi K, Pugazhendhi A. COVID-19 and frequent use of hand sanitizers; human health and environmental hazards by exposure pathways. Sci Total Environ. 2020 Nov 10;742:140561. doi: 10.1016/j.scitotenv.2020.140561. Epub 2020 Jun 27. PMID: 32623176; PMCID: PMC7320712.
[10]Lakshmi C, Srinivas CR. Hand eczema: an update. Indian J Dermatol Venereol Leprol. 2012 Sep-Oct;78(5):569-82. doi: 10.4103/0378-6323.100547. PMID: 22960812.
[11]Vogel L. Hand sanitizers may increase norovirus risk. CMAJ. 2011 Sep 6;183(12):E799-800. doi: 10.1503/cmaj.109-3922. Epub 2011 Aug 15. PMID: 21844107; PMCID: PMC3168661.