Sobering thoughts as hand gel to blame for positive test

MEDICAL staff at a secure hospital unit for psychiatric patients have been forced to alter breath tests after alcohol hand gels were found to produce results equivalent to drinking a pint of beer.

Clinicians at the Orchard Clinic in Edinburgh have revised strict breath tests after they found that the 80 per cent proof fumes from the disinfectant rubs could yield "false positive" results among inmates.

The unit - which houses "mentally disordered" criminals from across Scotland - has asked clinical staff to "delay" the use of breathalysers or use soap and water instead after a female patient complained when she failed a routine check.

Despite insisting that she had not "touched a drop", the unnamed inmate tested positive for alcohol after returning from a period of weekend leave - and feared losing her privileges as a result. Medical staff investigated her denial and asked a clinician to reproduce the test - by first disinfecting hands in the normal way before using the "alcometer" device.The result recorded was equivalent to drinking two units of alcohol - which is the same as an average-strength pint of beer or a glass of wine.

They determined that alcohol used in the gels was lingering in the atmosphere in such quantities that traces could be inhaled during a breath test and massively skew the readings.

Staff at the unit highlighted the findings in a letter to the British Journal of Psychiatry.

It warned: "Recently a patient with 'restricted' status returned from leave outwith the clinic.

"On the patient's return she was breathalysed. The alcometer gave a reading of 0.04mg/lBrAC - equivalent to just under one unit of alcohol. The patient denied consuming alcohol. Staff had used an alcohol-based hand disinfectant lotion prior to carrying out the test. This was consistent with hand hygiene guidelines following the H1N1 flu pandemic.

"We later reproduced the positive alcometer results after using alcohol hand lotion in the standard way.

The reading rose from 0.01mg/LBrAC (background reading] to 0.1mg/lBrAC - equivalent to two units of alcohol."

The letter warned other practitioners of the "serious implications" for the management of forensic patients and urged them to consider using soap and water instead of the rubs - which became mandatory last year during the swine flu outbreak.

It concluded that vapours emitting from the hand gels - present in all hospital wards across the UK - were lingering in the atmosphere where they could be inhaled by patients.

The letter recommended that tests should be carried out at least five minutes after the application of the hand gel - sufficient time for the fumes to evaporate.

Or, the letter said, soap and water could be used instead.

Guidance has now been issued to all staff trained to use alcometers, but it is not known if any other patients have fallen foul of the sensitivity of the devices.

It emerged that there may also be implications for other organisations which use breathalysing equipment and hand gels, such as the police.

Dr Fionnbhar Lenihan, a consultant at the clinic, located in the grounds of the Royal Edinburgh Hospital, said: " We are aware only of this one incident involving alcohol hand gel and procedures have since changed to prevent this reoccurring.

"Breathalysing patients is considered on an individual basis, as is the need for any necessary reappraisal. We are extremely grateful to staff for their alertness and attention to detail regarding this matter." z