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Am J Perinatol 2022; 39(15): 1634-1642
DOI: 10.1055/s-0041-1736287
Short Communication

Handwashing Results in Incomplete Nicotine Removal from Fingers of Individuals who Smoke: A Randomized Controlled Experiment

Thomas F. Northrup 
1   Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
,
Angela L. Stotts
2   Department of Family and Community Medicine, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
,
Robert Suchting
3   Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, Texas
,
Amir M. Khan
4   Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
,
Michelle R. Klawans
5   Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
,
Charles Green
6   Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
,
Eunha Hoh
7   Division of Environmental Health, School of Public Health, San Diego State University, San Diego, California
,
Melbourne F. Hovell
8   Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, California
,
Georg E. Matt
9   Department of Psychology, San Diego State University, San Diego, California
,
Penelope J. E. Quintana
10   Division of Environmental Health, School of Public Health, San Diego State University, San Diego, California
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Abstract

Objective Tobacco residue, also known as third-hand smoke (THS), contains toxicants and lingers in dust and on surfaces and clothes. THS also remains on hands of individuals who smoke, with potential transfer to infants during visitation while infants are hospitalized in neonatal intensive care units (NICUs), raising concerns (e.g., hindered respiratory development) for vulnerable infants. Previously unexplored, this study tested handwashing (HW) and sanitization efficacy for finger-nicotine removal in a sample of adults who smoked and were visiting infants in an NICU.

Study Design A cross-sectional sample was recruited to complete an interview, carbon monoxide breath samples, and three nicotine wipes of separate fingers (thumb, index, and middle). Eligible participants (n = 14) reported current smoking (verified with breath samples) and were randomly assigned to 30 seconds of HW (n = 7) or alcohol-based sanitization (n = 7), with the order of finger wipes both counterbalanced and randomly assigned. After randomization, the first finger was wiped for nicotine. Participants then washed or sanitized their hands and finger two was wiped 5 minutes later. An interview assessing tobacco/nicotine use and exposure was then administered, followed by a second breath sample and the final finger wipe (40–60 minutes after washing/sanitizing).

Results Generalized linear mixed models found that HW was more effective than sanitizer for nicotine removal but failed to completely remove nicotine.

Conclusions Without proper protections (e.g., wearing gloves and gowns), NICU visitors who smoke may inadvertently expose infants to THS. Research on cleaning protocols are needed to protect vulnerable medical populations from THS and associated risks.

Key Points

  • NICU infants may be exposed to THS via visitors.

  • THS is not eliminated by HW or sanitizing.

  • THS removal protections for NICU infants are needed.

Keywords

thirdhand smoke - THS - neonatal ICU - THS removal - handwashing - sanitizer

Note

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (1R03HD088847; PI: T.F.N.) at the U.S. National Institutes of Health and Department of Health and Human Services. This work was supported in part by the National Heart, Lung, and Blood Institute (R01 HL107404, PI: A.L.S.) at the U.S. National Institutes of Health and Department of Health and Human Services.




Publication History

Received: 09 June 2021

Accepted: 01 September 2021

Article published online:
11 October 2021

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