COVID-19: Hand Sanitizer Poisonings Soar, Psych Patients at Risk

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Cases of poisoning — intentional and unintentional — from ingestion of alcohol-based hand sanitizer have soared during the COVID-19 pandemic.

In the United Kingdom alone, alcohol-based hand sanitizer poisonings reported to the National Poisons Information Service (NPIS) jumped 157% — from 155 between January 1 and September 16, 2019, to 398 between January 1 and September 14, 2020, new research shows.

Georgia Richards

More needs to be done to protect those at risk of unintentional and intentional swallowing of alcohol-based hand sanitizer, including children, people with dementia/confusion, and those with mental health issues, according to Georgia Richards, DPhil student, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, England.

"If providers are supplying alcohol-based hand sanitizers in the community to reduce the spread of SARS-CoV-2, the contents should be supplied in lockable and automated dispensers to reduce contamination and improve safety," Richards told Medscape Medical News.

The study was published online December 1 in BMJ Evidence-Based Medicine.

European, US Poisoning Rates Soar

In the paper Richards describes two deaths that occurred in hospitals in England.

In one case, a 30-year-old woman, detained in a psychiatric unit who received the antidepressant venlafaxine was found dead in her hospital bed with a container of hand-sanitizing gel beside her.

"The gel was readily accessible to patients on the ward from a communal dispenser, and patients were allowed to fill cups or other containers with it to keep in their rooms," Richards reports.

A post-mortem analysis found a high level of alcohol in her blood (214 mg of alcohol in 100 mL of blood). The medical cause of death was listed as "ingestion of alcohol and venlafaxine." The coroner concluded that the combination of these substances suppressed the patient's breathing, leading to her death.

The other case involved a 76-year-old man who unintentionally swallowed an unknown quantity of alcohol-based hand-sanitizing foam attached to the foot of his hospital bed.

The patient had a history of agitation and depression and was treated with antidepressants. He had become increasingly confused over the preceding 9 months, possibly because of vascular dementia.

His blood ethanol concentration was 463 mg/dL (100 mmol/L) initially and 354 mg/ dL (77mmol/L) 10 hours later. He was admitted to the intensive care unit, where he received lorazepam and haloperidol and treated with ventilation, with a plan to allow the alcohol to be naturally metabolized.

The patient developed complications and died 6 days later. The primary causes of death were bronchopneumonia and acute alcohol toxicity, secondary to acute delirium and coronary artery disease.

Since COVID-19 started, alcohol-based hand sanitizers are among the most sought-after commodities around the world. The volume of these products — now found in homes, hospitals, schools, workplaces, and elsewhere — "may be a cause for concern," Richards writes.

Yet, warnings about the toxicity and lethality of intentional or unintentional ingestion of these products have not been widely disseminated, she notes.

To reduce the risk of harm, Richards suggests educating the public and healthcare professionals, improving warning labels on products, and increasing the awareness and reporting of such exposures to public health authorities.

"While governments and public health authorities have successfully heightened our awareness of, and need for, better hand hygiene during the COVID-19 outbreak, they must also make the public aware of the potential harms and encourage the reporting of such harms to poisons information centers," she notes.

Increases in alcohol-based hand sanitizer poisoning during the pandemic have also been reported in the United States.

The American Association of Poison Control Centers (AAPCC) reports that data from the National Poison Data System (NPDS) show 32,892 hand sanitizer exposure cases reported to the 55 US poison control centers from January 1 through November 15, 2020 — an increase of 73% compared with the same time period during the previous year.

An Increase in Self-Harm

Weighing in on this issue, Robert Bassett, DO, associate medical director of The Poison Control Center at Children's Hospital of Philadelphia, Pennsylvania, told Medscape Medical News that "cleaning agents and disinfectants have been around for eons and their potential for toxicity hasn't changed."

"Now with COVID, and this hyper-vigilance when it comes to cleanliness, there is increased access and the exposure risk has gone up," he said.

"One of the sad casualties of an overstressed healthcare system and a globally depressed environment is worsening behavioral health emergencies and, as part of that, the risk of self-harm goes up," Bassett added.

"The consensus is that there has been an exacerbation of behavioral health emergencies and behavioral health needs since COVID started and hand sanitizers are readily accessible to someone who may be looking to self-harm," he said.

This research had no specific funding. Richards is the editorial registrar of BMJ Evidence Based Medicine and is developing a website to track preventable deaths. Bassett has disclosed no relevant financial relationships.

BMJ Evid Based Med. Published online December 1, 2020. Full text

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