Alcohol-Based Hand Sanitizers and Unintended Pediatric Exposures: A Retrospective Review

Abstract

Alcohol-based hand sanitizers (ABHS) have proliferated throughout the United States in recent years and are now common products in households and hospitals. These products are effective and can reduce absenteeism caused by gastrointestinal illness in elementary school students. The most common ABHS generally use ethyl alcohol as their active ingredient, with concentrations of this compound in the 60% ethanol-by-weight range. Inactive or ingredients are water, isopropyl alcohol, some fragrances, and other emollients. Isopropanol compounds are also occasionally used. Although these agents would not be considered to have a good flavor by most consumers, purposeful abuse to achieve intoxication has been previously reported. In light of the high alcohol concentrations and extraordinary dissemination of these products, we sought to characterize what acute impact, if any, exposure to these products has on young children. To provide a preliminary description in a pediatric population, we studied exposures to ABHS in individuals less than 6 years of age within the Texas Poison Center Network (TPCN) during 2006 and 2007. In 2006 and 2007, there were a total of 826 and 1022 total exposures meeting the study criteria, respectively. Of these exposures, 685 and 792 were in children under 6 years of age, and 621 and 737 exposures were ingestions, 2 and 1 were inhalations, 32 and 20 were ocular, and 30 and 33 were dermal. The type of exposure could not be discerned in 1 case in the 2007 database. Of the entire study population, 55 and 62 sustained a minor effect, and 9 and 11 had effects. Our study demonstrates a paucity of significant effects for exposures related to these products. Since there were no moderate or major effects reported from 1477 children, the product appears relatively safe when misused by this age group. As with many pediatric exposures, the exposures in children under 6 almost invariably occurred as a brief taste or accidental ocular or dermal exposure, thus resulting in little or no toxicity. Of course, significant poisoning and even deaths do occur in children despite this tasting tendency, resulting from substances capable of causing toxicity in low concentrations. Examples of such substances include camphor, sulfonylureas, lead, clonidine, and methylsalicylates. 10 In the setting of young children and ABHS in current formulations, it seems that significant intoxication is extremely unlikely.