The article published in BMJ Case Reports stated: “alcohol-based hand sanitizers, if ingested, can have toxic effects and may even be lethal,” and highlighted the cases of a man and a woman who both died after drinking it. Further steps need to be taken to warn people of the potential dangers of the product, which has become extremely popular during the COVID-19 pandemic, it said.
The pandemic has coincided with a spike in poisoning cases as a result of people both intentionally and unintentionally ingesting alcohol-based hand sanitizers.
In March 2020, there was a 79% increase in calls to Poison Control related to hand sanitizer compared to March 2019. Researchers have detected significant upticks in poisoning cases related to alcohol-based hand sanitizers outside the US too.
In the U.K., there was a 157% increase in such cases reported to the National Poisons Information Service between January and September 2020, compared to the same period in 2019.
Alcohol-based hand sanitizers can come in the form of a gel, liquid or foam, containing 60-95% ethanol or 70-95% isopropanol. As they can be lethal when ingested, many of them contain denaturants to make them taste bitter and discourage people from drinking them.
However, the Food and Drug Administration (FDA), which has recalled more than 200 unsafe hand sanitizers, has discovered numerous instances of alcohol-based hand sanitizers being disguised as food or drinks, including children’s snacks, beer, water, juice and vodka, as well as flavored varieties claiming to taste like chocolate or raspberries.
One case study highlighted in BMJ Case Reports was that of John Haughey.
In September 2015, the 76-year-old man with a history of depression and agitation, died at Hull Royal Infirmary in England after swallowing an unknown quantity of an alcohol-based hand sanitizing foam that was in a dispenser at the foot of his bed.
Haughey had shown increasing signs of confusion in the nine months leading to his admission to the hospital. An analysis of this case and another from 2013 has shed light on the dangerous potential for misuse of hand sanitizers.
Lead researcher Georgia C. Richards, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford wrote in BMJ Case Reports: “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.”
The researchers say that “appropriate” national action from the U.K.’s Department of Health after the 2014 death of Donna Kirkland could have prevented hundreds of further poisoning cases. Kirkland, a 30-year-old woman, died in the Caludon Centre mental health facility in Coventry, England, after ingesting alcohol-based hand sanitizer.
A Prevention of Future Deaths report sent by the coroner to the then-U.K. Health Secretary Jeremy Hunt said that a polystyrene cup and a soda bottle containing alcohol-based hand sanitizer were found on and beside Kirkland’s bed.
“The liquid was an alcohol-based hand sanitizing gel… which was readily accessible to patients from a dispenser installed close to the main doors of the ward,” the report said.
“Patients were not only allowed to access the dispenser but were permitted, if they so wished, to fill cups or other containers with the alcohol-based hand sanitizing gel. Patients were allowed to keep alcohol-based hand sanitizing gel in their rooms.”
It added: “In my opinion action should be taken to prevent future deaths and I believe you or your organization have the power to take such action.”
In response, the NHS Trust pledged to “raise the awareness of its staff of the potential risks associated with the ingestion of alcohol.”
However, as the BMJ Care Reports write-up explained: “There are no mechanisms for verifying or monitoring the implementation of these actions, nor is it possible to determine whether the actions became standard practice and are still being endorsed across the Trust.”
It continued: “Had appropriate actions been taken at a national level by the U.K.’s Department of Health in 2014 … hundreds of poisonings reported to the NPIS in 2019 and 2020 might have been prevented.
“The combination of increased demand and exposure to alcohol-based hand sanitizers, and the negative impacts of the COVID-19 outbreak on mental health, social supports, financial security and health services is a cause of serious concern.”
The researchers have issued fresh calls for the launch of public health campaigns to increase awareness of how people should and shouldn’t use alcohol-based hand sanitizers, and the requirement for manufacturers to display clear warning labels on products.
They also recommend that healthcare establishments track the volume of hand sanitizer being dispensed, and prevent access to alcohol-based hand sanitizers by patients with alcohol-related conditions and those in geriatric, pediatric or mental health facilities.
“Awareness and reporting of such exposures to public health agencies is essential to understand the full extent of the problem,” Richards told Newsweek by email.
“But data on the extent of the problem is limited as it relies on; the public or healthcare professionals reporting such incidents to public health agencies and public health agencies sharing such data, or healthcare professionals publishing such findings as a case report in a medical journal, as I do in the article.”
“We requested such data from Public Health England but could only get access to a short time frame of data due to the ‘costs’ of running such searches in their database.”
She added: “We are also conducting a systematic review of case reports to determine the extent of the problem in published literature.”
Despite the popularity of alcohol-based hand sanitizers, the Centers for Disease Control and Prevention states that handwashing with plain soap and water is the best way to reduce the spread of coronavirus.