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Coroners’ concerns to prevent harms
Alcohol-based hand sanitisers: a warning to mitigate future poisonings and deaths
  1. Georgia C Richards
  1. Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Georgia C Richards, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; georgia.richards{at}kellogg.ox.ac.uk

https://doi.org/10.1136/bmjebm-2020-111568

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    Alcohol-based hand sanitisers, if ingested, can have toxic effects and may even be lethal. Preventable deaths from ingesting hand sanitisers have been identified. This article describes two Prevent Future Death (PFD) case reports, and recommends eight actions to mitigate intentional and accidental ingestion of alcohol-based hand sanitisers in healthcare and community settings.

    This article is part of the Coroners’ Concerns to Prevent Harms series1 . It covers the toxicity of alcohol-based hand sanitisers from two Prevention of Future Deaths reports.2 3

    Since the COVID-19 outbreak, alcohol-based hand sanitisers have become among the most in-demand commodities globally.4 5 Panic buying left many shelves empty, and production increased to meet demands. Alcohol-based hand sanitisers are liquids, gels or foams that contain 60–95% ethyl alcohol (ethanol) or 70–95% isopropyl alcohol (isopropanol) used to disinfect hands6 (see box 1). The volume of these products now to be found around homes, hospitals, schools, workplaces and elsewhere may be a cause for concern. Warnings about the toxicity and lethality of intentionally or unintentionally ingesting alcohol-based hand sanitisers have not been widely disseminated.

    Box 1

    EBM facts: alcohol-based hand sanitisers6 10 18

    Formulations

    • liquids

    • gels

    • foams

    Ingredients

    • alcohol: ethanol (60–95%) or isopropanol (70–95%)

    • hydrogen peroxide (in selected products)

    • gelling or foaming agents, depending on formulation

    • an emollient (eg, glycerol)

    • sterile distilled or boiled water

    Indications for use

    • To disinfect hands, external use only

    • In healthcare settings it should be regularly used in line with the WHO’s ‘My 5 Moments for Hand Hygiene’, except when hands are soiled then water and soap is advised.

    • In all other settings it may be used when access to water and soap are not readily accessible.

    Regulations

    • In the UK, the MHRA categorises alcohol-based hand sanitisers as biocides if they claim to kill germs, disinfect, sanitise or use an active antimicrobial ingredient. If so, they are regulated through the Health and Safety Executive.

    • Other products …

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    Footnotes

    • Twitter @Richards_G_C

    • Correction notice Thia article has been corrected since it appeared Online First. In the second paragraph, 61% has been corrected to "157% increase in alcohol-based hand sanitiser poisonings from alcohol-based hand sanitisers reported to the National Poisons Information Service (NPIS)". Figure 1 caption of the same percentage has been updated from 61% to 157%.

    • Contributors GCR devised the idea for this article, identified the coroners’ reports, conducted a systematic literature search, submitted two freedom of information requests, analysed the data on calls to poisons centres, and wrote, edited and submitted the manuscript.

    • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed are those of the author and not necessarily reflect those of the NHS, the NIHR, or the Department of Health and Social Care.

    • Competing interests GCR is financially supported by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR), the Naji Foundation and the Rotary Foundation to study for a Doctor of Philosophy (DPhil/PhD) at the University of Oxford. GCR is the Editorial Registrar of BMJ Evidence Based Medicine and is developing the preventabledeathstracker.net website.

    • Patient consent for publication Not required. The coroner reports discussed in this article are openly available at https://www.judiciary.uk/subject/prevention-of-future-deaths/

    • Provenance and peer review Commissioned; externally peer reviewed.

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