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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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