Indiana University Bloomington

Indiana Prevention Resource Center (IPRC)

Alcohol in Another Form: Alcohol-Based Hand Sanitizer, a Public Health Risk from a Useful Product

In the midst of the cold and flu season come reminders to wash hands frequently or to use hand-sanitizers to help prevent disease transmission.  Hand sanitizers are products which help to reduce the spread of illness in schools, hospitals, malls, airports, and other institutional settings.  Due to the amount of alcohol in hand sanitizer, it has a potential for alcohol poisoning.   When ingested, alcohol in hand sanitizers may produce the same side-effects as beverage alcohol, including nausea and vomiting, cardiac irregularities, and respiratory depression.

Source: http://www.medicaldaily.com/downsides-hand-sanitizer-antimicrobial-additives-can-harm-your-health-and-environment-273736

The American Association of Poison Control Centers (AAPCC) reports there have been over 17,000 exposures if children under 12 every year since 2011. The term “exposure” in this context does not always mean poisoning, but refers to all calls concerning accidental or deliberate ingestion, ocular or dermal contact, or the inhalation of a substance.  While there have been case studies and reports of children being affected by hand sanitizers over the past few years, the Georgia Poison Center and Georgia Emergency Rooms made headlines in September when they announced a troubling trend of children drinking hand sanitizer.

Hand sanitizers typically contain 40-95% ethyl alcohol or isopropyl alcohol in addition to scents, a jelling agent and other chemicals.  The alcohol may be denatured with chemicals rendering it unsafe for consumption even without other ingredients.
For a comparison of alcohol content, wine is about 12% alcohol and a bottle of 60% hand sanitizer is the equivalent of 120 proof distilled spirits.  Ethyl alcohol or ethanol is the type of alcohol used in beverages, mouthwashes and other personal hygiene products, cosmetics, cleaning products, and medicine.  Isopropyl alcohol or isopropanol is used as a disinfectant or solvent and is found in rubbing alcohol, cleaning and industrial products.  Some hand sanitizers are made with the antimicrobial benzalkonium chloride rather than alcohol.
Hand sanitizers may be attractive to children due to smelling like fruit, flowers, baked goods or candy and may be brightly colored or contain glitter. Enticing names of available products include “iced ginger bread,” “spiced pumpkin,” “candy cane bliss,” “warm vanilla sugar,” “candy corn,” and “strawberry cheesecake.”

Most ingestion of hand sanitizers is unintentional, however, a study published in 2012 using data from the National Poison Data System found that 16% of exposures in 6-19 year olds between the years 2005-2009 were deliberate.  A small number of Youtube videos show youth drinking (or pretending to drink) hand sanitizers as a dare.  Social media provides drink recipes and methods of isolating the alcohol from the gel.

By their anti-microbial action, hand sanitizers aid in preventing infections and are gentler to use for those who work in health care and need to wash their hands dozens of times a day.  They are, however, yet another house-hold cleaning product which may be dangerous to children and should be controlled to prevent accidents or misuse.  Carole Nowicke, a research associate at the Indiana Prevention Resource Center suggests proper hand washing technique, using hand sanitizers appropriately and keeping them out of unsupervised reach of children.  “If hands are visibly soiled or greasy, you will need to wash with soap and water; alcohol-based hand cleaners are not a substitute.  Hand sanitizers are a useful product to help prevent spreading infection, but are not designed to be consumed.”  If you suspect your child has ingested hand sanitizer, call Poison Help at 1-800-222-1222 immediately. Do not wait for symptoms to develop.

 

References

American Association of Poison Control Centers (2015).  Hand Sanitizers. http://www.aapcc.org/alerts/hand-sanitizer/
Bonifield, John. (September 15, 2015). More children getting drunk on hand sanitizer. http://edition.cnn.com/2015/09/14/health/hand-sanitizer-poisoning/index.html
Stopera, Matt (Apr. 24, 2012).  14 Things You Need To Know About Drinking Hand Sanitizer: So, kids are drinking hand sanitizer to get drunk. Here’s everything you need to know about this hot new trend. Buzzfeed. Matt Stopera http://www.buzzfeed.com/mjs538/things-you-need-to-know-about-drinking-hand-saniti#.eyNKD0dpQ
FDA issues proposed rule to address data gaps for certain active ingredients in health care antiseptics. April 30, 2015. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm445002.htm
Georgia Poison Control Center (September, 2015).  Hand Sanitizer.  http://www.georgiapoisoncenter.org/hand-sanitizer/
Gormley, N. J., Bronstein, A. C., Rasimas, J. J., Pao, M., Wratney, A. T., Sun, J., & ... Suffredini, A. F. (2012). The rising incidence of intentional ingestion of ethanol-containing hand sanitizers. Critical Care Medicine, 40(1), 290-294. doi:10.1097/CCM.0b013e31822f09c0
Miller, M., Borys, D., & Morgan, D. (2009). Alcohol-Based Hand Sanitizers and Unintended Pediatric Exposures: A Retrospective Review. Clinical Pediatrics, 48(4), 429-431.
Rayar, P., & Ratnapalan, S. (2013). Pediatric Ingestions of House hold Products Containing Ethanol: A Review. Clinical Pediatrics, 52(3), 203-209. doi:10.1177/0009922812470970
Reynolds, S.A.,  Levy, F., &  Walker, E. S. (March, 2006).  Hand sanitizers. Emerging Infectious Diseases, 12 (3), 527-529.  http://wwwnc.cdc.gov/eid/article/12/3/pdfs/05-0955.pdf



By Carole Nowicke, Ph.D. 3/15/2016