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The rising incidence of intentional ingestion of ethanol-containing hand sanitizers

Gormley, Nicole J. MD; Bronstein, Alvin C. MD; Rasimas, Joseph J. MD, PhD; Pao, Maryland MD; Wratney, Angela T. MD; Sun, Junfeng PhD; Austin, Howard A. MD; Suffredini, Anthony F. MD

doi: 10.1097/CCM.0b013e31822f09c0
Case Reports

Objective: To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System.

Design: A case report, a literature review of published cases, and a query of the National Poison Data System.

Setting: Medical intensive care unit.

Patient: Seventeen-yr-old male 37-kg with an intentional ingestion of a hand sanitizer product into his gastrostomy tube.

Interventions: Intubation, ventilation, and hemodialysis.

Measurements and Main Results: Incidence and outcome of reported cases of unintentional and intentional ethanol containing-hand sanitizer ingestion in the United States from 2005 through 2009. A literature search found 14 detailed case reports of intentional alcohol-based hand sanitizer ingestions with one death. From 2005 to 2009, the National Poison Data System received reports of 68,712 exposures to 96 ethanol-based hand sanitizers. The number of new cases increased by an average of 1,894 (95% confidence interval [CI] 1266–2521) cases per year (p =.002). In 2005, the rate of exposures, per year, per million U.S. residents was 33.7 (95% CI 28.4–39.1); from 2005 to 2009, this rate increased on average by 5.87 per year (95% CI 3.70–8.04; p = .003). In 2005, the rate of intentional exposures, per year, per million U.S. residents, was 0.68 (95% CI 0.17–1.20); from 2005 to 2009, this rate increased on average by 0.32 per year (95% CI 0.11–0.53; p = .02).

Conclusions: The number of new cases per year of intentional hand sanitizer ingestion significantly increased during this 5-yr period. Although the majority of cases of hand sanitizer ingestion have a favorable outcome, 288 moderate and 12 major medical outcomes were reported in this National Poison Data System cohort. Increased awareness of the risks associated with intentional ingestion is warranted, particularly among healthcare providers caring for persons with a history of substance abuse, risk-taking behavior, or suicidal ideation.

From the Critical Care Medicine Department (NJG, JS, AFS), Clinical Center, Bethesda, MD; the Rocky Mountain Poison Center (ACB), Denver Health, University of Colorado School of Medicine, Denver, CO; the National Institute of Mental Health (JJR, MP), Bethesda, MD; Children's National Medical Center (ATW), Washington, DC; and the National Institute of Diabetes and Digestive and Kidney Diseases (HAA), Bethesda, MD.

This study was supported by the Intramural Research Programs of the Clinical Center, National Institutes of Health (NIH), the National Institute of Mental Health, and the National Institute of Diabetes and Digestive and Kidney Diseases, at the NIH, Bethesda, MD, and the American Association of Poison Control Centers' National Poison Data System, Rocky Mountain Poison Center, Denver, CO. These organizations provided material support for design and conduct of the study; collection, management, analysis of the data; and preparation of the manuscript.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: asuffredini@cc.nih.gov

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins