Objective: To describe a case of intentional ingestion of hand sanitiser 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: 17-year-old male 37kg with an intentional ingestion of a hand sanitiser product into his gastrostomy tube.
Interventions: Intubation, ventilation and haemodialysis.
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 to 2009. A literature search found 14 detailed case reports of intentional alcohol-based hand sanitiser ingestions with one death. From 2005 to 2009, the National Poison Data System received reports of 68,712 exposures to 96 ethanol-based hand sanitisers. The number of new cases increased by an average of 1894 (95% CI, 1266 to 2521) cases per year (p = 0.002). In 2005, the rate of exposures, per year, per million US residents was 33.7 (95% CI, 28.4 to 39.1); from 2005 to 2009, this rate increased on average by 5.87 per year (95% CI, 3.70 to 8.04; p = 0.003). In 2005, the rate of intentional exposures, per year, per million US residents, was 0.68 (95% CI, 0.17 to 1.20); from 2005 to 2009, this rate increased on average by 0.32 per year (95% CI, 0.11 to 0.53; p = 0.02).
Conclusions: The number of new cases per year of intentional hand sanitiser ingestion significantly increased during this 5-year period. Although the majority of cases of hand sanitiser ingestion have a favourable 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 behaviour or suicidal ideation.