Disinfecting efforts lead to accidental poisonings

Since early March, calls to poison centers about exposures to cleaning and disinfectant chemicals increased sharply, according to an early online report in MMWR.

Moreover, when comparing the first quarter of the year over the last three years, “…exposures among children aged ≤5 years consistently represented a large percentage of total calls in the 3-month study period for each year (range = 39.9%-47.3%),” wrote Arthur Chang, MD, of the Division of Environmental Health Science and Practice at the National Center for Environmental Health, CDC, and colleagues. “Further analysis of the increase in calls from 2019 to 2020 (3,137 for cleaners, 4,591 for disinfectants), showed that among all cleaner categories, bleaches accounted for the largest percentage of the increase (1,949; 62.1%), whereas nonalcohol disinfectants (1,684; 36.7%) and hand sanitizers (1,684; 36.7%) accounted for the largest percentages of the increase among disinfectant categories.”

State and local public health officials, as well as the CDC, have recommended disinfecting surfaces and frequent hand washing or use of sanitizers to prevent spread of Covid-19, which raised the possibility that greater use of these substances could increase the risk of accidental exposure to toxins.

“The National Poison Data System, CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January–March 2020 with the number of reports during the same 3-month period in 2018 and 2019,” Chang and colleagues wrote. The data covered 55 poison centers that provide 24-hour service. For the 3 months ending March 31, “poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January–March 2019 (37,822) and January–March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and Covid-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.”

Most of the exposures were inhalations, “with an increase of 35.3% (from 4,713 to 6,379) for all cleaners and an increase of 108.8% (from 569 to 1,188) for all disinfectants,” they wrote.

Chang et al provided two case vignettes to illustrate the concerns: a woman who developed mild hypoxemia after inhaling fumes from a mixture of bleach, vinegar, and hot water that she was using to disinfect produce. The other case involved a pre-school child who drank an unknown quantity of hand sanitizer. The family said the child became dizzy, fell, and hit her head. She “was unresponsive at home and transported to the ED via ambulance… She vomited while being transported to the ED, where she was poorly responsive. Her blood alcohol level was elevated at 273 mg/dL (most state laws define a limit of 80 mg/dL for driving under the influence); neuroimaging did not indicate traumatic injuries. She was admitted to the pediatric intensive care unit overnight, had improved mental status, and was discharged home after 48 hours.”

Peggy Peck, Editor-in-Chief, BreakingMED™

Cat ID: 151

Topic ID: 88,151,254,930,125,926,138,192,927,151,590,928,925,934