Hand sanitizers are effective and inexpensive products that can reduce microorganisms on the skin, but ingestion or improper use can be associated with health risks.
Many hand sanitizers contain up to 60%–95% ethanol or isopropyl alcohol by volume, and are often combined with scents that might be appealing to young children.
Recent reports have identified serious consequences, including apnea, acidosis, and coma in young children who swallowed alcohol-based (alcohol) hand sanitizer. The major route of exposure to both alcohol and nonalcohol-based (nonalcohol) hand sanitizers was ingestion. The majority of intentional exposures to alcohol hand sanitizers occurred in children aged 6–12 years.
Alcohol hand sanitizer exposures were associated with worse outcomes than were nonalcohol hand sanitizer exposures. Caregivers and health care providers should be aware of the potential dangers associated with hand sanitizer ingestion. Children using alcohol hand sanitizers should be supervised and these products should be kept out of reach from children when not in use.
During 2011–2014, a total of 70,669 hand sanitizer exposures in youth were reported to NPDS, including 65,293 (92%) alcohol exposures, and 5,376 (8%) nonalcohol exposures.
It should be noted that hand washing with soap and water is the recommended method of hand hygiene in non–health care settings. If soap and water are not available, use of a hand sanitizer that contains at least 60% alcohol is suggested. Other options, such as nonalcohol hand sanitizers or wipes, can be used if soap and water or alcohol hand sanitizers are not available or practical.
In September 2016, the Food and Drug Administration issued a rule banning the use of triclosan, triclocarban, and 17 other chemicals in consumer hand and body antibacterial soaps and washes because of health and bacterial resistance concerns. However, this ban does not apply to hand sanitizers, hand wipes, or antibacterial soaps used in a health care setting. Hand washing with plain soap and water is safe and effective and does not carry these associated risks.
Increasing awareness of the potential dangers associated with intentional or unintentional ingestion of alcohol hand sanitizers might help encourage proper use and avoid adverse outcomes. Using alcohol hand sanitizers correctly, under adult supervision, and with proper child safety precautions and making sure they are stored out of reach of young children might reduce unintended adverse consequences.
Clinicians evaluating pediatric patients with clinical signs and symptoms consistent with alcohol toxicity, such as nausea, vomiting, respiratory depression, and drowsiness or laboratory results consistent with ethanol or isopropanol toxicity, should consider the possibility of an alcohol hand sanitizer ingestion and contact their local poison control center.