POISON CONTROL
Don’t be Blind to the Risk of
Contaminated Hand Sanitizers Chiemela Ubani, Pharm.D.
Anthony DeGelorm, Pharm.D.
Clinical Toxicology Fellow at Florida/USVI Poison Information Center-Jacksonville
With the international emergence of the SARS-CoV-2 virus, the Centers for Disease Control and Prevention (CDC) has updated its infection control guidance to place more emphasis on the use of personal protection equipment (PPE), hand washing, social distancing and alcohol-based hand rubs to prevent the spread of the virus.1 Alcohol-based hand rubs, such as hand sanitizers, are inexpensive, readily available and easy to use, thereby making them a staple product to have on hand. Most hand sanitizers contain ethyl alcohol (ethanol) or isopropyl alcohol (isopropanol) as active ingredients. These are generally safe when used topically and are known to inactivate the virus at concentrations between 65-90%.1 A growing need for hand sanitizer 36
Clinical Toxicology Fellow at Florida/USVI Poison Information Center-Jacksonville
products has led to a spike in mass production and a lack of quality control, allowing items with contaminants to reach the market. Substances like methanol, which are normally removed in the ethanol manufacturing process, are left in the products due to haphazard and hasty distilling techniques.7 Methanol is not an U.S. Food and Drug Administration (FDA) approved ingredient for hand sanitizers and is known to be quite toxic. Due to multiple cases and deaths from the ingestion of these contaminated products, the FDA issued a warning in June 2020 about nine hand sanitizers manufactured by Eskbiochem SA de CV in Mexico that reached the U.S. market.2 The FDA has now expanded that list to over 75 products.2 With hand sanitizers becoming increasingly important in EMpulse Fall 2020
preventing transmission of the SARSCoV-2 virus and an increasing number of products coming to market, it’s essential for healthcare providers to become familiar with the signs and symptoms of methanol toxicity. Methanol, also known as wood alcohol, has been around for centuries and was used as a component of embalming fluid as far back as ancient Egypt.5 Methanol is considered a “toxic alcohol,” which refers to alcohols that are not intended for human consumption. Methanol-containing products commonly encountered include windshield washer fluid, gas line antifreeze, solid cooking fuel and photocopying fluid. Methanol can be absorbed via oral, inhalation and dermal routes. Ingestion can occur accidentally with children or inten-
