HEALTH ADVISORY: Hand Sanitizer and Disinfectant Chemical Exposure

April 27, 2020

Background: 

The Texas Department of State Health Services (DSHS) is warning the public of improper use of hand sanitizers and disinfectant products during the COVID-19 pandemic.

From March to April, the Texas Poison Center Network (TPCN) has experienced a 64 percent increase in calls compared to the previous year about health concerns from accidental ingestion of hand sanitizer. Most of these calls (303, 69 percent) involved young children less than 5 years. The majority of calls reported accidental ingestion, but some reported hand sanitizer contacting skin and eyes.

Hand sanitizers can be tempting to children because they may be packaged in colorful bottles, with sweet smells. The most effective hand sanitizers contain ethyl alcohol at concentrations ranging from 60 to 95 percent. Young children can get alcohol poisoning by swallowing just a few squirts of hand sanitizer.

Additionally, the TPCN received increased calls about accidental use of bleach (67 percent increase) and other disinfectant products (149 percent increase calls). About 24percent (295) of these calls reported accidental ingestions involving young children less than 5 years. Calls also reported exposures to skin and breathing in fumes.

When used correctly, hand sanitizers and disinfectant products, including bleach, are safe and effective. However, improper use can have harmful health effects, and young children are more at risk for these health effects. 

Clinical Presentation:

The risk of harmful effects depends on the route of exposure, the amount of substance and the type of product. Common signs and symptoms associated with exposure to hand sanitizer and disinfectant products include conjunctivitis, mild irritation or redness of the skin, nausea or vomiting, mouth or throat irritation, and cough and abdominal pain. Some signs of alcohol poisoning include confusion, vomiting, slow breathing, low body temperature and bluish skin color.

When bleach is mixed with other cleaners breathing in the fumes may cause coughing, chest tightness, burning and irritation of the eyes, nose and throat, headache, choking and in severe cases death. 

Recommendations for Public:

To reduce improper use and prevent unnecessary chemical exposures, users should:

• Always read and follow directions on the label,
• Only use water at room temperature for dilution (unless stated otherwise on the label),
• Wear eye and skin protection,
• Ensure adequate ventilation,
• Store chemicals out of the reach of children.
• Avoid mixing chemical products. NEVER mix bleach with other household cleaners. Bleach can become a dangerous gas if mixed with other household cleaners such as ammonia.
• Use hand sanitizer only when soap and water are not available. Guidance on proper hand sanitizer use may be found at the Centers for Disease Control and Prevention website.

Guidance for cleaning and disinfecting public spaces, workplaces, businesses, schools and homes may be found at the Centers for Disease Control and Prevention website.

For More Information: 

Individuals who believe they may have been exposed to hand sanitizers and disinfectant products and are concerned about their health should contact their health care provider, or the Texas Poison Center Network at 1-800-222-1222.

DSHS Environmental Surveillance and Toxicology Branch
512-776-7268
epitox@dshs.texas.gov

More information: EPA, CDC Release Guidance for Cleaning and Disinfecting Spaces Where Americans Live, Work, and Play