Alcohol-based hand sanitizers are an important component of a hospital-based hand hygiene program, however, an unanticipated but potentially adverse byproduct is the intentional consumption of hand sanitizers by patients. In a letter to the editor of the Medical Journal of Australia, researchers Lachlan Batty, Anna Brischetto, Ajay Kevat and Michael Oldmeadow report the case of a patient with a history of substance abuse who ingested six bottles of hand sanitizer that contained 66 percent alcohol.
Batty, et al. report that the 45-year-old man, who had a history of polysubstance misuse, was admitted to the healthcare institution with epigastric pain in the setting of acute-on-chronic alcohol intake. No evidence of pancreatic or biliary disease was found and the diagnosis of probable alcohol-related gastritis was made. The researchers report, "On Day 3 of admission, the patient became increasingly drowsy. Clinical examination showed that he was rousable, and had a Glasgow Coma Scale score of 13. There were no other significant findings. Some hours later, six near-empty 375 mL bottles of Aqium Gel (Ego Pharmaceuticals), an antibacterial hand sanitizer that has an ethanol content of 66 percent, were found by the patients bedside ... On direct questioning, the patient admitted to intentionally consuming the contents of the hand sanitiser bottles. This was supported by a breath test performed about 40 minutes after the bottles were found, which showed a blood alcohol concentration of 0.271 percent. Following advice from the Poisons Information Line, supportive therapy was instigated and the patient made an uneventful recovery."
Batty, et al. acknowledge that intentional consumption of ethanol- and isopropanol-based hand sanitizers by hospitalized patients has been described in the United States and serious adverse outcomes (including the need for intubation) have occurred, and note, "Experience at our institution over the past six months suggests that consumption of alcohol-based hand sanitizers by inpatients may be an increasing problem in Australian settings we are aware of a further three patients who have consumed these products while at our institution. An increased awareness of this practice is required among healthcare workers in Australia, as it has the potential to create diagnostic dilemmas and lead to serious outcomes, and preventive measures need to be identified and implemented."
Reference: Batty LM, Brischetto AJ, Ajay C Kevat AC and Oldmeadow MJ. Letters: Consumption of alcohol-based hand sanitisers by hospital inpatients. MJA 2011; 194 (12): 664.