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Methanol as an Unlisted Ingredient in Supposedly Alcohol-Based Hand Rub Can Pose Serious Health Risk

Authors:

Abstract

Alcohol-based hand rub (hand sanitizer) is heavily used in the community and the healthcare setting to maintain hand hygiene. Methanol must never be used in such a product because oral, pulmonary and/or skin exposures can result in severe systemic toxicity and even deaths. However, sporadic cases of acute poisoning indicate that alcohol-based hand rub with undeclared methanol may be found in the market from time to time. The unexpected presence of methanol poses a serious threat to public health. Unintentional ingestion by young children and inadvertent consumption by older subjects as alcohol (ethanol) substitute can occur. Methanol is more lethal and poisoning often requires antidotal therapy, in addition to supporting therapy and critical care. However, specific therapy may be delayed because the exposure to methanol is initially not suspected. When repeatedly used as a hand rub, skin absorption resulting in chronic toxicity (e.g., visual disturbances) occurs, particularly if methanol induced desquamation and dermatitis are present. Nationwide surveillance systems, regional/international toxicovigilance networks and situational awareness among the healthcare professionals should facilitate the early detection, management and prevention of such poisoning incidents of public health significance.
International Journal of
Environmental Research
and Public Health
Review
Methanol as an Unlisted Ingredient in Supposedly
Alcohol-Based Hand Rub Can Pose Serious
Health Risk
Alan P. L. Chan 1and Thomas Y. K. Chan 1,2,3,*
1
Division of Clinical Pharmacology and Drug and Poisons Information Bureau, Department of Medicine and
Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
alanchanpl@hotmail.com
2Prince of Wales Hospital Poison Treatment Centre, Shatin, New Territories, Hong Kong, China
3Asia Pacific Network of Clinical Toxicology Centres, Drug and Poisons Information Bureau,
Hong Kong, China
*Correspondence: tykchan@cuhk.edu.hk; Tel.: +852-3505-3907
Received: 11 June 2018; Accepted: 5 July 2018; Published: 9 July 2018


Abstract:
Alcohol-based hand rub (hand sanitizer) is heavily used in the community and the
healthcare setting to maintain hand hygiene. Methanol must never be used in such a product
because oral, pulmonary and/or skin exposures can result in severe systemic toxicity and even
deaths. However, sporadic cases of acute poisoning indicate that alcohol-based hand rub with
undeclared methanol may be found in the market from time to time. The unexpected presence of
methanol poses a serious threat to public health. Unintentional ingestion by young children and
inadvertent consumption by older subjects as alcohol (ethanol) substitute can occur. Methanol is
more lethal and poisoning often requires antidotal therapy, in addition to supporting therapy and
critical care. However, specific therapy may be delayed because the exposure to methanol is initially
not suspected. When repeatedly used as a hand rub, skin absorption resulting in chronic toxicity
(e.g., visual disturbances) occurs, particularly if methanol induced desquamation and dermatitis
are present. Nationwide surveillance systems, regional/international toxicovigilance networks
and situational awareness among the healthcare professionals should facilitate the early detection,
management and prevention of such poisoning incidents of public health significance.
Keywords: methanol; poisoning; hand sanitizers; product substitution; risk assessment
1. Introduction
Hand hygiene products are heavily used in everyday life. In the healthcare setting, most of the
cross-infections occur by direct contact via the hands of health workers, and their strict adherence
to good hand hygiene is the most effective strategy to stop infections spreading [
1
]. By reducing
cross-transmission, the use of alcohol-based hand rub (hand sanitizer) helps decrease the risk of
healthcare associated infections, and hence selection pressure of antibiotics and the emergence of
antibiotic resistance [
2
]. In the community, the combination of hand hygiene and face mask is effective
in reducing influenza transmission [
3
]. In the educational setting, hand hygiene may decrease the risk
of respiratory tract infection among children [
4
]. There are national and WHO guidelines on hand
hygiene [
5
,
6
]. In general, hands should be washed with soap and water if they are visibly dirty. If hands
look clean, alcohol-based hand rub is an effective alternative and, in the healthcare setting, the preferred
method for routine hand antisepsis. Hand hygiene products contain an antiseptic to inactivate
microorganisms and/or temporarily suppress their growth on the skin [
6
]. Many preparations are
Int. J. Environ. Res. Public Health 2018,15, 1440; doi:10.3390/ijerph15071440 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2018,15, 1440 2 of 6
available [
6
], but alcohol-based hand rub is always preferred because of its greater effectiveness and
better compliance rate, while causing less skin irritation and requiring less time for application [1,6].
Alcohol-based hand rub mostly contains ethanol, isopropyl alcohol, n-propyl alcohol, or their
combinations [
2
]. When misused, these preparations can become toxic to humans. For example,
after accidental or deliberate ingestion, isopropyl alcohol causes more severe central nervous system
and respiratory depression than ethanol [
7
]. Methanol is even more toxic after inhalation, oral or skin
exposures [
8
] and must never be used in hand hygiene products. However, sporadic cases of human
poisoning [
9
] indicate that such hazardous products may be found in the market from time to time.
The unexpected presence of methanol poses a serious threat to public health since hand rub is widely
used both in the healthcare and community settings.
In this review, the main objective is to describe the serious health risk caused by methanol as
an unlisted ingredient in supposedly alcohol-based hand rub. Reports of acute methanol poisoning
and chronic toxicity are reviewed.
2. Literature Search to Identify Relevant Reports of Methanol Toxicity
To identify published papers in indexed/non-indexed journals, news and other reports, a search
of Medicine/Embase (1989 to 29 June 2018), WanFang Data (1989 to June 2018), Google and Google
Scholar was performed, using methanol, hand sanitizers, hand hygiene products and alcohol-based
hand rub as the keywords. Additional cases, if any, were retrieved from the annual reports of poison
control centers [
10
] and international [
11
] or national [
12
15
] studies of methanol poisoning from the
USA [10,12], Europe [11,13,14], Africa [11,15] and Asia [11].
Only reports of acute poisoning (Section 3), following ingestion, inhalation and skin exposure to
undeclared methanol in alcohol-based hand rub, were reviewed. Acute methanol poisoning caused by
methylated spirits (denatured alcohol) [16] and adulterated alcohol [17] was not included.
Reports of chronic toxicity (Section 4) were also reviewed to characterize the risk and severity of
impaired vision and other organ damages, if methanol containing products were inadvertently used
as hand rub. Reports of toxic effects when the preparations were used for medicinal purposes [
18
,
19
]
were excluded because the doses, exposure time and intensity of use were quite different.
3. Acute Poisoning Caused by Methanol as an Unlisted Ingredient in Alcohol-Based Hand Rub
The search of biomedical literature databases, Google and Google Scholar altogether identified 3
relevant reports of acute methanol poisoning [
9
,
10
,
20
]. Details about the poisoning incidents and their
year of occurrence are summarized in Table 1.
Table 1. Reports of acute poisoning caused by methanol in alcohol-based hand rub.
Country (Year) Details
Canada (2013) [9]2 deaths after ingesting a hand sanitizer containing methanol (an undeclared
ingredient), but ethyl alcohol was the active ingredient actually listed
USA (2014) [10] M/42 died after ingesting a hand sanitizer containing methanol and ethanol
Hong Kong (2016) [20]M/29 required hemodialysis and IV ethanol infusion after ingesting a hand sanitizer
containing methanol (undeclared) 22%, isopropyl alcohol 36% and ethanol 3.5%
In Canada [
9
], two Ontario residents had died after ingesting a hand sanitizer. Both bottles were
found to contain methanol, an undeclared ingredient, rather than ethyl alcohol, the active ingredient
listed on the label. Health Canada issued a warning to consumers and worked with its manufacturer
to implement a recall of these products.
In USA [
10
], a 42-year-old man died after ingesting a hand sanitizer. According to the Annual
Report of the American Association of Poison Control Centers, the product contained methanol and
ethanol. Methanol was detected in serum (0.31 mmol/L), but the blood sampling time was not stated.
No further information was provided.
Int. J. Environ. Res. Public Health 2018,15, 1440 3 of 6
In Hong Kong [
20
], a 29-year-old man required intensive care unit care for severe methanol
and isopropyl alcohol poisoning after drinking 500 mL of an alcohol-based hand rub. He presented
with deep coma (GCS 3/15) and metabolic acidosis (arterial pH 7.28) with an increased osmolar gap
(131.5 mOsm/kg). His serum methanol and isopropyl alcohol levels at 4 h post ingestion were 72.0 and
55.9 mmol/L, respectively. Hemodialysis, folinic acid and intravenous ethanol infusion were started.
He regained consciousness and was extubated 2 days later. His vision was intact. He was transferred
to a psychiatric unit after 9 days of medical treatment. The hand rub was listed to contain isopropyl
alcohol, glycerine and triethanolamine, but was found to contain isopropyl alcohol 36%, methanol
22%, and ethanol 3.5%.
4. Chronic Toxicity Caused by Methanol Containing Hand Rub
The search of literature databases, Google and Google Scholar had not identified any reports of
subacute or chronic toxicity caused by methanol as an unlisted ingredient in alcohol-based hand rub.
However, the case series [
21
] summarized here clearly indicates transdermal absorption of methanol
and a very high risk of systemic toxicity among users of alcohol rub containing methanol.
In China [
21
], a hospital mistakenly purchased industrial (denatured) alcohol for surgeons to
disinfect the hands and forearms before surgery. It was used 3–5 sessions per week. There were soon
skin dryness and desquamation of the areas exposed to the hand rub. Six months later, 6 surgeons
in the same unit developed erythema and rash in the affected areas, with intense itching, especially
the fingers and finger web. Four surgeons stopped using this product and recovered spontaneously.
The fifth surgeon had further exposures until the skin condition worsened. About 1 month after
stopping using the product, he developed mild visual impairment which gradually improved after
treatment. The sixth surgeon continued to use the hand rub until blurred vision occurred. Methanol
poisoning was suspected. Chemical analysis of the product revealed that its methanol concentration
was 3000–5000 times the legal limit. Neither the actual methanol concentration nor its legal limit was
stated. There was initial improvement in vision after cessation of use. However, a month later, visual
acuity deteriorated to 0.3 and 0.7. Neurological symptoms included lower limb weakness, paroxysmal
electric shock sensation in 4 limbs and peripheral neuropathy. Subsequently, further assessments
revealed a diagnosis of retrobulbar neuritis and retinitis. Three months later, the visual impairment
markedly improved and neurological symptoms gradually improved. Eighteen months later, there was
still numbness of left hand fingers.
5. Discussion
Alcohol-based hand rub should not contain methanol [
6
], for obvious reasons. Methanol is
very toxic, following oral, pulmonary and/or skin exposures [
8
]. Severe systemic toxicity and even
deaths can occur after occupational or non-occupational exposures [
12
15
,
17
,
22
,
23
]. In acute poisoning,
the main toxicity of methanol does not manifest until its metabolite formic acid has accumulated
to toxic levels, typically 12–24 h after exposure [
24
]. Apart from severe metabolic acidosis, nausea,
vomiting, headache, semi-coma, and ocular toxicity may be seen [
8
]. Unless timely antidotal therapy
is given [
25
], substantial exposure can result in coma, seizures, death, permanent blindness, and
permanent damage to the central nervous system [
8
,
23
]. Subacute poisoning has also been reported
in workers with inhalation and skin exposures [
25
]. There are little data on chronic toxicity due to
continuous or repeated exposures over a period of time. Chronic inhalation exposure to methanol can
result in eye irritation and headache in workers [
8
]. Rarely, repeated exposures to methanol have been
reported to cause visual disturbances and clinical symptoms of multiple sclerosis [21,26].
Albeit very rarely reported, alcohol-based hand rub with methanol as an undeclared ingredient
could be found in the market from time to time [
9
,
10
,
20
]. The reasons for its use as the substitute
for isopropyl alcohol or ethyl alcohol are not known. The present review highlights the serious
threat to public health if such preparations are available to the public (Section 3) and healthcare
professionals (Section 4).
Int. J. Environ. Res. Public Health 2018,15, 1440 4 of 6
Health authorities and the manufacturers repeatedly remind the consumers that alcohol-based
hand rub is for external use only. As clearly stated on its product labelling, hand rub should never be
swallowed. However, unintentional ingestion by young children is common [
27
]. In older children,
adolescents and adults, hand rub is increasingly used as alcohol (ethanol) substitute rather than for
self-harm. [
27
29
]. In fact, consumption of surrogate alcohols (non-beverage alcohols and illegally
produced alcohols) is a major public health problem in many parts of the world [
30
,
31
]. When taken
by mouth, methanol, if ever used as a substitute for isopropyl alcohol or ethanol, in the hand rub
will cause a much greater mortality and morbidity. Methanol has a lower lethal dose (~1.2 versus
1–4 and 3.6–6 mL/kg) and poisoning often requires antidotal therapy (fomepizole or ethanol) [
24
,
32
],
in addition to supporting therapy and critical care [
13
]. Methanol also causes severe metabolic acidosis
and more target organ toxicity (e.g., ocular toxicity) [
8
]. Specific therapy [
24
,
32
] may be inadvertently
delayed because the exposure to methanol is initially not suspected.
Obviously, methanol is highly toxic and, if ingested, can be fatal [
8
]. When used on the skin,
it is well known that methanol can cause irritation and inflammation [
8
]. Dermal exposure resulting in
acute poisoning and systemic toxicity remains the main concern [
22
,
23
,
25
]. Exposure assessments in
healthy volunteers indicate that the extent and rate of skin absorption of methanol depends on many
factors, including its form (vapors, liquid or solution), contact time, dose, concentration, and size of
exposure area [
33
35
]. Skin occlusion will enhance the percutaneous absorption of methanol [
36
],
by preventing its evaporation and increasing the stratum corneum hydration and skin temperature.
In diseased skin, such as methanol induced desquamation and dermatitis [
8
,
21
], both the structure and
barrier function become compromised, thus allowing methanol and other chemicals to be absorbed
even more readily [
37
]. The case series described in Section 4[
21
] clearly documents skin absorption
and a very high risk of systemic toxicity among users of alcohol rub containing methanol.
The poisoning incidents due to undeclared methanol in alcohol-based hand rub are all of major
public health significance because of its high intrinsic toxicity, widespread use and easy availability.
Nationwide surveillance systems based on, for example, spontaneous reporting and early detection of
warning signals by poison control centers [
38
], will play an important role in the risk management
strategies. Toxic threats occurring sporadically in different countries necessitate the establishment
of a regional or international toxicovigilance network to detect early warning signals and initiate
immediate preventive measures. The present review should enhance the situational awareness among
health professionals, who provide timely treatment and sound the alarm.
6. Conclusions
Methanol is highly toxic, and severe systemic toxicity and even deaths can occur after oral,
pulmonary and/or skin exposures. Therefore, methanol must never be used in alcohol-based hand rub,
which mostly contains ethanol, isopropyl alcohol, n-propyl alcohol, or their combinations. However,
sporadic reports of acute poisoning indicate that hand rub with undeclared methanol may be found
in the market from time to time. The unexpected presence of methanol poses a serious threat to
public health since hand rub is heavily used and widely available. Unintentional ingestion by young
children and inadvertent consumption by older subjects as alcohol (ethanol) substitute can occur.
Given the frequent consumption of surrogate alcohols in many parts of the world, methanol, if ever
used as a substitute for isopropyl alcohol or ethanol, in the hand rub will cause an even bigger public
health problem. Methanol is more lethal and poisoning often requires antidotal therapy, in addition to
supporting therapy and critical care. However, specific therapy may be delayed, since the exposure
to methanol is initially not suspected. If repeatedly used as a hand rub, skin absorption resulting
in chronic toxicity (e.g., visual disturbances) occurs, particularly if methanol induced desquamation
and dermatitis are present. Nationwide surveillance systems, regional/international toxicovigilance
networks and situational awareness among the healthcare professionals will facilitate the early
detection, management and prevention of poisoning incidents of public health significance.
Int. J. Environ. Res. Public Health 2018,15, 1440 5 of 6
Author Contributions:
A.P.L.C. was responsible for the comprehensive search of biomedical literature databases,
Google and Google Scholar, inclusion and exclusion criteria, initial evaluation of available reports, data synthesis
and original drafts preparation. T.Y.K.C. initiated and coordinated the project and contributed to the data
evaluation and writing of the final report.
Funding:
This work is supported by research funding from the Drug and Poisons Information Bureau, Faculty of
Medicine, the Chinese University of Hong Kong.
Conflicts of Interest: The authors declare no conflict of interest.
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... The Food and Drug Administration (FDA) recommends a concentration of 60% to 95% ethanol or iso-propanol 19,20 . The use of methanol in hand sanitizer can be hazardous and is therefore not recommended 21 and none of the hand sanitizers included in current study was labeled as methanol based 21 . ...
... The Food and Drug Administration (FDA) recommends a concentration of 60% to 95% ethanol or iso-propanol 19,20 . The use of methanol in hand sanitizer can be hazardous and is therefore not recommended 21 and none of the hand sanitizers included in current study was labeled as methanol based 21 . ...
Article
Full-text available
ABSTRACT Introduction: Hand washing and the use of alcohol based hand-rub are two effective hand-hygiene procedures. Though the compliance to hand washing was relatively low, the COVID-19 pandemic situation has drastically increased the use of hand sanitizers. Thus, many hand sanitizer brands have entered the market and this study was taken up to assess the microbial efficacy of different types of hand sanitizers available in Thimphu. Methods: Ten gel based and ten liquid hand sanitizers were collected from various retail pharmacy shops in Thimphu during first quarter of 2020. Laboratory based experiment was performed using standard organism; Gram Negative Bacteria (GNB) Escherichia coli (American Type Culture Collection 25922) and Pseudomonas aurigenosa (American Type Culture Collection 27853), Gram Positive Bacteria (GPB) Staphylococcus aureus (American Type Culture Collection 25923) and a cocktail of GNB and GPC. The efficacy of hand sanitizer was assessed with the size of the Zone of Inhibition (ZoI). Results: The hand sanitizers were found to be effective against all strains of micro-organism but with different size of ZoI. The maximum size of Zone of Inhibition was observed by sample N and Q (ZoI diameter 33.0±0.14mm) for American Type Culture Collection 25923. The Zone of Inhibition of liquid base hand sanitizers was significantly higher than that of gel base (p<0.05). Conclusions: The study presents that liquid base alcohol based hand sanitizer is more efficient than the gel form.
... Ingestion of low-concentrated hydrogen peroxides may result in gastrointestinal (GI) tract irritation. Isopropyl alcohol consumption may lead to severe respiratory and central nervous system depression, and ethanol toxicity may result in a set of common complications 4,7 . When added to hand sanitizers, the serious toxic effects of methanol can occur through inhalational, oral, or dermal exposure 4,7 . ...
... Isopropyl alcohol consumption may lead to severe respiratory and central nervous system depression, and ethanol toxicity may result in a set of common complications 4,7 . When added to hand sanitizers, the serious toxic effects of methanol can occur through inhalational, oral, or dermal exposure 4,7 . ...
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A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19–91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)—equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.
... Use of hand sanitiser containing methanol may cause transdermal absorption and increases the risk of systemic toxicity. 37 The increase in the demand for hand sanitisers and other medicines in the face of COVID-19 has increased the growth of e-commerce. Online sale of pharmaceutical products has just started in Nepal during recent years. ...
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Objectives To evaluate the pattern of substandard and falsified pharmaceutical products recall in Nepal. Setting We analysed drug recall notices issued by the Department of Drug Administration (DDA), Nepal, and systematically reviewed peer-reviewed research articles during January 2010 to December 2020. Participants This study did not include human participants. However, data were collected from 72 drug recall notices issued by DDA and four research papers. Results A total of 346 pharmaceutical products were recalled during the reported period. The number of recalled pharmaceutical products has increased significantly over the past decade in Nepal. The most frequently recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements and pain and palliative medicines among others. Number of imported recalled drugs were slightly higher (42.2%) than domestic recalled drugs (40.7%). Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, higher number of modern drugs (62%) were recalled than traditional ones (35%). Hand sanitisers used to minimise COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitisers contained significant amounts of methanol (as high as 75% v/v) instead of appropriate amount of ethyl or isopropyl alcohol. The peer-reviewed research papers reported issues with labelling, unregistered drugs and drugs failed in several laboratory testing. Conclusion Our analysis showed that number of recalls of substandard and falsified drugs are increasing in Nepal. Since the recall data in this paper did not include number of samples tested and location of samples collected, more studies to understand the prevalence of substandard and falsified drugs in Nepal is recommended.
... 3 Sporadic cases of acute poisoning caused by ingestion of commercial products (e.g., pesticides and hand sanitizers) containing undeclared methanol have been reported. [4][5][6] Adequate diagnosis and treatment of methanol intoxication can be delayed because the evaluation of toxicity generally relies on information regarding the toxicity of the main component of a commercial product in a poisoned patient. Herein, we describe two patients who developed coagulopathy and metabolic acidosis after ingestion of liquid anticoagulant rodenticide. ...
Article
Methanol is highly toxic to humans. Although methanol poisoning is not uncommon in developing countries, poisoning caused by ingestion of commercial products containing undeclared methanol has rarely been reported. Herein, we describe two patients who experienced methanol poisoning after ingestion of liquid rodenticides. A 39-year-old woman attempted suicide by ingesting liquid rodenticide which contained bromadiolone. She developed high anion gap metabolic acidosis and coagulopathy. Methanol poisoning was confirmed 20 hours later. She received oral ethanol therapy and hemodialysis. Vitamin K1 was also administered. She did not develop any hemorrhage or visual impairment and was discharged after 11 days. The rodenticide sample was tested and found to have a methanol concentration of 324 g/L. In another case, a 62-year-old man ingested the same brand of rodenticide. Laboratory data showed mild metabolic acidosis with an increased osmol gap, suggestive of methanol poisoning. He received hemodialysis and eventually recovered without sequelae. Liquid rodenticide may contain methanol as a solvent. Ingestion of a methanol-containing commercial product without a clear label can result in a considerable delay in diagnosis and management. Methanol poisoning should be considered for patients who present with unexplained metabolic acidosis following exposure to liquid rodenticides or other liquid commercial products.
... On the other hand, alcohol-based HS are often adulterated with methanol, as it is a cheaper alternative and known to have severe adverse effects on the human body (Chan and Chan 2018). Several companies also use n-propanol other than the recommended isopropanol to formulate HS. ...
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Sanitization of inanimate objects or body surfaces using disinfectant is essential for eliminating disease-causing pathogens and maintaining personal hygiene. With the advent of health emergencies, the importance and high demand for hand sanitizers (HS) are observed in everyday life. It is also important to know the constituent added to formulate HS, as the presence of harsh chemicals can cause skin irritation. In this study, different spectroscopic techniques were used to assess several commercially available HS along with the in-house prepared HS as per the WHO protocol. Fourier transform infrared spectroscopy and Raman spectroscopy identified the different HS chemical bonds and quantified the amount of alcohol and water in the HS. Varying amount of alcohols in HS, calibration profile was generated to identify its amount in commercial samples. Further, the commercial samples were also checked for contaminants whose presence in the HS might bring down its sanitization efficacy. Supplementary information: The online version contains supplementary material available at 10.1007/s11696-022-02208-x.
... When formic acid is generated in large amounts and accumulates in the body, it can cause metabolic acidosis and ocular toxicity [15]. Therefore, MeOH must not be present in daily-use materials [16]. ...
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Background Demand for alcohol-based products, including gel- and aqueous-type hand sanitizers, room sprays, and mouthwashes, has sharply increased during the ongoing COVID-19 pandemic because of their microbicidal properties. However, toxic methanol can be found from intentional addition of methanol by manufacturers and invariable production during the manufacture alcohol (ethanol). Although the FDA has recommended that such products should contain less than 630 ppm of methanol, it is only a temporary measure established specifically to regulate such products during the current COVID-19 pandemic and hence is not strictly regulated. Objective This study aims to detect and quantify the level of methanol in alcohol-based products. However, some manufacturers unethically add methanol in their products and promote them as methanol-free. Besides, they do not provide proficiency and toxicity test results. Therefore, these kinds of products need to be analyzed to determine if they are acceptable to use. Method This study qualitatively and quantitatively investigates the amount of methanol in commercial alcohol-based products using a newly developed headspace gas chromatography/mass spectrometry method. Moreover, alcohol beverages which contain methanol were analyzed to be compared with the levels of methanol in alcohol-based products and determine if their methanol levels are acceptable. Results Methanol concentrations in gel-type hand sanitizers (517 ppm) and mouthwashes (202 ppm) were similar to those in white wine (429 ppm) and beer (256 ppm), respectively, while that of aqueous-type hand sanitizers (1139 ppm) is 1.5 times more than that of red wine (751 ppm). Conclusion Methanol levels in most of the alcohol-based products did not exceed the FDA-recommended limit.
... The FDA has continued to regulate hand sanitizer products to ensure to product quality and protect the public from unsafe products from poor manufacturing practices (FDA 2020c;Chan and Chan 2018;FDA 2020d;FDA 2021). The FDA temporary guidance highlighted 12 impurities that should be monitored in the finished products (FDA 2020a). ...
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The COVID-19 pandemic has led to increased usage of hand sanitizer products by the public to prevent the spread of COVID-19 and decrease the likelihood of acquiring the disease. The increase in demand has also led to an increase in the number of manufacturers. This work describes the FDA's Center for Drug Evaluation and Research (CDER) laboratories efforts to develop tests to assess the quality of hand sanitizer products containing ethanol or isopropanol as the primary active ingredient. The products were evaluated for the active ingredient content and determination of the 12 impurities listed in the FDA Hand Sanitizer Temporary Guidance, followed by a spike recovery assay performed to verify the test results. Extensive method development was conducted including an investigation into the stability of ethanol, isopropanol, and the 12 impurities. Stability and kinetic studies confirmed the instability of acetal in acidic liquid hand sanitizer products during spike recovery assay testing. The headspace GC-MS method was validated according to ICH Q2 (R1) guidelines and the spike recovery assay was validated using three concentrations of standards for the drug product. During method application, six liquid hand sanitizer products were tested and all were determined to have ethanol or isopropanol above 70% v/v. Two liquid hand sanitizer products were determined to contain acetaldehyde as an impurity above the FDA recommended safety levels. Supplementary information: The online version contains supplementary material available at 10.1186/s41120-021-00049-8.
Article
Methanol toxicity and its associated pathologies have been widely studied, however, at the beginning of the COVID-19 pandemic, there was an increase in methanol toxicity due to apparent consumption of contaminated hand sanitizer. We report a cluster of five deaths and one presumed death due to the apparent consumption of hand sanitizer, contaminated with methanol, in the setting of chronic alcoholism. The deaths occurred in Coconino County, Arizona, over a four-and-a-half-month period (June-October 2020), before and during a Food and Drug Administration recall of contaminated hand sanitizer. Methanol-related deaths are relatively uncommon in Coconino County, with only one methanol associated death (source of ingestion unknown) occurring over the previous five years.
Article
Background: After unprecedented demand for ethanol in the pandemic, profiteers used methanol for making illegal alcoholic drink. Methods: This cross-sectional descriptive-analytical study investigated the effects of methanol poisoning on 400 patients who referred to hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences from March 20 to September 20, 2020. Results: Ninety-eight-point five percent of patients had consumed alcohol for social reasons and only 0.3% had used it as a measure to avoid COVID-19. Eighty-seven percent of the patients used homemade alcohol bought from peddlers. The most common clinical symptom was gastrointestinal disorders (64.8%) and the most common complications were vision problems (12.3%). Ten-point-six percent (42 patients) of the patients died. The most important factors affecting mortality risk were dyspnea, neuropathic problems, abnormal radiological findings, dialysis, abnormal blood pressure, vision problems and dizziness. Conclusions: Informing the public about the risks of using homemade alcoholic beverages is essential if the associated disability and mortality has to be avoided.
Article
Herein, we have demonstrated the successful combination of gold nanoparticles (AuNPs) and green carbon (GC) (biomass-derived) obtained from date seeds to detect methanol (MeOH) via a simple electrochemical approach. We have synthesized GC by pyrolysis method whereas AuNPs were deposited by the photochemical deposition technique. We have systematically characterized the [email protected] nanocomposite by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), FESEM, high-resolution transmission electron microscopy (HR-TEM), and Raman spectroscopy. In comparison to a bare glassy carbon electrode (GCE) or GC fabricated GCE, the newly-fabricated [email protected] nanocomposite modified GCE ([email protected]/GCE) has shown better performance in MeOH sensing. The proposed sensor exhibited excellent sensitivity (0.0143 μAmM⁻¹), a lower detection limit (LOD = 0.39 mM at S/N = 3), and a wide linear dynamic range (LDR = 1–80 mM). This [email protected]/GCE sensor also showed good operational stability, reproducibility, and repeatability in MeOH detection. The research findings indicated the potential application of the [email protected] nanocomposite as an electroactive material for effective electrochemical sensing of environmental pollutants.
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What is already known about this topic? Nonrecommended use of alcohol-based (alcohol) hand sanitizers, including intentional or unintentional ingestion, might be associated with greater health risks in young children than similar use of nonalcohol-based (nonalcohol) hand sanitizers. What is added by this report? During 2011-2014, 70,669 exposures to alcohol and nonalcohol hand sanitizers were reported in children aged ≤12 years to the National Poison Data System. Approximately 90% of these exposures occurred among children aged 0-5 years. Among that age group, 97% of exposures were oral ingestions. Children aged 6-12 years had more intentional exposures of alcohol hand sanitizers, suggesting this might be a potential product of abuse among older children. Older children also reported more symptoms and had worse outcomes than did younger children. Major (life-threatening) outcomes were rare. Seasonal trends in data might correlate with increased use during the school year or flu season. What are the implications for public health practice? Caregivers and health care providers need to be aware of the potential risks and dangers associated with improper use of hand sanitizer products among children and the need to use proper safety precautions to protect children. Increased parental or teacher supervision might be needed while using alcohol hand sanitizer products, especially for older children who might be abusing these products during the school year. © 2017, Department of Health and Human Services. All rights reserved.
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Methanol poisoning results in neurological complications including visual disturbances, bilateral putaminal hemorrhagic necrosis, parkinsonism, cerebral edema, coma, or seizures. Almost all reported cases of methanol poisoning are caused by oral ingestion of methanol. However, recently there was an outbreak of methanol poisoning via non-oral exposure that resulted in severe neurological complications to a few workers at industrial sites in Korea. We present 3 patients who had severe neurological complications resulting from non-oral occupational methanol poisoning. Even though initial metabolic acidosis and mental changes were improved with hemodialysis, all of the 3 patients presented optic atrophy and ataxia or parkinsonism as neurological complications resulting from methanol poisoning. In order to manage it adequately, as well as to prevent it, physicians should recognize that methanol poisoning by non-oral exposure can cause neurologic complications.
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Background Methyl alcohol poisoning has been mainly reported in community. Two cases of methyl alcohol poisoning occurred in a small-sized subcontracted factory which manufactured smartphone parts in Korea. Case presentationOne young female patient presented with dyspnea and visual disturbance. Another young male patient presented with visual disturbance and myalgia. They treated with sodium bicarbonate infusion and hemodialysis for metabolic acidosis. In addition, he received ethyl alcohol per oral treatment. Her and his urinary methyl alcohol concentration was detected as 7.632 mg/L, 46.8 mg/L, respectively, although they were treated hemodialysis. Results of the working environment measurement showed that the concentration of methyl alcohol (1030.1–2220.5 ppm) in the air exceeded the time weighted average (200 ppm). They were diagnosed with optic neuropathy due to methyl alcohol poisoning and still have visual impairment. Conclusions Workers who hired as dispatched employees in a small-sized subcontracted factory were exposed to high concentrations of methyl alcohol. The workplace had poor ventilation system. In addition, workers did not wear proper personal protect equipment. Working environment measurement and annual chekups for workers were not performed. They were in a blind spot to occupational safety and health. More attention is needed to protect vulnerable workers’ health.
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Background Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. Methods Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. Findings In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. Interpretation Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts.
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Background: This is the 32nd Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2014, 56 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 7.82 [7.02, 11.17] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death. Results: In 2014, 2,890,909 closed encounters were logged by NPDS: 2,165,142 human exposures, 56,265 animal exposures, 663,305 information calls, 6,085 human confirmed nonexposures, and 112 animal confirmed nonexposures. US poison centers (PCs) also made 2,617,346 follow-up calls in 2014. Total encounters showed a 5.5% decline from 2013, while health care facility human exposure cases increased by 3.3% from 2013. All information calls decreased by 17.7% and health care facility (HCF) information calls were essentially flat, decreasing by 0.04%, medication identification requests (Drug ID) decreased 29.8%, and human exposures reported to US PCs decreased 1.1%. Human exposures with less serious outcomes have decreased 3.40% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.29% per year since 2000. The top 5 substance classes most frequently involved in all human exposures were analgesics (11.3%), cosmetics/personal care products (7.7%), household cleaning substances (7.7%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.4%). Sedative/Hypnotics/Antipsychotics exposures as a class increased the most rapidly (2,368 calls (12.2%)/year) over the last 13 years for cases showing more serious outcomes. The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (14.0%), household cleaning substances (11.0%), analgesics (9.3%), foreign bodies/toys/miscellaneous (6.7%), and topical preparations (5.8%). Drug identification requests comprised 43.3% of all information calls. NPDS documented 1,835 human exposures resulting in death with 1,408 human fatalities judged related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in calls involving less serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, viral, bacterial, venomous, chemical agent, or commercial product), the identification of events of public health significance, resilience, response and situational awareness tracking. NPDS is a model system for the real-time surveillance of national and global public health.[Box: see text].
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Traditionally, ingestion of alcohol-based hand rub solution results in isopropanol poisoning, which has a low toxicity. We describe a case of combined methanol and isopropanol intoxication by ingestion of alcohol-based hand rub solution. Metabolic acidosis was absent in our patient, presumably because formic acid production is blocked by isopropanol, which inhibits alcohol dehydrogenase. Our case highlights the importance of considering methanol intoxication in patients who ingested alcohol-based hand rub solution, even when there is no metabolic acidosis, and timely removal of the toxic alcohols by dialysis in these patients would prevent permanent retinal damage. .
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In 2017, the global hand hygiene day (5th May) focuses on battling antimicrobial resistance (AMR). It promotes strong infection prevention and control and comprehensive antimicrobial stewardship programmes to prevent hospital-acquired infections and reduce the spread of AMR in healthcare facilities.
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The medical field has long recognized the importance of hand hygiene in preventing health care-associated infections, yet studies indicate that this important task is performed only 40% of the time. Health care workers cite several barriers to optimal performance of hand hygiene, but the time required to perform this task is foremost among them. Introduction of alcohol-based hand rubs, bundled interventions, and incorporation of technologies designed to monitor and promote hand hygiene all represent promising advances in this field.