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

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International Journal of Environmental Research and Public Health (IJERPH)
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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... Keracunan metanol paling sering terjadi karena konsumsi yang tidak disengaja atau disengaja, dan keracunan epidemik yang tidak disengaja karena kesalahan penyulingan dan fermentasi serta kontaminasi minuman. Produk yang mengandung metanol termasuk cairan pembersih kaca depan, antibeku saluran gas, pembersih karburator, cairan mesin fotokopi, parfum, bahan bakar penghangat makanan, dan jenis bahan bakar lainnya (Ahmed, Khan, Ali, & Feroze, 2017;Chan & Chan, 2018;Kraut & Mullins, 2018) Kejadian keracunan metanol yang disengaja semakin meningkat seiring dengan peningkatan pola konsumsi minuman beralkohol di masyarakat. Mahalnya miras berkadar tinggi menjadi salah satu faktor yang mendorong masyarakat mendapatkan kadar alkohol tinggi dengan harga serendah mungkin. ...
... Paparan dapat menyebabkan berbagai tingkat toksisitas dan dapat memerlukan berbagai perawatan mulai dari pemantauan laboratorium yang ketat hingga terapi antidotal dan dialisis. Perawatan utamanya adalah etanol atau fomepizole, dan tidak seperti toksisitas etilen glikol, dialisis sering direkomendasikan (Ahmed et al., 2017;Chan & Chan, 2018;Kraut & Mullins, 2018). ...
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Kejadian keracunan metanol sering karena konsumsi yang tidak disengaja atau disengaja. Paparan metanol sangat berbahaya, dengan morbiditas dan mortalitas yang signifikan jika tidak diobati. Perawatan utama keracunan metanol adalah etanol atau fomepizole. Fomepizol diakui lebih aman dan efektif dibandingkan etanol. Namun, hambatan penggunaan fomepizol adalah harganya mahal dan ketersediaannya yang terbatas di beberapa daerah, terutama di negara-negara berkembang. Dalam ulasan ini menjelaskan tentang pilihan antara penggunaan etanol dan fomepizol ketika fomepizol tidak tersedia. Studi ini merupakan studi tinjauan literatur. Literatur relevan yang digunakan untuk melakukan tinjauan literatur ini berasal dari database pubmed, dengan menggunakan kata kunci pencarian "Methanol"[tw] OR "Methanol poison*"[tw] OR "Methanol toxic*"[tw] OR "Methanol intoxic*"[tw]. Hasil dari penelusuran didapatkan 8 artikel yang memenuhi kriteria inklusi dan eksklusi untuk direview. Penghambatan alkohol dehidrogenase merupakan dasar untuk pengobatan keracunan metanol. Penanganan dasar keracunan metanol harus segera dilakukan dengan memberikan antidotum seperti fomepizol atau etanol untuk mencegah metanol termetabolisme menjadi metabolit yang dapat menyebabkan asidosis metabolik, kerusakan mata hingga kematian. Penanganan keracunan metanol menggunakan fomepizol ataupun etanol tidak menunjukkan perbedaan efektivitas klinis antara keduanya, meskipun fomepizol memberikan efek samping yang lebih baik. Etanol sebagai antidotum pada keracunan metanol masih dapat diberikan sebagai altenatif ketika fomepizol tidak tersedia.
... In the present study, methanol was the most frequently detected and was also the major VOC of various organic samples, including inks, alcohols, diluents, degreaser, thinner, and screen wash. It has been reported that methanol poisoning has a high mortality rate among survivors and can lead to long-term visual sequelae and severe brain damage [57][58][59]. Since methanol can be absorbed by humans through various routes, such as dermal contact, ingestion and inhalation, corresponding protective measures must be taken, such as ventilation and wearing appropriate protective equipment, to avoid prolonged exposure to methanol vapors. ...
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The risk of occupational exposure to organic solvents varies across industries due to factors such as processing materials, ventilation conditions, and exposure duration. Given the dynamic nature of organic solvent use and occupational exposures, continuous monitoring and analysis are essential for identifying high-risk hazards and developing targeted prevention strategies. Therefore, this study aims to analyze the use of organic solvents and volatile organic compounds (VOCs) in different industries in Bao’an District, Shenzhen, China, from 2018 to 2023, to understand their temporal variation and industry-specific differences and to identify high-risk occupational hazards. This study includes 1335 organic solvent samples, used by 414 different industry enterprises, and 1554 air samples. The result shows that the usage of organic solvents in various industries decreased with the outbreak of the pandemic and, conversely, increased as the situation improved. The most frequently detected volatile components in organic solvents were alkanes, followed by aromatic hydrocarbons. The ratios of the detection frequency of VOCs to the total number of detected categories increased year by year after 2020, indicating a tendency towards reduction and concentration of the types of organic solvents used in industrial production. Among the 8 high-risk VOCs, toluene (22.5%), n-hexane (22.0%), xylene (16.1%), and ethylbenzene (15.3%) have relatively high detection rates, suggesting that they need to be focused on in occupational health. Through air samples, the results show that trichloroethylene and xylene pose a high risk to human health (HQ > 1). We recommend that industry should strengthen monitoring of these two VOCs.
... Exposure to xylene and toluene has been reported to pose serious occupational health risks and environmental challenges to living organisms (Banton et al. 2019;Kuranchie et al. 2019;Davidson, Hannigan, and Bowen 2021;Rashnuodi et al. 2021;Soltanpour, Mohammadian, and Fakhri 2021;Wang et al. 2021). Similarly, the same has been reported about methanol (Chan and Chan 2018;Log and Moi 2018;Gromadzi� nska and Wąsowicz 2019;Pressman et al. 2020). Liu et al. (2019) investigated some hydrocarbons solvents for bitumen recovery and reported that the toxicity of toluene limited their application. ...
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Solvent-aided dilution processes are often employed to recover bitumen by reducing its viscosity. In this study, methanol, toluene, and xylene were investigated as potential hydrocarbon solvents for solvent-aided hydrocarbon recovery of Agbabu bitumen. To achieve this, the solubility of the sample in the solvents was determined with a solubility test, its viscosity was measured with the Saybolt Furol Viscometer using the ASTM D88 method, and its SARA analysis was conducted using high-performance liquid chromatography. Agbabu bitumen was found to have a high content of saturates and aromatics. Viscosity decreases as pressure increases, while solubility reduces as temperature increases. The sample was most soluble in toluene, and its viscosity was reduced most in it, followed by xylene. Methanol reduced the saturates content and significantly raised the asphaltene content, keeping the mixture viscosity high. In terms of asphaltene stability of the mixtures, the bitumen-methanol system with the lowest colloidal instability index of 0.874 will give a mild asphaltene deposit issues compared with others that are unstable. This approach of combining multiple tests with the CII can accurately predict the behavior of Agbabu bitumen in solvents and enhance decision on the choice of bitumen recovery technology.
... 47,48 Methanol-induced desquamation and dermatitis are manifestations of skin absorption following prolonged exposure to methanol-containing ABHS. 49,50 There is a need for sensitization of the public on the health risks associated with using ABHS adulterated with high methanol content. ...
Article
In the year 2020, coronavirus disease-2019 (COVID-19) became a global public health emergency. The World Health Organization recommended wearing of masks, regular hand washing with soap or use of alcohol-based hand sanitizers to prevent human-to-human transmission of the disease. As a result, there was a rapid proliferation of hand sanitizers in the market, leading to concerns about the quality of these products. This study aimed to conduct a qualitative and quantitative evaluation of commercial alcohol-based hand sanitizers marketed in Kampala, Uganda. Commercial products (130) were sampled from five divisions of Kampala city and assessed for appearance, packaging, labelling and conformity with regulator’s mark of quality. Additionally, the pH of the samples was determined. Gas chromatography coupled with mass spectrometry and flame ionization detectors were used for qualitative and quantitative analysis of the alcohol-based hand sanitizers, respectively. Only 15 samples (12%) met all the specifications for appearance, packaging, labelling, and regulation characteristics assessed. Alcohol was detected in 128 samples (98%). The permitted alcohols detected in the samples were ethanol (86%), isopropyl alcohol (4%) and ethanol/isopropyl alcohol admixture (3%). However, samples containing methanol, either alone (4%) or mixed with ethanol (1.5%) were encountered. Isopropyl alcohol was found as a denaturant in only one sample contrary to the label claims in seven samples. Twenty-two samples (17%) had a different alcohol from that declared on the label. Seventy-eight samples (60%) had alcohol content within the requisite range of 60-95% v/v while forty-two had less than 60% v/v alcohol, and one contained more than 95% v/v. Sixty-seven samples did not comply with the specifications for pH. The results obtained from the study underscore the need for market surveillance of these products.
... With the increasing use of ABHS, cases of methanol toxicity are emerging, associated with serious consequences such as seizures and permanent vision loss, mainly due to intentional ingestion of ABHS in individuals with alcohol dependence. [25][26][27] Children are also at risk of accidental ingestion. 28 Seven ABHS samples (5.7%) showed no detectable ethanol nor permitted alcohols, suggesting deliberate marketing of ABHS devoid of active ingredients. ...
Article
The global public health impact of COVID-19 necessitated multifaceted approaches such as use of alcohol-based hand sanitizers (ABHS) to control transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study evaluated compliance with Kenya Bureau of Standards (KEBS) specification of commercially available alcohol-based hand sanitizers purchased from selected retail outlets in the Nairobi metropolitan area. Out of the 122 samples analyzed, 63% met KEBS specifications based on visual inspection, while gas chromatography-mass spectrometry (GC-MS) identified methanol as a contaminant in 26% of samples. Quantification of the permitted alcohols, ethanol and isopropanol, using gas chromatography with flame ionization detector (GC-FID) revealed that 44.3% had an alcohol content within the specified range of 60 - 95% v/v, with 5.7% containing neither alcohol. Furthermore, only 10% of samples from local manufacturers met KEBS specifications. These results highlight the need for strict monitoring and regulation of alcohol-based hand sanitizers, particularly in the context of the COVID-19 pandemic. Moreover, the presence of methanol and variations in alcohol content underscore the importance of implementing comprehensive quality control measures to ensure the effectiveness and safety of these highly important public health tools.
... M ethanol poisoning can occur either intentionally through the consumption of methanol-containing products, particularly in areas where the production, distribution, sale, and consumption of alcohol are legally prohibited, or as a result of accidental ingestion. [1,2] Developing countries have witnessed numerous outbreaks of methanol poisoning, [3][4][5][6] which have contributed to a significant global mortality rate, ranging from 12% to 44%. [1,7,8] Initial clinical symptoms of methanol poisoning typically include headaches, vertigo, nausea, vomiting, and abdominal pain; however, these symptoms may also manifest in later stages. ...
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Objective Methanol poisoning can occur either intentionally through the consumption of methanol-containing products or accidentally through ingestion, resulting in visual impairment. We assessed the long-term visual sequelae in patients with methanol poisoning. Methods This prospective cohort study was conducted at referral centers, Khorshid and Alzahra University Hospitals, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. The study included patients hospitalized for methanol poisoning from June 22, 2018, to June 21, 2020, with follow-up extended until June 2021. Toxico-clinical and ophthalmologic examination data were collected from patients upon hospital admission, discharge, and during follow-up. Findings Thirty-nine patients were assessed in this study. The majority of them (94.9%) were male, with an average age of 34 years. Patients who presented with reduced visual acuity (VA) upon admission subsequently showed abnormalities (in acuity and visual fields) during follow-up ( n = 13). Among the patients who displayed visual field defects on admission, bilateral optic disc atrophy was observed in follow-up ( n = 13). Conversely, patients who reported blurred vision, with or without photophobia upon admission, had normal results in their follow-up eye examinations. Among the 36 patients who underwent dialysis, 14 (38.9%) exhibited visual impairment during follow-up examinations. Additionally, 38 patients received sodium bicarbonate, and 14 of them (36.85%) also presented ocular abnormalities. Conclusion Patients who demonstrated VA deficits upon admission are more likely to experience long-term VA and visual field defects, as well as optic disc atrophy. Patients who solely complained of blurred vision, with or without photophobia, during admission were less likely to develop long-term visual defects.
... Managing methanol toxicity depends on the extent of exposure and requires close monitoring of laboratory parameters. Therapy with an antidote and/or extracorporeal treatment is the mainstay of treatment [8,9]. The treatment approach is directed towards interrupting methanol breakdown to formic acid using a competitive alcohol dehydrogenase enzyme inhibitor, such as fomepizole or ethanol. ...
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Background Acute methanol intoxication, whether unintentional or deliberate, necessitates prompt intervention to prevent severe morbidity and mortality. Homemade alcoholic beverages are a frequent source of such poisoning. This retrospective analysis examined two outbreaks of methanol intoxication in Saudi Arabia. It investigated the clinical presentation, implemented management strategies, and any lasting complications (sequelae) associated with these cases. The aim was to assess the potential impact of different treatment modalities and the timeliness of their initiation on patient outcomes. Methods This was a retrospective case series of methanol poisoning cases which presented to the adult emergency department (ED) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. There were two separate outbreaks in the city, the first one was from September 1 to September 10, 2020 and the second one was from May 14 to May 20, 2021. Electronic charts were reviewed, and data were extracted to previously prepared data extraction sheets. Result From the 22 patients who arrived in the ED alive, the most common complaints were nausea or vomiting followed by altered level of consciousness. About 9% from the patient were hypotensive, 36% were tachycardic, 41% were tachypneic and 4% were having SpO2 < 94%. Brain CT was abnormal in 6 patients. Vision impairment was the most common sequalae of methanol poisoning (7 out of 12 patients who were assessed by ophthalmologist, 58%). When the patients were divided based on severity (mild, moderate, severe), nausea or vomiting and loss of consciousness were the most common complaints among the moderate group while loss of consciousness predominated in the severe group. Two patients presented with low blood pressure and were in the sever group. The severe group had a mean Glasgow Coma Scale (GCS) of 8. Most of the patients in the severity groups underwent the same management apart from those who died or deposited. Eight patients in the severe group had to be intubated. Conclusion This study demonstrates the multifaceted clinical presentation of methanol poisoning, culminating in a 17.4% mortality rate. Notably, our findings emphasize the critical role of prompt diagnosis and swift initiation of combined fomepizole therapy and hemodialysis in mitigating mortality and minimizing the potential for chronic visual sequelae associated with methanol poisoning.
... The numerous instances of substandard alcohol-based hand sanitizers have been reported in both America (5,6) and Africa (7)(8)(9). Furthermore, there have been documented cases of an unexpected rise in vision loss and fatal incidents related to methanol toxicity (10,11) resulting from the ingestion of alcohol-based hand sanitizers in Iran (12), the United States (13,14), and the United Kingdom (15). ...
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A practical colorimetric analysis for alcohol determination was devised using a composite of food colorants, specifically a green solution of brilliant blue FCF and tartrazine at a ratio of 1:5 v/v. This colorimetric method was characterized by its simplicity, user-friendliness, environmental compatibility, cost-effectiveness, and suitability for self-measurement through visual examination. The colorimetric procedure entails admixture 1 mL of the alcohol sample with 50 µL of the green test solution and 250 µL of a 30% NaOH solution at ambient temperature. The ensuing color changes were visually assessed within 5 min. Through color sensing, methanol, ethanol, and isopropanol were identified by the manifestation of lemon yellow, orange, and biphasic solutions, respectively. Ethanol was semi-quantified based on color sensing from green to orange, with corresponding concentration ranges. The limit of detection for both methanol and ethanol was determined to be 30% v/v. The developed method demonstrated an accuracy of 93%, with the error range of 1 − 10% v/v and standard deviation of 3.9% v/v, as confirmed by the analysis of 100 commercially available alcohol-based hand sanitizers. This methodology has the potential for further expansion to encompass a wide range of rapid colorimetric analyses of products containing alcohol, including food items, alcohol raw materials, and cosmetics.
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This study focuses on exploring novel ingredients for the production of safe, high-quality alcoholic beverages and enhancing the processes involved in fermenting beverages. These efforts aim to support local community development initiatives targeting food security, food sovereignty, and small businesses. The article presents the technology for producing distillates from vegetative raw materials, integrating digital technologies for quality control across all manufacturing stages. Distillates were obtained using the “Minispirtzavod Simpl 2018 set “Authentic” equipment, featuring remote control capabilities and a built-in Wi-Fi module. The quality of distillates derived from various vegetable raw materials, including grapes, apples, wheat, and birch sap, was evaluated through organoleptic analysis, assessing appearance, aroma, and taste. Gas chromatography was employed to determine the content of ethyl alcohol, furfural, methyl alcohol, aldehydes, ethers, and fusel alcohol in the distillates. The resulting distillates contained 40.9% to 43.5% vol.% ethanol and exhibited distinct aromatic profiles and flavors based on the vegetative raw material used. This diversity offers opportunities to expand the range of alcoholic products available.
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The development of a cost‐effective, ultra‐selective, and room temperature gas sensor is the need of an hour, owing to the rapid industrialization. Here, a new 2D semiconducting Cu(I) coordination polymer (CP) with 1,4‐di(1H‐1,2,4‐triazol‐1‐yl)benzene (1,4‐TzB) ligand is reported. The CP1 consists of a Cu2I2 secondary building unit bridged by 1,4‐TzB, and has high stability as well as semiconducting properties. The chemiresistive sensor, developed by a facile drop‐casting method derived from CP1, demonstrates a response value of 66.7 at 100 ppm on methanol exposure, accompanied by swift transient (response and recovery time 17.5 and 34.2 s, respectively) behavior. In addition, the developed sensor displays ultra‐high selectivity toward methanol over other volatile organic compounds , boasting LOD and LOQ values of 1.22 and 4.02 ppb, respectively. The CP is found to be a state‐of‐the‐art chemiresistive sensor with ultra‐high sensitivity and selectivity toward methanol at room temperature.
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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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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.