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Caution in using hand sanitizers in Covid-19

11 August 2020

Dr. Muhammad Torequl Islam :
The use of hand sanitizers is expected in health care where there is not enough opportunity to wash hands with soap/detergent and water. Needless to say, one of the first steps taken to prevent novel coronavirus (also called severe acute respiratory distress syndrome coronavirus 2 or SARS-CoV-2) infection is to use regular soap/detergent or hand sanitizers in accordance with the health rules. The World Health Organization (WHO) has clarified the components of hand sanitizers (e.g., ethanol, isopropyl alcohols, hydrogen peroxide with their various combinations) and their usage. WHO is also providing updated information on a regular basis, however, some unexpected incidents are happening regularly worldwide among the users.
By capitalizing on this at an early stage, many unscrupulous traders in different countries of the world raise the prices of such products, which cause a kind of special suffering to the public, though, many blame the inadequate supply of raw materials and the short-sightedness of the manufacturing companies. However, even if stocking status is ignored, the prices of hand sanitizers are a bit higher than the soaps and detergents, which is limiting the poor people to reach these kinds of products. Already, many small unnamed (new) hand sanitizer companies have emerged that have gained prudent public concerns about the quality of raw materials, manufacturing facilities/equipments, quality control and supply management process.
Although no deaths have been reported, there have been a number of accidents involving the use of hand sanitizers in Bangladesh since the beginning of the SARS-CoV-2 infection; among them, the skin of the users' hands gets burnt is mentionable. Most people are not aware about the preservation process; even they don't know about proper using process of hand sanitizers. They just rubbed their hands with a few drops of sanitizer and went to work; which basically does not work. In warmer climates, it is highly recommended not to use alcohol-based sanitizers, especially in vehicles in high-temperature areas that do not have air conditioning system.
Alcoholic sanitizers have combustible power. Therefore, it is highly recommended that the peoples working in the kitchen or any kind of flammable areas be especially careful in its use. Children are fascinated by their containers and colors; negligence can lead to accidents or even death. Misuse of sanitizer ingredients can be harmful to our health and the environment. Basically, these chemicals are released by evaporation which has toxic and dangerous effects on the environment. The following are the acute and long-term toxic effects of the ingredients used in our widely used sanitizers.
Acute toxicity
Ethanol: Central nervous system and respiratory depression, lactic acidosis, ketoacidosis, nausea
Isopropanol: Central nervous system and respiratory depression, skin and mucous membrane irritation, lactic acidosis, ketoacidosis, nausea
H2O2 (3%): Mild gastrointestinal and mucosal irritation, vomiting, skin irritation
Chronic toxicity
Ethanol: Cardiac arrhythmia, acute liver injury, myoglobinuria, hypokalemia, hypomagnesemia, hypocalcemia, hypophosphatemia, cardiac arrest and even death
Isopropanol: Ketosis, osmolal gap ketonemia, rhabdomyolysis, myoglobinuria, acute renal failure and even death
H2O2 (3%): Air embolism and even death (in rare cases)
From January to May 2020, the American Association of Poison Control Centers handled 9,504 cases of alcoholic hand sanitizers on children under 12 years of age. According to this organization, very small amounts of alcohol can cause alcohol-related toxicity in children, which can lead to mental confusion, nausea and drowsiness, and in severe cases, death by stopping respiratory activity. In addition, frequent use of hand sanitizers may increase the risk of other viral infections, including the development of anti-microbial resistance. In the overall judicial analysis, special care should be taken in the use of hand sanitizers.

(Dr. Muhammad Torequl Islam is Assistant Professor, Department of Pharmacy, BSMRSTU, Gopalganj-8100, Bangladesh. E-mail: [email protected])

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