Hand Sanitizer Dispensers Not Child’s Play

It is a way of life brought on by the pandemic.  Alcohol based hand sanitizers (ABHS) are common fixtures wherever we go.  Grocery stores, schools, or clinics. However, have you ever really noticed the height of the dispenser, more importantly, the dispensing level itself?  For shorter individuals, mostly children the dispensing station is a hazard.  Hardly the outcome one is looking for to keep the public safe.

Many dispensers are at eye level for kids.  While not all dispensers wreak havoc, many can squirt haphazardly and can land in the eye of a child standing nearby.  Even bottle dispensers can cause problems for younger patients when curious minds handle them.  In addition to discomfort or stinging, ABHS can cause corneal and conjunctival injuries.

In January 2021, Yangzes et al published two case studies of eye injuries in kids due to ABHS in JAMA Ophthalmology. They say “small children are at risk of severe ocular injury and possibly even blindness due to inadvertent ocular exposure to ABHS. In most public places, the hand sanitizers are installed at a waist-level height of an adult but at eye level or above for a young child.” They go on to say that “for ABHS, the US Food and Drug Administration recommends a concentration of 60% to 95% ethanol or isopropanol. The irritant in our case report was 70% ethyl alcohol, which led to total loss of corneal epithelium along with conjunctival ischemia in one case and localized epitheliopathy in the other.” The two patients in their cases were lucky and were treated promptly. They did not go on to have any permanent corneal or ocular damage, however they do warn that there are other published cases on alcohol based eye injuries in which subjects were not as lucky.

Also this year, Martin et al performed a retrospective review of ABHS cases from the French Poison Control Centers, which indicated that “a 7-fold increase of alcohol-based hand sanitizer-related ocular exposures in children was found [in 2020] in comparison with 2019, and a pediatric ophthalmology center reported 13% of [those] patients requiring surgery for severe lesions.” Dr. Martin says that “the number of cases occurring in public places increased in 2020 (from 16.4% in May to 52.4% in August). Similarly, admissions to the eye hospital for ABHS exposure increased during the same period (16 children in 2020 including 10 boys; mean [SD] age, 3.5 [1.4] years vs. 1 boy aged 16 months in 2019). Eight of them presented with a corneal and/or conjunctival ulcer, involving more than 50% of the corneal surface for 6 of them. Two cases required amniotic membrane transplant.”

Many eye care professionals are asking for the redesign of dispensers.  Stand-alone dispensers seem to cause the most problems with “spraying” erratically.  Other suggestions are simple- use foam, not gel in dispensers. Or, placing caution signs warning of hazards to children.

Eye care professionals and healthcare professionals in general prefer simple soap and water for hand washing instead of sanitizer.  However, when this is not possible, hand sanitizer becomes necessary.

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