1
|
Zutrauen S, Cheesman J, McFaull SR. Pediatric injuries and poisonings associated with detergent packets: results from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), 2011-2023. Inj Epidemiol 2024; 11:31. [PMID: 38992784 PMCID: PMC11238368 DOI: 10.1186/s40621-024-00513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Detergent packets are common household products; however, they pose a risk of injuries and poisonings, especially among children. This study examined the epidemiological characteristics of pediatric injuries and poisonings related to all types of detergent packets in Canada using emergency department (ED) data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. METHODS The CHIRPP database was searched for ED visit records for injuries and poisonings related to all types of detergent packets between April 1, 2011 and October 12, 2023 (N = 2,021,814) using variable codes and narratives. Data for individuals aged 17 years and younger were analyzed descriptively. Temporal trends in the number of detergent packet-related injuries and poisonings per 100,000 CHIRPP cases were assessed using Joinpoint regression and annual percent change (APC). A proportion ratio and 95% confidence intervals (CI) were calculated to compare the proportion of detergent packet-related cases in CHIRPP during two 34-months periods, pre-COVID-19 pandemic and after the beginning of the pandemic. RESULTS There were 904 detergent packet-related cases among children and youth aged 17 years and younger identified in CHIRPP between April 1, 2011 and October 12, 2023, representing 59.9 cases per 100,000 CHIRPP cases. The majority (86.5%) of cases were among children aged 4 years and younger. Poisonings (58.8%) and eye injuries (30.6%) were the most frequent primary diagnoses. Unintentional ingestion (56.9%) and squeezing/breaking a detergent packet (32.3%) were the most frequent exposure mechanisms. Sixty-five patients (7.2%) were admitted to hospital. The number of detergent packet-related cases per 100,000 CHIRPP cases increased by 5.0% (95% CI 0.8, 10.2) annually between 2012 and 2022. The number of detergent packet-related poisonings per 100,000 CHIRPP cases decreased by 15.3% (95% CI - 22.3, - 10.6) annually between 2015 and 2022, whereas eye injuries showed an average annual percent increase of 16.6% (95% CI 11.2, 23.0) between 2012 and 2022. The proportion of detergent packet-related cases in CHIRPP after the beginning of the pandemic (79.9/100,000 CHIRPP cases) was 1.43 (95% CI 1.20, 1.71) times greater than pre-pandemic (55.7/100,000 CHIRPP cases). CONCLUSIONS Detergent packet-related injuries and poisonings are a persisting issue. Continued surveillance and prevention efforts are needed to reduce detergent packet-related injuries and poisonings in Canada, particularly among children and youth.
Collapse
Affiliation(s)
- Sarah Zutrauen
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - James Cheesman
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Steven R McFaull
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| |
Collapse
|
2
|
Nitescu GV, Lescaie A, Ilisei I, Ulmeanu A, Baconi L, Craciun D, Chivu CD, Preda DM, Ulmeanu C. Laboratory features in acute paediatric poisoning with liquid laundry detergent capsules: a seven-year retrospective study in Romania. Clin Toxicol (Phila) 2024; 62:446-452. [PMID: 38966916 DOI: 10.1080/15563650.2024.2370300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The epidemiological and clinical characteristics of acute poisoning with liquid laundry detergent capsules have been comprehensively reported. However, studies of laboratory test results in these exposures are uncommon. This study analyzed the impact of the ingestion of liquid laundry detergent capsules on admission laboratory tests in paediatric patients. METHODS This retrospective study was conducted in the clinical toxicology unit of a paediatric poison centre between 2015 and 2021. Paediatric patients (less than 18 years of age) who ingested liquid laundry detergent capsules were included. The relationship between the European Association of Poisons Centers and Clinical Toxicologists/European Commission/International Programme on Chemical Safety Poisoning Severity Score and admission laboratory test results was assessed using Fisher's exact test or analysis of variance. RESULTS A total of 156 patients were included in the study. A considerable proportion of patients presented with leucocytosis, acidosis, hyperlactataemia or base deficit. The median values of white blood cell count (P = 0.042), pH (P = 0.022), and base excess (P = 0.013) were significantly different among the Poisoning Severity Score groups. Hyperlactataemia was strongly associated with the Poisoning Severity Score (P = 0.003). DISCUSSION Leucocytosis is a non-specific marker of severity following ingestion of liquid laundry detergent capsules. The incidence of metabolic acidosis and hyperlactataemia was higher in this study than in previous reports, but these metabolic features were not related to the severity of exposure. The exact mechanisms of toxicity are not yet known, but the high concentration of non-ionic and anionic surfactants, as well as propylene glycol and ethanol, in the capsule are likely contributing factors. CONCLUSIONS Pediatric patients who ingest liquid laundry detergent capsules may develop leucocytosis, metabolic acidosis, hyperlactataemia, and a base deficit.
Collapse
Affiliation(s)
- Gabriela Viorela Nitescu
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Andreea Lescaie
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Ioana Ilisei
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Alexandru Ulmeanu
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Luiza Baconi
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dorina Craciun
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Carmen Daniela Chivu
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Diana Monica Preda
- Pediatric Outpatient Clinic, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Coriolan Ulmeanu
- Pediatric Poison Center, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| |
Collapse
|
3
|
Zhang AM, Smith GA, Casavant MJ, Kistamgari S, Gaw CE. Longitudinal trends in liquid laundry detergent packet exposures: 2014-2022. Clin Toxicol (Phila) 2023; 61:990-998. [PMID: 38112310 DOI: 10.1080/15563650.2023.2287977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Liquid laundry detergent packet exposures modestly declined in the mid-2010s among children less than 6 years of age due to public awareness and voluntary product safety standards. We aimed to assess longitudinal trends in the number and rate of liquid laundry detergent packet exposures in the United States by age. METHODS Data from the National Poison Data System were analyzed to characterize liquid laundry detergent packet exposures between January 2014 and December 2022. RESULTS From 2014-2022, there were 114,826 single and polysubstance exposures to liquid laundry detergent packets. Children less than 6 years of age (86.8 percent) were most commonly exposed. When evaluating multi-year trends, we found that the annual exposure rate per 1 million children less than 6 years old increased by 16.8 percent from 392.6 in 2018 to 458.7 in 2020. Subsequently, the annual exposure rate in children less than 6 years of age declined by 6.8 percent from 2020 to 2022 (427.4 exposures per 1 million). The annual rate of adolescent exposures increased by 85.4 percent from 2014 (4.1 exposures per 1 million) to 2017 (7.6 exposures per 1 million), with a subsequent increase of 155.3 percent from 2017 to 2018 (19.4 exposures per 1 million). Among adults, the annual exposure rate increased by 147.1 percent from 2014 (1.7 exposures per 1 million) to 2022 (4.2 exposures per 1 million). The number of more serious medical outcomes and hospital admissions among children less than 6 years of age declined by 44.3 percent and 68.6 percent, respectively, between 2014 and 2018. CONCLUSIONS Despite declines in the number, rate, and severity of liquid laundry detergent packet exposures among children less than 6 years old, the exposure burden remains high. Additionally, exposures have increased among older children, adolescents, and adults. Renewed safety efforts are warranted to protect prior public health gains and further reduce exposures.
Collapse
Affiliation(s)
- Alice M Zhang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Child Injury Prevention Alliance, Columbus, OH, USA
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Section of Toxicology, Nationwide Children's Hospital, Columbus, OH, USA
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher E Gaw
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
4
|
Palmer SB, Spiller HA, Kistamgari S, Casavant MJ, Rine NI, Yang J, Zhu M, Smith GA. Hydrocarbon ingestions among individuals younger than 20 years old reported to United States Poison Centers, 2000-2021. Inj Epidemiol 2023; 10:48. [PMID: 37828629 PMCID: PMC10571327 DOI: 10.1186/s40621-023-00461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Hydrocarbon-based products have many household and commercial uses and exposure to these substances is common. Severe clinical effects can occur if these products are ingested. This study investigated the characteristics and trends of hydrocarbon ingestions reported to United States Poison Centers. METHODS Data from the National Poison Data System were analyzed for cases of hydrocarbon ingestion among individuals < 20 years old reported to United States Poison Centers from January 1, 2000 through December 31, 2021. RESULTS There were 284,085 hydrocarbon ingestions reported during the 22-year study period in which a hydrocarbon was the first-ranked substance. Most of these cases occurred among children < 6 years old (83.2%), males (64.6%), at a residence (96.5%), were single-substance exposures (98.3%), and were managed on-site rather than in a health care facility (74.9%). However, 4.5% of cases were associated with a serious medical outcome, including 34 deaths. Thirty-two deaths were among children < 6 years old and most were associated with aspiration. Gasolines accounted for 24.6% of total cases, followed by lubricating oils and/or motor oils (19.9%), other types of hydrocarbons (14.9%), lamp oils (11.3%), and lighter fluids and/or naphtha (10.3%). The rate of hydrocarbon ingestions among United States youth < 20 years old decreased significantly (p < 0.0001) by 66.5% from 2000 to 2021. The greatest rate decrease was observed among lamp oils (- 78.4%, p < 0.0001), followed by gasolines (- 75.9%, p < 0.0001). CONCLUSIONS Although the rate of hydrocarbon ingestions decreased during the study period and most reported cases resulted in non-serious outcomes, the number of cases remains high with a non-trivial minority (4.5%) of cases associated with a serious medical outcome, including death. Most deaths were among children < 6 years old. This underscores the need to increase primary prevention efforts, especially for young children.
Collapse
Affiliation(s)
- Samiza B Palmer
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Henry A Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natalie I Rine
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Motao Zhu
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Child Injury Prevention Alliance, Columbus, OH, USA.
| |
Collapse
|
5
|
Chen T, Kistamgari S, Smith GA. Consumer Product-Related Pediatric Eye Injuries Treated in United States Emergency Departments. Ophthalmic Epidemiol 2022:1-10. [DOI: 10.1080/09286586.2022.2129696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tiffany Chen
- Center for Injury Research and Policy in The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- New Jersey Medical School, Newark, NJ, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy in The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Gary A. Smith
- Center for Injury Research and Policy in The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Child Injury Prevention Alliance, Columbus, Ohio, USA
| |
Collapse
|
6
|
Aldy K, Du T, Weaver MM, Roth B, Cao DJ. Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020. Clin Toxicol (Phila) 2022; 60:1039-1043. [PMID: 35603994 DOI: 10.1080/15563650.2022.2074856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Exposure to single-use detergent sacs (SUDS), or laundry pods, have declined in the pediatric population between 2015 and 2018. Older adult exposures are less well described, and it is unclear if there is an increased risk of unintentional exposure to SUDS in older adults, especially in those with dementia. This study aims to review SUDS exposures in adults greater than 60-year-old between 2012 and 2020. METHODS Using the National Poison Data System (NPDS), a query was performed for cases involving an acute single substance exposure with substance coded as "laundry detergent unit dose" (Generic code: 0201181, 0201182, and 0201183) in adults greater than 60-years-old between January 1, 2012 and December 31, 2020. Exclusion criteria included unknown age, age less than 60 years, any multi-substance exposure, and chronic or acute-on-chronic acuity. The distribution of cases was analyzed for demographics, exposure circumstances, management, clinical effects, and medical outcome. RESULTS SUDS exposure reported to NPDS increased from 46 cases in 2012 to 219 cases in 2020. Among the 1289 total reported cases, 94.9% (n = 1223) were unintentional exposures with an average age of 75-year-old. The majority of exposures occurred in females (69%, n = 883). More than 1 exposure route was reported in 90 cases (7%), and the most common route of exposure was ingestion (64.9%, n = 836). Major effects were identified in 1% (n = 13) of exposures, and 0.5% (n = 7) of cases resulted in death. CONCLUSIONS Despite a declining incidence of pediatric SUDS exposure, older adult exposures have increased over 400% between 2012 and 2020.
Collapse
Affiliation(s)
- Kim Aldy
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony Du
- Baylor College of Medicine, Houston, TX, USA
| | - Mary Madison Weaver
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett Roth
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| |
Collapse
|
7
|
Bennett CE, Venkataramani A, Henretig FM, Faerber J, Song L, Wood JN. Recent Trends in Marijuana-Related Hospital Encounters in Young Children. Acad Pediatr 2022; 22:592-597. [PMID: 34325061 DOI: 10.1016/j.acap.2021.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Multiple states have passed legislation permitting marijuana use. The impact of legalization on trends in hospital encounters for marijuana exposures in young children across states remains unknown. We aimed to describe trends in marijuana-related hospital encounters over time in children <6 years and assess the association of state-level marijuana legislation with the rate of marijuana-related hospitalizations. METHODS We identified inpatient, emergency department and observation encounters for children <6 years with marijuana exposures (defined by International Classification of Diseases diagnosis codes) unique on the patient-year level at 52 children's hospitals in the Pediatric Health Information System database from 01/01/2004 to 12/31/2018. Trends in encounters across the study period were evaluated using negative binomial regression with outcome of marijuana-related hospital encounters and year as the predictor variable accounting for clustering by hospital. We then estimated a negative binomial regression difference-in-difference model to examine the association between the main outcome and state recreational and medical marijuana legalization. RESULTS Of the 1296 included unique patient-year encounters, 50% were female with mean age 2.1 years (standard deviation = 1.4). Fifty percent were inpatient (n = 645) and 15% required intensive care with 4% requiring mechanical ventilation. There was a 13.3-fold increase in exposures in 2018 compared to 2004 (P< .001). We did not find an effect of state legalization status for recreational (P = .24) or medical (P = .30) marijuana. CONCLUSIONS The observed dramatic increase in marijuana-related hospital encounters highlights the need for prevention strategies aimed at reducing unintentional marijuana exposures in young children, even in states without legislation permitting marijuana use.
Collapse
Affiliation(s)
- Colleen E Bennett
- Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett and JN Wood), Philadelphia, Pa; National Clinician Scholars Program, University of Pennsylvania (CE Bennett, A Venkataramani, and JN Wood), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (CE Bennett, FM Henretig, and JN Wood), Philadelphia, Pa.
| | - Atheendar Venkataramani
- National Clinician Scholars Program, University of Pennsylvania (CE Bennett, A Venkataramani, and JN Wood), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (A Venkataramani, FM Henretig, and JN Wood), Philadelphia, Pa; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania (A Venkataramani), Philadelphia, Pa
| | - Fred M Henretig
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (A Venkataramani, FM Henretig, and JN Wood), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (CE Bennett, FM Henretig, and JN Wood), Philadelphia, Pa; Division of Emergency Medicine and Poison Control Center, The Children's Hospital of Philadelphia (FM Henretig), Philadelphia, Pa
| | - Jennifer Faerber
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia (J Faerber and L Song), Philadelphia, Pa
| | - Lihai Song
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia (J Faerber and L Song), Philadelphia, Pa
| | - Joanne N Wood
- Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett and JN Wood), Philadelphia, Pa; National Clinician Scholars Program, University of Pennsylvania (CE Bennett, A Venkataramani, and JN Wood), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (A Venkataramani, FM Henretig, and JN Wood), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (CE Bennett, FM Henretig, and JN Wood), Philadelphia, Pa
| |
Collapse
|
8
|
Giordano F, Petrolini VM, Spagnolo D, Fidente RM, Lanciotti L, Baldassarri L, Moretti FL, Brambilla E, Lonati D, Schicchi A, Locatelli CA, Draisci R. Significant variations of dangerous exposures during COVID-19 pandemic in Italy: a possible association with the containment measures implemented to reduce the virus transmission. BMC Public Health 2022; 22:441. [PMID: 35246098 PMCID: PMC8896978 DOI: 10.1186/s12889-022-12860-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In response to the COVID-19 health emergency, mass media widely spread guidelines to stop the virus transmission, leading to an excessive and unaware use of detergents and disinfectants. In Italy and in other countries this tendency caused a significant increase of exposures to these products in 2020. Evaluating data collected by the Italian Pavia Poison Centre (PPC), this study intends to examine the relationship between the COVID-19 lockdown and the variations of exposures to specific product categories possibly associated to the containment measures implemented. Simultaneously, this work shows the effectiveness of the European Product Categorisation System (EuPCS) in surveillance activities of dangerous chemicals. METHODS Exposure cases managed by the PPC during March-May 2020 (lockdown) and during the same months of 2017-2018-2019 were compared. Differences in categorical variables were tested with the Chi-square test. The level of significance was set at Alpha = .05. The study included all EuPCS groups but specifically focused on cleaners, detergents, biocides and cosmetics. RESULTS During the lockdown, calls from private citizens showed a highly significant increase (+ 11.5%, p < .001) and occupational exposures decreased (- 11.7%, p = .011). Among Cleaners, exposures to Bleaches slightly increased while Drain cleaning products went through a significant reduction (- 13.9%, p = .035). A highly significant increase of exposures to Disinfectants was observed (+ 7.7%, p = .007), particularly to those for surfaces (+ 6.8%, p = .039). Regarding Cosmetics, both handwashing soaps and gel products significantly increased (respectively: + 25.0, p = .016 and + 9.7%, p = .028). Among children 1-5 years, the statistical significance is reached with exposures to Dishwashing detergents (+ 13.1%, p = .032), handwashing soaps (+ 28.6%, p = .014) and handwashing gel products (+ 16.8%, p = .010). Contrarily, Liquid Laundry Detergent Capsules decreased in a highly significant manner (- 25%; p = .001). The general severity of exposures showed a highly significant decrease (Moderate: - 10.1%, p = .0002). CONCLUSIONS This study investigated the relationship between the COVID-19 lockdown and the variations of exposures to some product categories related to the containment measures. The results obtained support any action to be taken by Competent Authorities to implement measures for a safer use of cleaners/disinfectants. This paper shows the benefit in applying the EuPCS to categorize products according to their intended use, though an extension of this system to products not covered by CLP Regulation may be a further advantage.
Collapse
Affiliation(s)
- Felice Giordano
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy.
| | - Valeria Margherita Petrolini
- Toxicology Unit, Poison Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Domenico Spagnolo
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| | - Rosanna Maria Fidente
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| | - Lucrezia Lanciotti
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| | - Lucilla Baldassarri
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| | - Francesco Luca Moretti
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| | - Elena Brambilla
- Toxicology Unit, Poison Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Davide Lonati
- Toxicology Unit, Poison Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Azzurra Schicchi
- Toxicology Unit, Poison Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Carlo Alessandro Locatelli
- Toxicology Unit, Poison Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Rosa Draisci
- National Center for Chemicals, Cosmetics and Consumer Protection, Istituto Superiore di Sanità, Viale Regina Elena 299, 00100, Rome, Italy
| |
Collapse
|
9
|
Rocka A, Piędel F, Madras D, Krawiec P, Pac-Kożuchowska E. Dark side of laundry pods: Analysis of exposure to laundry detergent capsules in children. J Paediatr Child Health 2021; 57:1912-1916. [PMID: 34129255 DOI: 10.1111/jpc.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/01/2022]
Abstract
AIM We aimed to evaluate the epidemiological characteristic and clinical features of laundry detergent capsule (LDC) exposure in children. METHODS Retrospective review of medical records of patients hospitalised due to the exposure to LDC at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Poland, from 2014 to 2019 was conducted. RESULTS During the study period, 38 children including 19 (50%) boys and 19 (50%) girls were admitted to our department due to exposure to LDC. The age of patients ranged from 11 months to 9 years, with a mean 48.61 ± 28.85 months of age. About 66% of patients were younger than 5 years. The major route of exposure was ingestion (n = 37; 97%). Most patients (n = 27; 71%) exhibited symptoms of exposure to the LDC. The most common symptoms were vomiting (n = 23; 60%), cough (n = 7; 18%) and salivation (n = 5; 13%). Seven patients required gastroscopy. Abnormalities were subsequently identified in three children. CONCLUSIONS Accidental exposure to LDC usually occurs in children younger than 5 years. Although the majority of cases had mild or moderate clinical outcomes, ingestion of LDC may lead to some severe consequences. Improvements in parental education regarding the risks of LDC, and in the packaging of LDC may prevent serious injury.
Collapse
Affiliation(s)
- Agata Rocka
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Faustyna Piędel
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Dominika Madras
- Students' Scientific Group at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Paulina Krawiec
- Department of Paediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | | |
Collapse
|
10
|
Santos RRD, Machado MED, Gomes ALM, Aguiar RCBD, Christoffel MM. Prevention of domestic accidents in childhood: knowledge of caregivers at a health care facility. Rev Bras Enferm 2021; 75:e20210006. [PMID: 34705994 DOI: 10.1590/0034-7167-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze caregivers' knowledge about prevention of domestic accidents in early childhood and its association with education level. METHODS This is a cross-sectional study conducted in a Primary Care Unit in Niterói with caregivers (convenience sample) of children under 6 years old. To classify the knowledge, we adopted the Positivity Index; to verify the association between the variable "schooling" and knowledge, the chi square test was used; statistically significant results: p < 0.05. RESULTS A total of 256 caregivers participated; 93.5% showed adequate knowledge. In the individual items, the knowledge (100%) about prevention of accidents with sharp toys, firearms, intoxication by products stood out; and less frequently (64.5%), the knowledge of the information contained in the Child's Health Booklet. There was no statistically significant association (p = 0.237) between education and knowledge. Conclusion: The caregivers presented knowledge about the prevention of domestic accidents, and this was not associated with the level of education.
Collapse
|
11
|
Rodgers GB. Evaluation of the impact of the voluntary safety standard for liquid laundry packets on the rate of child exposures reported to Poison Control Centers in the US. Inj Prev 2021; 28:43-48. [PMID: 33833071 DOI: 10.1136/injuryprev-2020-044115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the impact of the voluntary safety standard for liquid laundry packets on the rate of child exposures reported to Poison Control Centers in the US. METHODS The analysis was based on an interrupted time series design. The voluntary safety standard for laundry packets was published at the end of 2015. Data on reported liquid laundry packet exposures involving children under age 6 years were collected for the July 2012 through December 2017 study period. A negative binomial multiple regression model for rate data was used to quantify the impact of the voluntary standard on (1) the rate of total reported exposures and (2) the rate of reported exposures that were medically treated. The analysis controlled for laundry packet sales, time trends and seasonal variations in reported exposures. RESULTS The voluntary safety standard was associated with a 28.6% reduction in the rate of total reported exposures and a 36.8% reduction in the rate of medically treated exposures. The analysis also provides some evidence that these estimated reductions may underestimate overall reductions in the rate of reported exposures if pre-standard packaging improvements and possible caregiver behavioural responses to laundry packet hazard warnings are considered. CONCLUSIONS The analysis suggests that the requirements of the voluntary standard have effectively reduced the rate of injury involving liquid laundry packets.
Collapse
Affiliation(s)
- Gregory B Rodgers
- Directorate for Economic Analysis, United States Consumer Product Safety Commission, Bethesda, Maryland, USA
| |
Collapse
|
12
|
O'Donnell EP, Canares TL. Accidents Waiting to Happen: A Review of Unintentional Household Injuries in Children. Pediatr Rev 2021; 42:109-122. [PMID: 33648990 DOI: 10.1542/pir.2019-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Erin P O'Donnell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Therese L Canares
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
13
|
Toce MS, Michelson K, Hudgins J, Burns MM, Monuteaux MC, Bourgeois FT. Association of State-Level Opioid-Reduction Policies With Pediatric Opioid Poisoning. JAMA Pediatr 2020; 174:961-968. [PMID: 32658263 PMCID: PMC7358978 DOI: 10.1001/jamapediatrics.2020.1980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies. OBJECTIVE To examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis used data from the National Poison Data System (NPDS), a database of poisoning information reported to poison control centers across the US. Individuals younger than 20 years who experienced poisoning associated with 1 or more prescription opioids from January 1, 2005, to November 30, 2017, were included. The analysis focused on 3 widespread policy interventions: the prescription drug monitoring program (PDMP), pain clinic legislation, and opioid prescribing guidelines. Data analysis was performed from January 30, 2020, to March 30, 2020. EXPOSURES Any opioid poisoning in individuals younger than 20 years that was reported to the NPDS. MAIN OUTCOMES AND MEASURES Opioid poisoning rates per million person-months before and after implementation of each of the 3 policies, overall and stratified by age (≤4 years, 5-9 years, 10-14 years, and 15-19 years). RESULTS A total of 338 476 opioid poisoning incidences in children and young adults were reported to the NPDS within the study period. Of this study population, the mean (SD) age was 9.74 (7.15) years, and 179 011 (52.9%) were female. The implementation of a PDMP was associated with a reduction in the monthly rate of opioid poisoning in children and adolescents (-0.07 per million person-months; 95% CI, -0.09 to -0.04) in the postimplementation period. This reduction was observed for all age groups except for the 10- to 14-year age group (-0.03 per million person-months; 95% CI, -0.05 to 0.00). Pain clinic legislation was associated with an immediate reduction in opioid poisoning (-6.22 per million person-months; 95% CI, -8.98 to -3.47). This association was statistically significant across all ages except for the 4 years or younger group. Analysis of the association of implementation of opioid prescribing guidelines was limited because of insufficient follow-up data and did not show an immediate or monthly change in the rate of opioid poisoning. CONCLUSIONS AND RELEVANCE Results of this study suggest that certain state-level opioid-reduction policies were associated with decreases in pediatric opioid exposures across age groups. Further examination of the underlying mechanisms of these associations, including age group-specific outcomes, may expand and strengthen policies that reduce opioid poisoning, misuse, and overdoses in children and adolescents.
Collapse
Affiliation(s)
- Michael S. Toce
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical Toxicology Program, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kenneth Michelson
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Joel Hudgins
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michele M. Burns
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical Toxicology Program, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program (CHIP), Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
14
|
Reynolds KM, Burnham RI, Delva-Clark H, Green JL, Dart RC. Impact of product safety changes on accidental exposures to liquid laundry packets in children. Clin Toxicol (Phila) 2020; 59:392-399. [PMID: 32960108 DOI: 10.1080/15563650.2020.1817478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the impact of the ASTM International (formerly American Society of Testing Materials) safety standard and associated product safety changes on accidental exposures to liquid laundry packets (LLPs) in children. METHODS The National Poison Data System was queried for reports of accidental exposures to LLPs in children <6 years old received from 01 July 2012 to 31 December 2018. In 2014, ASTM International began developing a standard specifying voluntary product changes to reduce the risk of LLP exposures in young children. Product changes were made between 2013 and 2016. Exposures were grouped into baseline, transition, and post periods based on the timing of the standard's implementation. Exposure counts and sales adjusted rates were compared between the baseline and post period for all exposures and exposures involving healthcare facility (HCF) evaluation, HCF admission, and major medical outcomes. RESULTS A total of 73,942 accidental exposures in children <6 years old were reported (baseline: 10,229, 13.8%; transition: 43,507, 58.8%; post: 20,206, 27.3%). The percentage of exposures involving HCF evaluation (41.5% to 33.8%), HCF admission (4.5% to 1.9%), and major medical outcomes (0.6% to 0.1%) decreased from the baseline to post period. Sales adjusted rates of all exposures decreased 57.4% (4.920-2.094 exposures/1 million packets sold). Decreases also occurred in HCF evaluations (65.0% decrease; 2.026-0.708 exposures/1 million packets sold), HCF admissions (81.4% decrease; 0.218-0.041 exposures/1 million packets sold), and major medical outcomes (90.9% decrease; 0.030-0.003 exposures/1 million packets sold). CONCLUSIONS The morbidity of accidental exposures to LLPs in children decreased substantially following implementation of the ASTM International safety standard. Ongoing monitoring should be performed to determine if additional safety measures are required.
Collapse
Affiliation(s)
- Kate M Reynolds
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Randy I Burnham
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Heather Delva-Clark
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Jody L Green
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA.,Inflexxion, an IBH Company, Costa Mesa, CA, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
15
|
Smith GA. Time to Protect Our Children From Liquid Laundry Detergent Packets. Am J Public Health 2020; 110:1119-1120. [PMID: 32639920 DOI: 10.2105/ajph.2020.305787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gary A Smith
- Gary A. Smith is with the Center for Injury Research and Policy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; the Department of Pediatrics, The Ohio State University College of Medicine, Columbus; and the Child Injury Prevention Alliance, Columbus, OH
| |
Collapse
|
16
|
Hanway SJ, Rodgers GB. Impact of the Voluntary Safety Standard for Liquid Laundry Packets on Child Injuries Treated in US Hospital Emergency Departments, 2012-2018. Am J Public Health 2020; 110:1242-1247. [PMID: 32552030 DOI: 10.2105/ajph.2020.305650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard's publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department-treated injuries during the study period.
Collapse
Affiliation(s)
- Stephen J Hanway
- Stephen J. Hanway is with the Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, MD. Gregory B. Rodgers is with the Directorate for Economic Analysis, US Consumer Product Safety Commission
| | - Gregory B Rodgers
- Stephen J. Hanway is with the Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, MD. Gregory B. Rodgers is with the Directorate for Economic Analysis, US Consumer Product Safety Commission
| |
Collapse
|
17
|
Hageman JR. Liquid Laundry Pods: An Innovation with Potential Toxic Consequences for Children and Adolescents. Pediatr Ann 2019; 48:e417. [PMID: 31710358 DOI: 10.3928/19382359-20191015-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|