Impact of the Voluntary Safety Standard for Liquid Laundry Packets on Child Injuries Treated in US Hospital Emergency Departments, 2012-2018

Pediatric injuries and poisonings associated with detergent packets: results from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), 2011-2023

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.

Impact assessment of mandatory safety device installation for gas stoves

Numerous fire accidents have occurred in Japan owing to food overheating when cooking on gas stoves because users left the cooking area unattended. In response, authorities enacted a legal revision mandating temperature sensor installation on gas stove burners. Nevertheless, the actual effectiveness of this measure remains uncertain. Furthermore, prior studies have raised concerns about the efficacy of specific safety standards for consumer products owing to insufficient evidence of reduction in accidents. Consequently, this study seeks to assess the impact of the standards revision implemented in 2008, requiring the placement of safety devices on all gas stove burners. Through a comprehensive analysis, it was aimed to ascertain how these measures have precisely influenced safety outcomes in cooking-related incidents. The data in this study were subdivided to mitigate potential bias from user attributes during data collection. The analysis employed the difference-in-differences method, specifically utilizing one-burner gas stoves unaffected by the standards revision. The data used in this study include accidents associated with gas stoves, spanning the period 2007-2019. To estimate the likelihood of overheating accidents, a binomial distribution model that utilized the Markov chain Monte Carlo methods was applied. For gas stoves with two or more burners, which were affected by the standards revision, the estimated probability of overheating accidents decreased by approximately 80%. In contrast, no decreasing trend was observed for one-burner gas stoves. The analysis suggests that the mandatory installation of safety devices on gas stoves has indeed resulted in a significant reduction in overheating accidents.

Longitudinal trends in liquid laundry detergent packet exposures: 2014-2022

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.

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

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.

Impact of product safety changes on accidental exposures to liquid laundry packets in children

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.