Household Product Poisonings

1. Household Product Poisonings • Shan Yin, MD, MPH • Cincinnati Children’s Hospital • Cincinnati Drug and Poison Information Center

2. Objectives • Review the epidemiology of pediatric poisoning • Discuss the problem of household product poisonings • As a group discuss potential interventions

3. Poisoning • 1.2 million exposures reported to US poison centers annually • 80-90 thousand estimated ED visits for poisoning (430 poisonings per 100,000 children) • 30-40 fatalities annually • Globally, 5th most common fatal injury for children <5

4. Definition • The term ‘‘household substance’’ means any substance which is customarily produced or distributed for sale for consumption or use, or customarily stored, by individuals in or about the household and which is— • (A) a hazardous substance as that term is defined in section 2(f) of the Federal Hazardous Substances Act (15 U.S.C. §1261(f)); • (B) a food, drug, or cosmetic as those terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. §321); or • (C) a substance intended for use as fuel when stored in a portable container and used in the heating, cooking, or refrigeration system of a house. 4

5. Household Products/Poisons • Hair relaxer • Mouthwash • Liquid drain openers • Toilet bowl cleaners • Oven cleaners • Lamp oil • Plants • Furniture polish • Windshield washer fluid • Kerosene • Antifreeze • Turpentine • Paint thinner • Batteries

6. Demographics • Poisonings peak around age 2 and then decline • Males are majority (55-60%) • 98% occur at home • Majority are ingestions (60-70%) • Contact to the eye (20-25%)

7. AAPCC Exposures

8. ED visits • Approx 35% were due to nonpharmaceuticals • 55% were products regulated by PPPA • 13% were hospitalized • 5.6% of ED visits for cleaning products were hospitalized

9. Spray Bottles • Accounted for 40.1% of exposures • Injuries from spray bottles remained constant over time • 14 times more likely to result in eye exposure

10. Nonpharmaceutical exposures reported to NPDS

11. Household Products • Average American household stores 3-10 gallons of hazardous materials • More than 50% of households with children < 7 have household chemicals in unlocked storage • In a study on low income families, only 4-9% kept poisons locked (despite 38-55% reporting that they did)

12. Consumer Perceptions • Household products are generally perceived as toxic • Some products believed to be less toxic specifically essential oils and dishwater products • Less likely to be stored safely than pharmaceuticals

13. Consumer Perceptions • 82% of families scored 3 or less (out of 11) on an “awareness” score • Bleaches, peroxides, cosmetics more likely to be stored at lower elevations • 20% of families had transferred cleaning products to another contained • More families believed first step after poisoning was call 911 vs PC

14. Household Cleaning Products

15. Button Battery

16. Lamp Oil

17. Lamp Oil Vs Gatorade

18. Legislation • Many nonpharmaceuticals are regulated under the Poisoning Prevention Packaging Act (PPPA) so are subject to child resistant packaging • CRCs reduce rates of poisonings 30-70% • “There is no such thing as child-proof packaging. So you shouldn’t think of packaging as your primary line of defense. Rather, you should think of packaging as your last line of defense.”

19. Inherently Dangerous • “What is it that is not a poison? All things are poison and nothing is without poison. It is the dose only that makes a thing not a poison.” • Hydrocarbons - oils, essential oils, fuels • Caustics - acids/alkalis • Alcohols • Button batteries

20. Haddon Matrix for Poisoning

21. 4 Es • Intervention Es • Education • Environment • Enforcement/Legislation • Engineering

22. Summary • Exposures are unintentional • Products are ubiquitous and necessary • Safer formulation • Safer storage • Safer containers • Parental education

23. References • Smolinske SC, Kaufman MM. Consumer perception of household hazardous materials. Clin Toxicol 2007 45:522-525 • Franklin RL, Rodgers GB. Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement. Pediatrics 2008;122:1244-1251 • Mckenzie LB, Ahir N, Stolz U, Nelson NG. Household Cleaning Product-Related Injuries Treated in US Emergency Departments in 1990-2006. Pediatrcs 2010;126:509-516. • Gielen AC, Wilson MEH, McDonald EM, et al. Randomized Trial of Anticipatory Guidance for Injury Prevention. Arch Pediatr Adolesc Med 2001;155:42-49 • Van Gorcum TF, Hunault CC, Van Zoelen GA, et al. Lamp oil poisoning: Did the European guideline reduce the number and severity of intoxications? Clin Toxicol 2009; 47:29-34. • Litovitz T, Whitaker N, Clarke L, et al. Emerging Battery-Ingestion Hazard: Clinical Implications. Pediatrics 2010;125:1168-1177. • Patel B, Groom L, Prasad V, et al. Parental poison prevention practices and their relationship with peceived toxicity: cross-sectional study. Inj Prev 2008; 14:389-395. 23

24. Home safety education does increase safe storage of medicines/products, increase PC number accessibility • Works better when interventions delivered at home • Works better when equipment provided or subsidized • No data to show that it reduces rates of poisoning