Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention - United States, May 2020.
12 Jun 2020-Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention)-Vol. 69, Iss: 23, pp 705-709
TL;DR: To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic.
Abstract: A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants.
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Cites background from "Knowledge and Practices Regarding S..."
...In addition, maladaptive proximal defenses may entail harmful practices aimed at avoiding the virus; some people have gargled bleach and cleaning supplies to reduce their chances of catching the virus (Gharpure et al., 2020)....
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TL;DR: Although the presence of SARS-CoV-2 on inanimate surfaces can represent a potential route of the transmission, appropriate disinfection measures should reduce the possibilities of transmission of the coronavirus, and hence, significantly decrease the risks of COVID-19.
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University of Washington1, University of California, San Diego2, Emory University3, Vanderbilt University4, Duke University5, Fred Hutchinson Cancer Research Center6, University of Texas Health Science Center at Houston7, University of Alabama at Birmingham8, Mayo Clinic9, University of Queensland10, University of Pennsylvania11, University of Virginia12
TL;DR: The editors of Clinical Infectious Diseases review some of the most important lessons learned about the epidemiology, clinical features, diagnosis, treatment and prevention of SARS-CoV-2 infection and identify essential questions about COVID-19 that remain to be answered.
Abstract: In this article, the editors of Clinical Infectious Diseases review some of the most important lessons they have learned about the epidemiology, clinical features, diagnosis, treatment and prevention of SARS-CoV-2 infection and identify essential questions about COVID-19 that remain to be answered.
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Cites background from "Knowledge and Practices Regarding S..."
...Approximately one-third of respondents in a recent CDC survey engaged in nonrecommended high-risk practices in the hope of preventing SARS-CoV-2 transmission, including the application of bleach to food and household disinfectants to skin, and inhalation or ingestion of cleaners and disinfectants [189]....
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TL;DR: This review discusses about the potential harmful effect of disinfectants, if used inappropriately, and safe preventive options as an alternative to robust use of disinfection methods to fight against COVID-19.
Abstract: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created a significant threat to global health. It originated in Wuhan, China and caused a total of 83,483 confirmed cases and 4634 deaths until June 2020. This novel virus spread primarily through respiratory droplets and close contact. The person-to-person transmission by direct transmittance through cough, sneeze, droplet inhalation, and contact spreading from dry surfaces contaminated with secretions of nose, mouth, and eyes of an infected person has been proven about SARS-CoV-2 transmission. As disease progressed, a series of complications tends to develop, especially in critically ill and immunocompromised patients. Pathological studies showed representative features of acute respiratory distress syndrome (ARDS) and implications on multiple organs as well. However, no specific antiviral drugs or vaccines are immediately available for the treatment of this lethal disease. The efficacy of some promising antivirals needs to be investigated by ongoing clinical trials. In current circumstances, supportive care, precautions, and social distancing are the only preventive options to ameliorate COVID-19. To disinfect the environment, mainly chemical disinfectants are being used robustly. However, due to panic state, fright, and unawareness, people are using it violently, which can have an adverse effect on human health and environment. This review discusses about the potential harmful effect of disinfectants, if used inappropriately. Here, we will also discuss safe preventive options as an alternative to robust use of disinfection methods to fight against COVID-19.
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References
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TL;DR: Researchers have increasingly turned to online convenience samples as sources of survey responses that are easy and inexpensive to collect as discussed by the authors. But as reliance on these sources has grown, so too have conce...
Abstract: Researchers have increasingly turned to online convenience samples as sources of survey responses that are easy and inexpensive to collect. As reliance on these sources has grown, so too have conce...
453 citations
TL;DR: Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.
Abstract: On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.
173 citations
TL;DR: The epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning are reviewed critically to assess the severity of injury, risk of mortality and risk of subsequent stricture formation.
Abstract: Introduction: Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach.Objective: The objective is to review critically the epidemiology, mechanis...
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TL;DR: Although the gas produced by mixing cleaning products in the home can cause severe respiratory irritation, most of the patients exposed to chlorine and chloramine gas can safely be treated at home with comfort measures and appropriate follow-up must be done to determine resolution of symptoms.
Abstract: Chlorine and chloramine gas are frequently produced in the home when cleaning products are mixed These gases are strong irritants with the potential for tissue damage Numerous literature citations report industrial exposures to chlorine/amine gas, but there are few reports regarding home exposures The purpose of this study was to determine symptoms, treatment, and outcome in individuals exposed to these gases in the home All exposures to chlorine/amine gas produced as a result of mixing cleaning products in the home and reported to a Regional Poison Information Center (RPIC) over a 12-month period were reviewed All calls were documented and follow-up was done at appropriate intervals All patients with respiratory embarrassment either at the initial contact or on follow-up were referred to a medical facility Of the 216 patients (ages 12 to 81 years), 200 had resolution of symptoms within 6 hours, whereas only 16 had symptoms for more than 6 hours after exposure; 145 patients were treated at home and 71 received further medical care Ten symptoms were identified, with the majority of patients experiencing more than one Emergency room treatment included oxygen (62 patients), bronchodilators (9 patients), and steroid therapy (3 patients) Of the 70 patients who had chest x-ray films, only one had a positive finding; 41 had arterial blood gas measurements done, and all were within normal limits Only one patient in the study group required admission for continued respiratory distress, but he had a preexisting chronic respiratory problem as well as an upper respiratory tract infection at the time of exposure Although the gas produced by mixing cleaning products in the home can cause severe respiratory irritation, most of the patients exposed to chlorine and chloramine gas can safely be treated at home with comfort measures Appropriate follow-up must be done to determine resolution of symptoms
60 citations
TL;DR: Caregivers and health care providers should be aware of the potential dangers associated with hand sanitizer ingestion, and children using alcohol hand sanitors should be supervised and these products should be kept out of reach from children when not in use.
Abstract: Hand sanitizers are effective and inexpensive products that can reduce microorganisms on the skin, but ingestion or improper use can be associated with health risks. Many hand sanitizers contain up to 60%-95% ethanol or isopropyl alcohol by volume, and are often combined with scents that might be appealing to young children. Recent reports have identified serious consequences, including apnea, acidosis, and coma in young children who swallowed alcohol-based (alcohol) hand sanitizer (1-3). Poison control centers collect data on intentional and unintentional exposures to hand sanitizer solutions resulting from various routes of exposure, including ingestion, inhalation, and dermal and ocular exposures. To characterize exposures of children aged ≤12 years to alcohol hand sanitizers, CDC analyzed data reported to the National Poison Data System (NPDS).* The major route of exposure to both alcohol and nonalcohol-based (nonalcohol) hand sanitizers was ingestion. The majority of intentional exposures to alcohol hand sanitizers occurred in children aged 6-12 years. Alcohol hand sanitizer exposures were associated with worse outcomes than were nonalcohol hand sanitizer exposures. Caregivers and health care providers should be aware of the potential dangers associated with hand sanitizer ingestion. Children using alcohol hand sanitizers should be supervised and these products should be kept out of reach from children when not in use.
40 citations