It is important to use cleaning and disinfectant products safely to prevent accidental exposure among family members.

Household cleaning and disinfectant use has increased in homes as a result of the coronavirus disease 2019 (COVID-19) pandemic.1 Poison control centers in the United States have seen a drastic rise in cleaner and disinfectant exposure calls, which have increased by approximately 20% based on data from the National Poison Data System, the CDC, and the American Association of Poison Control Centers.2 Also, exposures among children 5 years and younger represented a large percentage (39.9% - 47.3%) of the reasons for these calls.2

In light of this knowledge, pharmacists can play an important role in educating the public about safe and appropriate use of products, including proper storage for chemicals and the debunking of misinformation from social media.

CDC Study Findings and Implications

The CDC conducted a survey of 502 adults 18 years and older to evaluate cleaning and disinfection practices in household settings in the United States in May 2020.3 Survey questions inquired about general knowledge, attitudes, and practices related to household cleaners and disinfectants and also included methods for preventing COVID-19.

The study revealed that 39% of survey participants reported engaging in unsafe practices, which included washing food products (eg, fruits and vegetables) with bleach, applying cleaning and disinfectant products to bare skin, and intentionally inhaling or ingesting these products. For these reasons, the CDC was able to identify that there are many knowledge gaps in consumer knowledge regarding use of these products. 

For example, only 23% of individuals responded that just room temperature water should be used for preparation of dilute bleach solutions, and 58% reported that bleach should not be mixed with ammonia. Sixty-four percent of participants reported that eye protection was recommended with certain cleaners and disinfectants. Also, 54% of individuals responded that hand sanitizers should be kept out of reach of children.3

Twenty-five percent of individuals reported experiencing at least one adverse effect (AE) that was most likely the result of using cleaners and disinfectants unsafely, which included dizziness, lightheadedness, headache, upset stomach, nausea, breathing problems, and irritation of the sinuses, skin, and eyes.3 

Mixing bleach solutions with vinegar or ammonia and applying heat can cause severe lung tissue damage if it is inhaled.3 Hand sanitizer ingestion can lead to irritation of the mucous membranes, gastrointestinal AEs, and alcohol toxicity.3

This study reveals that further public education is needed regarding COVID-19 safe cleaning and disinfection practices. However, one limitation is that the survey only captures a snapshot in time, so ongoing research is necessary for a larger picture.3         

Safety Tips

Pharmacists should educate patients regarding the importance of always reading and following label directions, and keeping household cleaning products and hand sanitizers locked away and out of reach of children and pets.4

Also, COVID-19 prevention messages should include evidence-based practices such as frequent handwashing with soap and water for at least 20 seconds and cleaning of high-touch surfaces.3 Products should never be ingested, injected, or inhaled, as this can result in serious adverse health consequences, including death.4 

Pharmacists can educate patients regarding the importance of wearing disposable gloves and discarding them after each cleaning. Additionally, patients should be informed that chemical products should never be mixed together when cleaning, and eye protection may be appropriate with certain chemicals to prevent injury. Also, in the case of dilutions, only room temperature water should be used, and products should always be clearly labeled to avoid the potential for confusion.4 

REFERENCES
  1. Gershman J.  Poison prevention tips during the COVID-19 pandemic.  Pharmacy Timeshttps://www.pharmacytimes.com/news/poison-prevention-tips-during-the-covid-19-pandemic.  Published March 31, 2020.  Accessed June 12, 2020.
  2. Chang A, Schnall AH, Law R, et al. Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020. MMWR Morb Mortal Wkly Rep 2020;69:496–498. DOI: http://dx.doi.org/10.15585/mmwr.mm6916e1
  3. Gharpure R, Hunter CM, Schnall AH, et al. Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention — United States, May 2020. MMWR Morb Mortal Wkly Rep 2020;69:705–709. DOI: http://dx.doi.org/10.15585/mmwr.mm6923e2
  4. CDC.  Coronavirus disease 2019 (COVID-19):  Cleaning and disinfection for households.  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html.  Last reviewed May 27, 2020.  Accessed June 13, 2020.