Purell cocktails and other complexities of managing a flu outbreak

Hand gel sanitizers are making an appearance all over our medical center. There's one right next to the elevator on the ground floor of the building where my office is and don't have to touch a thing. Just put your hand under it and it dispenses a cool alcohol-based gel that sanitizers my hands and dries very quickly. Alcohol does that. And other things:

Alcohol hand gel meant to combat swine flu has been banned from a prison after inmates started eating it and became embroiled in a drunken brawl.

Inmates have been drinking the liquid soap placed on their wing after realising it contained alcohol.

The detergent was meant to beat off the threat of swine flu in the Verne Prison on Portland, Dorset.

However, instead of rubbing it into their hands, inmates at the category C prison have been placing their mouths over the dispensers and consuming it.

Prison officers had expressed their concerns at suddenly having to deal with a number of drunken convicts before the brawl erupted.

It is thought one prisoner became aggressive after downing the gel and started a fist fight with another inmate.

Now the governor of the Verne has removed all of the dispensers from the prison.

A source at the Verne said: "The cleansers were put out on a wing to combat swine flu but as soon as they were put out, the prisoners started drinking the stuff straight out of them.

"There was a fight after one of the prisoners got violent after drinking the gel. (The Telegraph [UK])

This isn't the first time we've posted something like this. Two-and-a-half years ago (February 2007) we reported a similar story about an inmate in Baltimore who got sloshed after drinking a good portion of a gallon jug of hand sanitizer. At the time we offered a consumer tip on cost-effective drinking:

Compared to the alcohol content of beer (5%), wine (12%) or whiskey (40%), Purell [70%] is also probably cost effective. The patient in this case had a blood alcohol of .33, four times Maryland's limit for drivers. the Maryland Poison Center has had a half dozen other similar cases. (Effect Measure, 2007)

We also wondered whether an open bottle of Purell in you car would be a moving violation. Given that a grandmother in Indiana was handcuffed and arrested for buying a box of Zyrtec-D cold medicine for her husband and then a box of Mucinex-D cold medicine for her adult daughter less than 7 days later, thereby exceeding the one week 3 gram Indiana state law limit of purchase of the active ingredient pseudoephedrine by 0.6 grams, it wouldn't surprise us. "Rules is rules," you know.

These abuse of hand sanitizer stories remind us of something we noted in 2007. Nothing about flu is simple. Not even the simple things.

More like this

In pregnant, very frequent users of ethyl alcohol- based hand sanitizers, there could also be a risk of Fetal Alcohol Syndrome. One study found that after frequent ethyl alcohol sanitizer use, alcohol could be measured via Breathalizer within several minutes, and in the blood within a slightly longer period of time. As the current "accepted" level of alcohol exposure in pregnant women is zero, pregnant women would be wise to avoid ethyl alcohol-based sanitizers (e.g. Purell) and go back to good hand-washing. FAS--the most frequent cause of mental retardation in children--can occur after only one drinking episode. AnnieRN

In Canada, Purell and other ethanol-based sanitizers, which contain 62%, are denatured with isopropanol. Apparently all medicinal alcohols (mouthwash, rubbing alcohol) have to be denatured (made toxic) or else the vendors have to pay and charge booze taxes on them. Is this not true in the US?

That is true in the US too. You can still get drunk off it, it is just not the safest thing in the world. I think they use methanol in the US, which I think can cause blindness.

I've got a bottle of the stuff in front of me here. Ethyl alcohol is listed as the active ingredient, and isopropyl alcohol as one of the inactive ingredients.

My daughter works as a police cadet trainee in Indiana and she was told by the police officers that schools in the area have banned alcohol hand gels due to the students consuming them to get drunk.
They placed hand gel dispensers in the classrooms and confiscate any individual hand gel containers.

Racter: That's interesting. Are you in the US or Canada? I've got a bottle in front of me, too (travel sized Purell) and it is ethyl alcohol. Maybe there are different formulations of it out there?

Maybe the prison formulations should contain ipecac....?

I'm in the U.S. I've got various bottles of the stuff all over the place, and as far as I can tell, all of them have been denatured with isopropyl alcohol.

AnnieRN: your claim that Fetal Alcohol Syndrome "can occur after only one drinking episode" sounds like complete nonsense to me. Can you back that claim up?

The only reason that the "accepted" alcohol consumption level for pregnant women (in this country) is zero is because we can't ethically ask pregnant women to drink varying levels of alcohol and then see what happens to their fetuses. But that's true for every single type of medication too.

But we do know that light alcohol consumption does NOT, on its own, increase a fetus' chance of developing fetal alcohol syndrome, as evidenced by the entire baby boomer generation, whose mothers had regular and socially acceptable "cocktail hours" while pregnant. We do not see an epidemic of FAS in that generation, do we?

And even in cases where pregnant women are known to drink heavily throughout their entire pregnancy, their babies only stand a 5% chance of developing FAS. The causes of FAS are not as straightforward as we are led to believe (see the book "Conceiving risk, bearing responsibility" by Elizabeth Armstrong at Princeton for more on this).

Other industrialized countries do no have such stringent anti-alcohol health recommendations for pregnant women, simply because the science does not warrant it.

I am not advocating that women drink heavily during pregnancy, of course. I would just like this particular source of pressure on pregnant women to be seen for what it is: a socially constructed stance with little basis in scientific fact.

Bans on Purell and similar gels in jails and prisons have also contributed to the huge rise in MRSA in correctional institutions. Officers from them have told me the ban is based not only on possible consumption, but on flammability - it's believed the gel could be lit and used against a guard as a temporary but effective weapon.

I recall that a number of years ago, Grady Memorial Hospital in Atlanta executed an (internally) high profile campaign to increase hand hygiene by installing gel dispensers everywhere you looked. IIRC, they then were asked by the state insurance commission to move all the dispensers on the belief the gel represented a fire hazard. Can't win for losing.

Same issue for alcohol sanitizers in remote Indian Reserves; there alcohol has the same health and violence problems of crack cocaine. In prisons and remote reserves it is too bad weed isn't tried as a surrogate.

Unrelated: dismayed to learn the meat lobby prevents the location of USA CAFOs and AFOs from being known to government institutes. The latter having to rely on satellite and aerial photos in their attempts to override the GOP human extinction instinct.

By Phillip Huggan (not verified) on 29 Sep 2009 #permalink


Should we really use the boomer generation as evidence that nothing went wrong?

By antipodean (not verified) on 29 Sep 2009 #permalink

Our urban hospital, very close to significant urban decay, homelessness, and highly prevalent drug dependence, had to remove the gel dispensers and replace them with fast breaking foam due to the ethyl alcohol.

Denatured or not, a certain clientele simply will drink the gel - and with great enthusiasm.

Code white rates do appear to have diminished somewhat, though I'm not certain of the precise stats.

By Meat Robot (not verified) on 29 Sep 2009 #permalink

Thanks for pointing out that that stuff has alcohol in it. I need to point that out to my wife. She's extremely allergic to alcohol. External use won't send her to the hospital but will cause a bad case of hives.

Dear agony aunt. My pathologically lazy teenager now uses hand sanitiser instead of soap and water in the bathroom because it's easier. It doesn't seem right. Should I worry?

ps. Note my correct spelling of the word sanitiser with an "S", not a "Z". Americans are interesting folk and generally bright, but spelling and pronouncing words correctly is not something they have perfected yet. Jolly ho chaps.

"Denatured or not, a certain clientele simply will drink the gel - and with great enthusiasm."

At least denatured alcohol is a prophylactic against the Andromeda Strain.

I'm still gnawing on the idea that topical use of topical alcohol-based products could produce levels of blood alcohol that would be even measurable by breathalizer (if that is indeed what Annie was suggesting). I use the stuff quite a bit, so if that's true, it's something I'd want to know -- but I won't deny being pretty skeptical. Can I see the evidence?

@16 - Sanitizers do not work well in the presence of dirt and grime. Take away the sanitizer and give the kid some soap.

Also, tell the teen that Febreze and body spray are not a substitute for doing laundry and bathing.

By Tsu Dho Nimh (not verified) on 30 Sep 2009 #permalink


"[I]t can be stated that no significant transdermal ethanol and 2-propanol absorption occur, when alcoholic disinfectants are applied continuously for at least 10 min on healthy, intact skin.

"In contrast to our results, other study groups reported a significant increase of alcohol blood levels after application of alcohol, containing [sic] preparations to the skin.... In contrast to our study, these authors did not exclude an absorption of the alcohol by inhalation." (References omitted.)

M. Kirschner et al. 2009, Langenbeck's Arch. Surg., 394, 151 (doi:10.1007/s00423-007-0237-7)

There is a more effective, non-toxic alternative to alcohol-based sanitizers: Silver Shield gel by Nature's Sunshine Products. Its ingredients are nano-silver, water and food grade gel (safe to consume). Used by US surgeons in Afghanistan where no water is available for surgery; stolen by the nurses there because it improved their skin so much. US Patent #7,135,195 states small initial list of pathogens killed in 6 minutes or less - google it and look for MRSA and H5N1 flu. Order online @ www.myNSP.com/STROM.

The foams would be better; maybe the wipes, too although one can certainly inhale dizzying amounts of alcohol. The problem with foams, too, then is to provide a dispenser which can't broken into.

Bitrex can be effective for some, although Emitrex (? made you barf) was tried with the old Ducco cement to keep kids from inhalant abuse. Don't know how that might work in Purells.

In Bethel, we like Listerine spray; in DC the drug stores around the Sheraton used to ban lemon extract because all the high school seniors on their class trip would buy it to drink (this in the days before high schoolers could get alcohol and other substances at hometown so easily).

There have been several reports of children accidently ingesting a lot of sanitizer. That is one of the problems with the local health corp. having the wall dispensers at child's height when standing on the seats-- kids are inherently programmed to push buttons like wheelchair door buttons, dispenser tabs, elevators, etc.

"Bitrex can be effective for some, although Emitrex (? made you barf) was tried with the old Ducco cement to keep kids from inhalant abuse. Don't know how that might work in Purells."

I don't know about Duco, but the adulterant in Testor's model cements is allyl isothiocyanate ("oil of mustard"). I'm not sure I see an application in hand sanitizers.