And you thought YOU needed a drink....

One of the guys in the pharmacy alerted us to the below article, it's worth a read!

Ingestion of hand sanitizer by a hospitalized patient with a history of alcohol abuse

The Centers for Disease Control and Prevention recommends the use of hand sanitizers for all health care professionals before and following direct patient contact.1 Alcohol-based sanitizers containing 60–95% ethyl or isopropyl alcohol are used in many health care institutions as a primary infection control measure. Readily available dispensers for alcohol-based sanitizer may be an inviting source for patients admitted for disorders related to alcohol abuse.2,3 We report a case of intentional ingestion of ethyl alcohol in a hospitalized patient with chronic alcoholism.

A 46-year-old man with a medical history significant bipolar disorder, chronic hepatitis C, type 2 diabetes mellitus, and alcohol abuse was treated at a tertiary medical center after being found unconscious in a local grocery store. The patient later said he ingested an unknown amount of alcohol-containing hand sanitizer and mouthwash for intentional alcohol abuse. Pertinent history included a previous admission 10 days before for toxic ingestion of ethyl and isopropyl alcohol from five to eight quarts of mouthwash and two bottles of rubbing alcohol. Vital signs were stable at the scene and on admission. A serum osmolality was measured at 407 mg/dL (the calculated value was 392 mg/dL). The patient's blood ethyl alcohol level was 0.399%, and the salicylate concentration was 1 mg/dL. A urine drug screen was negative. He was initially admitted to a medical step-down unit for acute monitoring and treatment of alcohol withdrawal.

On day 2 of admission, the patient was witnessed ingesting Avagard (3M, St. Paul, MN) foam hand antiseptic (62% w/w ethyl alcohol) directly from the self-contained wall dispenser in his room. He was warned against further ingestion, and the nursing staff became more vigilant in his monitoring. On day 3, the patient was again witnessed ingesting hand sanitizer from the wall dispenser. No acute behavioral changes or adverse effects were noted. After the second occurrence, the hand sanitizer product and wall dispenser were removed from both inside and directly outside the patient's room.

A recent hospitalwide initiative to employ methods encouraging hand hygiene practices increased the number of available hand sanitizer units in patient care areas. Because of the potential abuse of such agents and previously published reports, a recent statement recommends the replacement of all removable bottles and pumpettes with self-contained dispensers.3 Although self-contained dispensers are used at our institution, the availability of alcohol based sanitizer in the patient's room provided the means for abuse.

This patient's significant history nonpotable alcohol ingestion and multiple admissions may have increased the likelihood of toxic ingestion of this product in the institutional setting, highlighting the need for careful assessment of alcohol abuse patterns. Despite the absence of significant adverse events in this patient, continued ingestion of ethyl alcohol during a hospitalization will not only increase the risk of alcohol intoxication and metabolic complications, but also increase the likelihood of falls and potential for medication-alcohol interactions. We recommend considering the temporary removal of alcohol-based hand sanitizers from wall dispensers in rooms that house high-risk patients with a significant history of alcohol abuse as a method to discourage ingestion.

American Journal of Health-System Pharmacy. Volume 65(23), 1 December 2008, p 2203–2204.