A COVID-19 Hazard Hidden in Plain Sight: Safety in the Use of Disinfectants
By Huan-Chieh Lin, MD; Ho-Chih Yu, Mdes; Ting-Chia Weng, MD
It was just another evening in Taiwan when I entered the local library. As an expected routine now, two guns were pointing right at me: a forehead thermometer and a sanitizer spray. These “guns” are everywhere now, ever since we declared war on COVID-19. Staff at restaurants, hotels, and public facilities are all geared up from head to toe, fearing unpredictable attacks from COVID-19 hidden in the dark corners of unsanitized hands, rising temperatures, and coughing droplets from unsuspecting infected people.
As I approached the visibly drained and masked librarian standing at the entrance, I reflexively leaned forward to have my temperature taken, to get a stamp of approval that announces to the world that I am safe to be around, I am not sick.
All of a sudden, my eyes flared with burning pain. I was shot with the wrong gun. What should have been the thermometer, came the sanitizer. I rushed to the washroom and washed my eyes immediately, and found a silver lining in the fact that I was wearing glasses, so at least some parts of my eyes were protected. An ophthalmologist comforted the wounded soldier that I was, and assured me that there was no visual impairment, however, there were mild corneal abrasions that would heal themselves in a few days.
Ocular Chemical Burns
A chemical burn is one of the most common types of eye injuries at the workplace and at home. Exposure to corrosive substances may result in damage to the ocular surface (eyelid, cornea, conjunctiva), as well as to the inner structures of the anterior segment (iris and lens), depending on the chemical properties of the substance. Most chemical eye injuries do not result in permanent damage to the eye; nonetheless, the situation depends heavily on the type of chemicals the eye was exposed to, as well as whether treatment was received in time. Responses to the injury must be immediate, which involves continuous flushing of the eyes using isotonic saline or clean water. Further ophthalmic evaluations may include a thorough sweep of fornices and pH measurement with test strips, a fluorescein eye stain to assess the status of the corneal and conjunctival epithelium, a visual acuity test, and intraocular pressure evaluations for both eyes, regardless of whether it was the injured eye.
The Hidden Dangers of Using Hand Sanitizer
The use of hand sanitizers and environmental disinfectants has become a daily routine during the COVID-19 pandemic. Alcohol-based sanitizer is the most common tool used for waterless hand disinfection. A 75% alcohol solution may be effective to kill certain bacteria and enveloped viruses, but it may not be as effective as a combination of soap and water in combating bacterial spores and non-enveloped viruses. There are also increasing reports of accidental injuries and poisonings from cleaning products and disinfectants, especially among children.
We recommend that the manufacturer of disinfectants declare their Safety Data Sheets (SDS) to users, and provide clear and comprehensive instructions regarding the potential hazards of each ingredient, protective measures during usage, and first-aid measures in case of accidents that takes into account precautions for the handling, storing, and transporting of these products, especially products containing flammable, high-proof alcohol.
Ergonomic Design to Reduce Human Error
At the current state of the war against COVID-19, it is clear that frontline and essential workers are becoming overburdened. Indeed, the fatigued librarian pulled the trigger on the wrong gun, yet this error could have been avoided through better ergonomic design, which optimizes the well-being of people by improving performance and processes. Here are some recommendations for improving this process:
1. Outlets can implement a two-step process. Two different staff should be assigned the task of ensuring people entering a building are thoroughly checked, — one for hand sanitizing, and the other for a temperature check. Staff should not operate hand sanitizing and temperature checks at the same time to avoid errors. Moreover, a clear record of the working hours of these personnel, as well as assigning shifts should be in place to make sure that they have adequate rest before performing these tasks.
2. Changing the sanitizing dispensing system from a spray gun to a pump dispenser allows people to perform self-cleaning and assist children in doing so. An automatic hand sanitizer dispenser reduces human labor and possible fatigue.
3. Installing a thermal camera, although expensive, can increase efficiency and provide non-contact surface temperature readings, which further reduce the risk of contact transmission.
4. Visitors with fever or respiratory symptoms should be provided with clear instructions for medical referrals. And we advice to record their personal information for contact tracing.
5. Safety Data Sheets for chemical sanitary products that indicates the bio-hazards of ingredients will help reduce chemical accidents. Displaying a warning sign or poster will also assist in educating the public on proper use and safety.
6. First-aid protocols and flammability prevention measures should be in place to deal with possible accidents.
The librarian who sprayed the hand sanitizer into my eyes visited my family the next day with a box of eye supplements and a red envelope, the traditional monetary gift of goodwill in Taiwan. She was nervous and could not stop apologizing and blaming herself. I was angry when the accident happened, but I realized that I was not the only victim in this accident. She was, too.
Involvement in a medical error can elicit a significant emotional trauma, especially when you are under the pressure of chronic prolonged working hours and extra stress from not receiving adequate support. It was unfair for the librarian to take full responsibility for the error. In the battle against COVID-19 worldwide, similar accidents may happen again. Not only should we implement proactive prevention strategies with ergonomic design, but we must also develop an effective support system for frontline and essential workers with coping strategies to promote physical and psychological well-being.
References
1. Eslani, M., Baradaran-Rafii, A., Movahedan, A., & Djalilian, A. (2014). The Ocular Surface Chemical Burns. Journal Of Ophthalmology, 2014, 1–9. doi: 10.1155/2014/196827
2. Ronald, J. (2012). Understanding a Safety Data Sheet (SDS) in Regards to Process Safety. Procedia Engineering, 45, 857–867. doi: 10.1016/j.proeng.2012.08.250
3. Whittingham, R. (2004). The blame machine. Amsterdam: Elsevier Butterworth-Heinemann.
Special thanks to Winda Liviya Ng, Amy Chih-Jou Hu, Guo-Dong Chung, Wei-Lun Huang, Yu-Kuei Lee, Chiao-Lin Yen, Chung-Yen Chen, Anjnesh Bahal, Marc Anthony and Yi-Ching Yang for their contributions in proofreading as well as brainstorming.
Authors: Huan-Chieh Lin, MD, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan ROC; Ho-Chih Yu, Mdes, Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan ROC; Ting-Chia Weng, MD, Department of Family Medicine; Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan ROC.
