5. What are current safety measures against poisonning?
The SCCS opinion states:
10. CURRENT SAFETY MEASURES
The DeNaMic report suggested that serious toxicity following exposure to household chemical consumer products is unusual, largely because of a range of risk management measures that have been instituted in the last 30 years (Wyke et al. 2009).
Such measures include modification of packaging and labelling, and substituting chemicals with a lower toxicity profile. However, certain types of products can still cause severe poisoning, such as those containing high concentrations of acid or alkaline ingredients (e.g. former household dishwasher products and oven cleaners) or alcohols and glycols, such as anti-freeze and windscreen wash (Wyke et al. 2009).
Accidental ingestion and its adverse effects on children have been reduced through safer formulation, packaging and storage. This has relied on:
Education of parents and caregivers about the risks and how to protect children. Legislation to prevent unsuitable containers (e.g. containers that are normally used to store food or drinks) being used to store harmful substances; and to make packaging around harmful substances resistant to tampering by children. Replacement of toxic substances by less toxic agents.
Most techniques proposed to control childhood poisoning involve some sort of physical restraint which prevents the child accessing the harmful substance. Child resistant packaging is one of the best documented successes in preventing the unintentional poisoning of children (WHO 2008a). In England and Wales, unintentional poisoning deaths of children aged under the age of 10 years fell steadily from 151 per 100,000 in 1968 to 23 per 100,000 in 2000 (WHO 2008a). This reduction was largely as a result of the introduction of child-resistant packaging. However, none of these techniques have proven to be totally effective or without undesirable side effects.
Another possible approach of poison prevention may be to reduce the attractiveness of the product by appropriate design of packages and labels (Schneider 1977). “Low attraction” shapes have been recommended for containers of harmful substances. Labelling containers with warning stickers showed no deterrent effect in children at risk aged less than 6 years (WHO 2008a, Wyke et al. 2009). It has even been suggested that in some cases, warning labels may attract children (Wyke et al. 2009).
Blister packs (non-reclosable packaging), used for some medicines in tablet or capsule form, may reduce the dose ingested and may be less likely to be harmful than having access to the full bottle of the comparable liquid form. The addition of bittering agents is another method of stopping children from consuming significant quantities of harmful substances. Some controlled studies have shown that this approach may be useful, but in real situations its effectiveness seems to be more questionable (see section 8.3).
Thus, Rodgers and Tenenbein (1994) recommended that the use of aversive agents must not be a substitute for other preventive measures, such as child-resistant closures. Despite limited safety data and the utter absence of data showing that denatonium benzoate or other aversive agents decreases either unintentional or suicidal poisoning severity, their use continues to be advocated.
In conclusion, the most effective way to prevent children coming into contact with a poison is to remove the poison itself. Harmful substances may be replaced by other substances with a lower toxicity having a similar intended effect.
In its Annual Report (Cases of Poisoning Reported by Physicians in 2001), the BgVV emphasised the problem of accidental ingestion by elderly and disoriented persons. In parallel, a corresponding press release was issued (BfR 2002).
In the context of the press release, 12,000 information leaflets in the German, Turkish, Russian, Serbian/Croatian and Polish languages were distributed to hospitals and chronic care institutions.
Between 1995 and 2002, the number of cases of severe health impairment after ingestion of products containing surfactants in the age groups over 65 years increased to 15 including as many as 13 deaths. In 2003 and 2004, however, no severe cases were reported to the BfR, possibly as a consequence of appropriate instructions given to nursing and cleaning staff (BfR 2002).
Source & ©:
and/or having child- appealing properties, (2011), 10. Current Safety Measures, pp. 23-25