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.
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
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
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).