Young or confused people and those dependent on alcohol could be at risk from ingestion of alcohol hand rubs in hospitals or care homes, warn doctors in this week’s BMJ.

They recommend that large hand rub dispensers are placed in secure holders to prevent accidental or intentional removal of the container by high risk patients.

Healthcare acquired infections are common and alcohol hand rubs are an important component of good hand hygiene, along with other measures (such as rolling up sleeves, minimal jewellery, and removal of wrist watches) to try and reduce healthcare acquired infections. Since April 2005, near patient alcohol-based hand rubs (e.g. attached to bedsides and entrances to wards) have been widely available in NHS hospitals, but no risk assessment has been undertaken involving their accidental or intentional ingestion.

Toxicologists at Guy’s and St Thomas’ NHS Foundation Trust Poisons Unit compared the number of enquiries to their poisons centre in London from other health professionals during the 16-month periods before and after the widespread introduction of alcohol hand rub. These enquiries related to both children and adults exposed to the rub (both ingestion and eye exposure).

This comparison revealed an increase in the total number (23 versus 50) of enquiries to the unit. There was also a marked increase (7 versus 29) in adult ingestion numbers, 19 of which were thought to be due to intentional ingestion.

All cases of ingestion occurred within hospitals or care homes.