Detergent Pod and Traditional Detergent Ocular Burn Emergencies in the US

Abstract

Purpose : Legislation introduced in the 114^th United States Congress called for federal regulation of liquid detergent pod (Pod) manufacturing safety standards. Heated debate rages regarding the use of Pods and traditional laundry detergents (TLDs) as they impact the safety of our pediatric population, but adults and seniors are often neglected in this discourse. We performed a retrospective, epidemiologic analysis assessing Pod and TLD ocular burn incidence and trends across the US.

Methods : We analyzed six years of emergency department (ED) data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (2013-2018). We identified ocular chemical burn (OCB) injuries presenting to US EDs and determined causes of injury: Pod, TLD, or other. We grouped patients by age in years (y): infants (0-2y), toddlers (3-5y), adolescents (6-18y), adults (19-49y), and seniors (>50y). We analyzed normality with both Shapiro-Wilk tests and Q-Q plots and variances with Levene’s tests. We performed Student’s t-, Welch’s t-, Mann-Whitney U, and χ² tests and calculated 95% confidence intervals (CI₉₅) and odds ratios (OR).

Results : From 2013-2018, an estimated 73653 (CI₉₅ [43337, 103969]) OCB patients presented to US EDs. Detergents caused 21.5% of these burns (n=15821). Pods caused 61.5% of ocular detergent burns (ODBs; n=9728; p<.001) and 68.5% of pediatric ODBs (n=8910, p<.001). Detergents caused half of all OCBs in toddlers (n=4590, p<.001), of which nearly 80% were caused by Pods (n=3620, p<.001). Pods caused 72.6% of ODBs in adolescents (n=1939); 58.4% in infants (n=3351); 38.3% in adults (n=1073); and 14.2% in seniors (n=154; ages, p<.001).
Mean annual incidence of Pod ODBs increased by 446+149 (CI₉₅ [128, ∞]; p=.02) in 2016-2018 compared to 2013-2015. The proportion of Pod ODBs increased by 9.8% from 2013 to 2018 and peaked at 74.9% in 2017, yielding an increase of mean annual incidence from 58.4+4.2% in 2013-2015 to 66.7+11.1% in 2016-2018.

Conclusions : Pods pose significant threats to pediatric, adult, and geriatric ocular health. Pediatric ODBs were more frequently caused by Pods than TLDs (OR 5.33; CI₉₅ [4.88, 5.83]). Detergents were most threatening to infants and toddlers (OR 5.14; CI₉₅ [4.95, 5.33]). Pods caused more ocular burns from 2016-2018 than 2013-2015. Health hazards of Pods persist in the US. There is urgent need for public health and public policy interventions to address the Pod epidemic.

This is a 2020 ARVO Annual Meeting abstract.