title: The impact of an international initiative on exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service between 2008 and 2015.
abstract: BACKGROUND
  Although the majority of those exposed to liquid laundry detergent capsules remain asymptomatic or suffer only minor clinical features after exposure, a small proportion develop central nervous system depression, stridor, pulmonary aspiration and/or airway burns following ingestion or conjunctivitis and corneal ulceration following eye exposure. As a consequence, the International Association for Soaps, Detergents and Maintenance Products (AISE) established a Product Stewardship Programme in Europe, requiring that safety measures be implemented to reduce the visibility of, and restrict access to, these detergent capsules by small children. Implementation occurred in the United Kingdom over several months during the first half of 2013.
  
  
  OBJECTIVE
  This study investigated whether the AISE Programme had an impact on the number and severity of exposures reported to the United Kingdom National Poisons Information Service.
  
  
  METHODS
  Telephone enquiries to the National Poisons Information Service relating to liquid laundry detergent capsules were analysed for the period January 2008 to December 2015.
  
  
  RESULTS
  While there was a significant difference (p = 0.0002) between the mean number of annual exposures (469.4) reported between 2008 and 2012 and the mean number reported between 2014 and 2015 (403.5), the number of exposures was decreasing steadily prior to implementation of the Programme in 2013, which did not impact this fall from 2013 onwards. In addition, the number of exposures per million units sold was not impacted by the Programme. There was no significant difference (p = 0.68) between the mean number of exposures (11.8) with PSS ≥2 reported between 2008 and 2012 and the mean number (13.0) reported between 2014 and 2015. Although there was a 28.7% decrease between 2010-2012 and 2014-2015 in the number of exposures with PSS ≥2 per million units sold, this decrease was not statistically significant (p = 0.18).
  
  
  CONCLUSIONS
  There is no evidence that the Product Stewardship Programme had a beneficial impact on the number of exposures reported to the National Poisons Information Service or their severity.
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Day
authors.affiliation: b NPIS (Edinburgh Unit) , Royal Infirmary , Edinburgh , UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: c NPIS (Newcastle Unit) , Regional Drug and Therapeutics Centre , Newcastle , UK.
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: d NPIS (Cardiff Unit) , University Hospital Llandough , Cardiff , UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.
authors.forename: J Allister
authors.initials: JA
authors.lastname: Vale
mesh_terms: D002214:Capsules; D002648:Child; D003902:Detergents / Q000506:poisoning*; D006795:Household Products / Q000506:poisoning*; D006801:Humans; D011039:Poison Control Centers; D011041:Poisoning / Q000453:epidemiology / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002214:Capsules; D003902:Detergents
keywords: AISE Product Stewardship Programme; laundry pods; liquid laundry detergent capsules; single-use detergent sacs