Laundry packets are small single-use pouches containing concentrated liquid detergents in a water-soluble membrane. They were first introduced into the US market nationwide in early 2012 and rapidly gained popularity as a convenient substitute for the more traditional liquid or powder laundry detergents. Packet-related injuries rose rapidly with increased sales. Although traditional laundry soaps and detergents have long been known to present a poisoning hazard to young children, the concentrated detergents in the laundry packets have been associated with more frequent and more severe medical outcomes. Most injuries have resulted from oral ingestion, but ocular, dermal, and inhalation injuries also have occurred.

In 2013, the US Consumer Products Safety Commission (CPSC) requested that ASTM International, a voluntary standards development organization, initiate the development of a national consensus voluntary safety standard for liquid laundry packets. The voluntary standards process began in August 2013. A final voluntary standard was published in October 2015 and updated in December 2015 as ASTM F3159-15.

The purpose of this study was to evaluate the effectiveness of the laundry packet voluntary standard in preventing child injuries treated in US hospital emergency departments.

Estimates of laundry packet injuries involving children younger than 5 years were derived from the CPSCs National Electronic Injury Surveillance System, a stratified national probability sample of US hospital EDs consisting of about 100 US hospitals that have at least 6 beds and provide 24-hour emergency service. The sample includes 4 strata based on hospital size and a fifth consisting of childrens hospitals. Each participating hospital provides the CPSC with information on all cases involving consumer products, including the age and sex of the injured, the primary injury diagnosis, the body part affected, a description of up to 2 products that were involved in the injury, and whether the injured party was hospitalized or treated and released. Each case record also includes a free-text narrative field in which the product and circumstances surrounding the injury can be described in some detail. All injuries involving laundry packets were determined by mention of laundry packet involvement in the case narratives for injuries involving soaps and detergents.

The primary explanatory variable used to quantify the effect of the voluntary standard was the estimated proportion of laundry packets sold that conformed to the requirements of the voluntary standard. We evaluated 2 alternative measures of conformance. The first, Conform1, was set equal to 0 before the publication of the voluntary standard for laundry packets at the end of 2015. Voluntary standards go into effect when published, but not all industry members conform immediately. For Conform1, we treated 2016 as a transition year, during which the level of industry conformance was rising but not complete. This variable was assumed to increase gradually during the transition period, from 0.33 in the January to June 2016 period to 0.67 in July to December 2016; it was set equal to 1 beginning in 2017 when the data task group of the ASTM F15.71 subcommittee for laundry packets expected full industry conformance to the requirements.

The second measure, Conform2, recognized that some early safety improvements in the packaging and labeling of the product, some of which were later incorporated into the voluntary standard, occurred before the 2015 publication of the voluntary standard and as early as mid-2013. This conformance measure assumes that the transition period began as early as the second half of 2013 and extended through 2016, after which conformance was complete. This extended transition period is, in fact, consistent with the transition period referenced by the ASTM F15.71 data task group. Consequently, Conform2 was set equal to 0 through the first half of 2013, increased gradually from 0.13 during July to December 2013, to 0.25 during January to June 2014, to 0.38 during July to December 2014, and so on, to 1 beginning in January 2017.

Is this an experimental, quasiexperimental, or observational study?