Hand Sanitizers Separating Fact From Fiction

Hand Sanitizers – Separating Fact from Fiction

Hand sanitizers have long been the go-to solution for people who want to stay healthy, but aren’t able to frequently wash their hands. To protect their health from infectious microorganisms, that are easily transmitted on the hands, individuals have been encouraged to frequently apply antiseptic hand rubs commonly known as hand sanitizers. With the advent of the novel coronavirus SARS-CoV-2, the virus which causes COVID-19, the focus and purchase of hand sanitizers has drastically increased. Although there is a multitude of hand sanitizers available, there is not a vast volume of information for the consumer concerning this widely used substance.

The purpose of this article is to help people better understand the differences between different types of hand sanitizers so they can make the best decision for their own personal health and safety.

The Basics of Hand Sanitizers

Hand sanitizers are different from antibacterial soaps, wound sterilization products, antiseptic wash products, and surface sterilizers such as Lysol because they remain on your hands to provide longer term protection. They must contain ingredients that have been shown safe to leave on your skin. In the medical world,  hand sanitizers are known as “rubs,” which are designed to be used when soap and water is not available. These compounds are designed to be rubbed onto the hands and not rinsed off.

On April 13, 2019, the Food and Drug Administration (FDA) released the final monograph for over-the-counter (OTC) hand sanitizers. Companies that produce and sell antiseptic hand rubs cannot legally claim that their product kills viruses. “It is prohibited by the Food and Drug Administration for manufacturers to make viral reduction claims.”  But they can, and do say, that their product kills germs.

What Are Germs?

The word “germs” is an ambiguous term to many. It is a great marketing buzz word, but it has different meanings. There are both good germs and bad germs but all are invisible to the naked eye.

The body needs good germs to do things such as aiding in digestion and overall health in general. Probiotics are an example of good germs. In the context of hand sanitizers, “germs” generally has a negative connotation. Merriam Webster defines “germ” as a microorganism causing disease: a pathogenic agent.

Germs typically include bacteria, viruses, and fungi. Of these three, viruses are the smallest. Generally, viruses can be 200 times smaller than some bacteria.

A virus is considered a nonliving but parasitic entity because they need to attach themselves to a healthy host cell in order to replicate itself. A virus that is denied a host cell will naturally self-destruct. Unlike a virus, bacteria are cellular organisms and can reproduce on their own.

Below is a chart from Merriam Webster comparing viruses and bacteria:

The differences between viruses and bacteria.

This article will focus on the bad germs, specifically harmful bacteria and viruses and how to fight them using hand sanitizers.

FDA Approved Active Ingredients

If you look at any hand sanitizer sold in the United States, you will see active ingredients listed on its label. While there are numerous different formulations of hand sanitizing rubs available on the market, there are only three active ingredients that have been approved by the U.S. Food and Drug Administration (FDA) for use in OTC consumer hand sanitizers. These are ethyl alcohol, isopropyl alcohol, and benzalkonium chloride (BAC). Notice that there are two types of hand sanitizers:  alcohol and non-alcohol. Many questions have been raised about alcohol-based hand sanitizers, and concerns for the safety of those using it.

More About Benzalkonium Chloride (BAC)

Benzalkonium chloride based sanitizers are the viable alternative for alcohol-based sanitizers. BAC is the active and FDA-approved ingredient found in all water-based, non-alcohol hand sanitizers.

BAC has been used for years as an effective topical antimicrobial agent because it only kills microorganisms, but it also inhibits their future growth. Medically BAC has been used as a preservative in eye drops to keep the eye solution sterile. https://www.sciencedirect.com/topics/immunology-and-microbiology/benzalkonium-chloride It killed disease causing organisms that would infect eyes, while still being safe enough to be an eye drop additive. BAC has also been widely used in first aid wound care treating minor cuts, scrapes, cracked skin or other types of minor wounds. BAC has been also a common preservative added to various kinds of cosmetic preparations including makeup, foot powder, rash cream, and sunscreen.

Labeling of Hand Sanitizers    

The FDA has recognized hand sanitizer as an OTC drug. So, as such, they keep an eye on these products, routinely running tests on the brands available. They found that despite great labeling, some brands have genuine safety concerns. The interest and marketing of antiseptic hand rubs, especially since the advent of COVID-19, has been so great that many companies have started marketing their own hand sanitizers. But since not all of these products have been created equal, the FDA has a large list of recalled hand sanitizers. As of October 2020, that list included 203 different products. The safety concerns usually fall into the categories of false labeling, including unproven claims, toxic types of alcohol, or not enough of the approved active ingredients.

Alcohol Hand Sanitizers and Children

the dangers of children injesting hand sanitizersAlcohol based sanitizers can cause poisoning in two different pathways, ingestion in the mouth and absorption through the skin. Well-meaning moms now buy alcohol hand sanitizers as a back-to-school necessity, sending their children to preschool and beyond with a bottle of hand sanitizer strapped to their backpacks and firm instructions to “use it.” While protecting children is a good thing, this OTC drug can cause alcohol poisoning just by rubbing it into their hands, they also share it with their friends, not realizing how it can affect them also.

With regards to ingestion, many of the alcohol hand sanitizers are scented with sweet, fruity, even candy scents, which make them smell good, but in young minds, also possibly taste better. Children and teenagers, trying to get a buzz by drinking it, are in grave danger of alcohol poisoning or death. The reason is that alcohol hand sanitizers contain denatured alcohol, which is ethyl alcohol (drinking alcohol) with a poison ingredient added, so it can’t be consumed, and also to make sure that the government gets its liquor tax money, as enforced by the Alcohol, Tobacco and Firearms agency.

In the spring of 2020, there was a spike in the number of poison control calls. This spike was mainly due to young children ingesting alcohol-based hand sanitizers. Most of these calls concerned children under age five who ingested their parents’ hand sanitizer.

Non-alcohol hand sanitizers, while they are intended for external use only, are far less dangerous than the alcohol-based formulations if they are ingested.

How Long Do Hand Sanitizers Protect After Use?

If you are using an alcohol-based solution, as soon as the gel dries, it no longer protects anything since alcohols evaporate within seconds. But if you opt for a non-alcohol formulation, the germ-killing protection provided by BAC continues for four to five hours.  This gives you the protection of invisible gloves.

Alcohol and Your Beautiful Hands

While rubbing this quickly drying gel on part of your body’s largest organ — your skin —  a few times an hour may be effective in preventing the spread of disease, very legitimate complaints are often heard because, despite added hand softeners, alcohols are non-discriminate in their lipid-stripping actions. While they strip away the lipid outer layer of the virus, they also strip away the lipids that make hands look young and feel soft. Frequent use of these products can cause callous, dry, flaky skin, wrinkles, and cracks — causing early aging to young looking hands. Open, cracked, and irritated skin not only makes application of such products painful, but the skin’s protective barrier is compromised, allowing more pathogens to enter the body which opens up the possibility for even more health problems.

The negative side effects of constant and continual use of alcohol-based products has many people looking for alternatives, and then reaching for water-based sanitizers containing BAC which is non-irritating to the skin despite the sometimes heard complaint that many water-based sanitizers leave your hands feeling tacky rather than smooth.

That Bottle of Sanitizer in Your Car

Your car is a logical place for at least one of your containers of hand sanitizing gel.  But your alcohol-based protectant is a highly flammable concoction. When you get a container with a minimum of 60% alcohol, there is a risk of that concoction causing a fire. When the temperature reaches 85⁰ F, the alcohol vapor can ignite with any spark. How hot does your car get in the summer? If your sanitizer is not alcohol based, you don’t have to worry about this.

Hand Washing to the Rescue

Hand washing with soap and water is the best way to help keep you healthy and prevent the spread of pathogens. But most people, given the option of washing their hands with soap and water, or using a hand sanitizer, usually choose the quick squirt over the longer, and more involved, process. It seems that with the practicality that hand sanitizers offer, and despite the information to the contrary from health officials, we have become trained to “squirt on” more often than “soap up”.

Neither the CDC or the FDA recommends any type of use of a hand sanitizer for visibly soiled hands. For best results and protection against harmful bacteria and viruses, first wash your hands thoroughly with soap and water and then apply your choice of a hand sanitizer.

Conclusion of Sanitizer Characteristics

Both alcohol and non-alcohol-based hand sanitizers are approved by the FDA, but neither can make any antiviral claims. Consider the possibility using of non-alcohol-based sanitizers, since they are effective for a longer period of time.  Although non-alcohol sanitizers can be more pricey than the alcohol formulations, their benefits far outweigh the cost. BAC formulations are non-irritating/non harmful to the skin, safe for both children and the elderly, do not age, irritate or burn the skin while providing hours, rather than seconds of protection.