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Hand Sanitizer: Effective or Toxic?

November 23rd, 2013

by Joseph Newman, PharmD student

Hand sanitizer is often used as a quick and convenient alternative to washing your hands. Whether it is a quick squirt after leaving the gym or the super market, or pulling it out after shaking lots of hands or coughing, it has become one of the most common ways to clean hands and get rid of germs. But is using all of this hand sanitizer actually preventing you from getting the flu or a cold? Is it any more or less effective when compared to washing with soap and water?

In his recent article1 on CNN, Bob Barnett evaluates the use of hand sanitizer and suggests that there are safety and efficacy concerns for hand sanitizers containing triclosan. Barnett states that according to Allison Aiello, an associate professor of epidemiology at the University of Michigan, there is no evidence that products containing triclosan have any benefit and that hospitals won’t use them. He goes on to cite other sources saying that there is little benefit of triclosan-containing products over washing with soap and water. Barnett claims that triclosan can disrupt the endocrine system and reduce muscle strength, as shown in animal studies. He also claims that triclosan does not protect against viruses and fungi. Barnett makes the distinction that alcohol-based hand sanitizers are good at killing bacteria and some viruses and can be used as an alternative to hand washing, but concludes by emphasizes the fact that washing with soap and water is the most effective way to eliminate germs.

I agree with most of this article. According to the World Health Organization, hand washing is “the most important hygiene measure in preventing the spread of infection.”2 I also agree that alcohol-based hand sanitizer is a good idea if you can’t wash your hands. Barnett’s recommendation for hand washing and alcohol-based hand sanitizer is one that is consistent with the standard for self-care in regards to hand hygiene. However, there are some limitations to his article, especially in his evaluation of triclosan-containing products. For one, he only cites a couple different sources. His claims of potentially harmful effects of triclosan and its limited effectiveness cannot be backed up without further research. Furthermore, Barnett says that studies support his claims, but then fails to provide information about or references to those studies.

Upon further research, I found that alcohol-based hand sanitizers are an “appropriate alternative to hand washing for hand cleansing”3 and that they improve hand hygiene practices within the home setting.4 Another study showed that alcohol-based hand sanitizers are safe. In this study, volunteers applied hand-rubs with varying amounts of ethanol onto their hands before being tested for blood concentrations of ethanol and acetaldehyde. According to the study, any alcohol absorbed through the skin was below toxic levels in humans.5 This supports Barnett’s claim that alcohol-based hand sanitizers can be safe and effective. As far as triclosan containing hand sanitizers, the FDA states that triclosan is not known to be hazardous to humans6 and according to one study, is “well tolerated by a variety of species, including human beings.”7 According to this research, it appears as though triclosan is not toxic, contrary to the research that Barnett refers to in his article.

Hand sanitizers that are alcohol-based appear to be safe to use as well as effective at promoting hand hygiene and preventing some illnesses, and while triclosan appears to be non-toxic, there was not very much research available on the effectiveness of hand sanitizers containing that ingredient. So what does this mean for me and you in terms of using these products to prevent colds, the flu and other common diseases? As a pharmacist, these types of questions come up often when discussing over-the-counter treatment of colds. Alcohol-based hand sanitizer can be a very useful tool in self-care of colds to prevent the transmission of germs while on-the-go. However, washing your hands is still the most important measure in preventing the spread of infection.2

So what do you think? Should we continue to use hand sanitizer? Should we switch to only soap and water? Or do you think there should be more research done on this issue?

 

References:

  1. Barnett, B. Is hand sanitizer toxic? CNN. October 16, 2013. Available at http://www.cnn.com/2013/10/16/health/hand-sanitizer-toxic-upwave/index.html?hpt=he_bn3. Accessed November 13, 2013
  2. Hospital Infection Control Guidance. World Health Organization Web site. 2003 Available at: http://www.who.int/csr/surveillance/infectioncontrol/en/print.html. Accessed November 13, 2013
  3. Vessey J, Sherwod J, Warner D, Clark D. Comparing Hand Washing to Hand Sanitizers in Reducing Elementary School Student’s Absenteeism. Pediatric Nursing [serial online]. July 2007;33(4):368-372. Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed November 14, 2013
  4. Sandora TJ, Taveras EM, Shih MC, et al. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics. 2005;116(3):587-94. Available at http://pediatrics.aappublications.org/content/116/3/587.long. Accessed November 14, 2013
  5. Kramer A, Below H, Bieber N, et al. Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans. BMC Infect Dis. 2007;7(1):117. Available at http://www.biomedcentral.com/1471-2334/7/117/. Accessed November 14, 2013
  6. Consumer Updates > Triclosan: What Consumers Should Know. Federal Drug Administration Website. August 29, 2012. Available at http://www.fda.gov/forconsumers/consumerupdates/ucm205999.htm. Accessed November 14, 2013
  7. Bhargava H, Leonard P. Triclosan: Applications and safety, American Journal of Infection Control, Volume 24, Issue 3, June 1996, Pages 209-218, ISSN 0196-6553, Available at http://www.sciencedirect.com/science/article/pii/S0196655396900176. Accessed November 14, 2013

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4 Responses to “Hand Sanitizer: Effective or Toxic?”

  1. Jessica Amtower Says:

    After reading this article, one of the first things to pop into my head is whether or not my hand sanitizer was alcohol-based (which it was). Personally, I feel that hand sanitizer is a very convenient method of being able to rid yourself of germs/bacteria when unable to wash your hands. While I am at work, and at my rotation, I always keep hand sanitizer on me, and use it often. This gives me the opportunity to get rid of any germs bacteria in between dealing with patients. Everyone has dealt with the patients that come in very sick, and you just can’t get away to go wash your hands every time that happens, so hand sanitizer is a great solution to this problem. I feel that hand sanitizer should continue to be used, but it should be recommended to wash your hands with soap and water as often as possible. Since alcohol-based hand sanitizer is proven to be effective, I would recommend that to patients as they are coming in the pharmacy. I think more research to determine the effectiveness of hand sanitizer containing triclosan could be helpful as well.

  2. Jess Davis Says:

    Shortly after getting my job at a pharmacy, I started carrying a small bath and body hand sanitizer in smock pocket. I use it constantly though out the day, especially when I am on data entry and taking bottles and new prescriptions from sick patients for hours at a time. I’m not sure if my sanitizer is alcohol based or not but I will not be looking in to it to make sure. I think one of the reasons why we do not wash our hands more in the pharmacy is because this takes time, whereas the sanitizer is quick and we can get right back to work. Normally on break we do take the time to wash our hands and I feel that by using both of these methods is why we do not have a high incidence of flu or bad colds in our pharmacy. I would recommend to patients that they carry an alcohol based hand sanitizer with them, especially if they have young children and to teach them about the proper use, along with proper hand washing techniques, coughing in to their elbow and sneezing into their elbow to stop the spread of germs.

  3. Mike Pelyhes Says:

    I agree that hand sanitizer should be a second line option for hand hygiene. Hand washing should be the primary means of hand cleansing when the option is there, or before and after eating. When hand washing is not possible, or is a significant disruption to the workflow then hand sanitizer should be used as a secondary option. Hand sanitizer is great when dealing with situations at work, the market, or the park where hand washing simply isn’t an option. In these circumstances an alcohol based hand sanitizer according to your compiled reference would seem to be the preferred option. Unless further evidence for the use of triclosan comes to light, I would likely recommend an alcohol based product to family, friends, and patients. The caveat would be that if an individual can’t use an alcohol based product then I would recommend the triclosan product. Until further evidence regarding it’s safety comes out though I am unlikely to suggest it as a preferred hand sanitizer.

  4. Danielle Eaton Says:

    In the fast-paced culture in which we live and work it is often difficult to find time to do the simplest task such as washing our hands. I thought this article was very interesting because I had never thought to look into which hand sanitizers contain active ingredients that are actually getting rid of cold and viruses. From the research presented in this blog post I would recommend alcohol-based hand sanitizers to my patients. I would stress however that if there is time, traditional hand-washing with soap and water is preferred. I would be interested to see more research conducted on the effectiveness and safety of hand-sanitizers containing triclosan. In general however, I would have no reservations using alcohol-based hand sanitizer myself, and recommending it to patients.

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