Answers about Hand Sanitizers

Suppers needed to write something about hand sanitizers. Dr. Andrea Eberly generously offered to do the research and summarize her findings.

Andrea’s Bottom Line Answer:

  • Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick ourselves and spreading germs to others. But…what is “hand hygiene”?
     
  • We can achieve disease-reducing hand hygiene though three methods:

1. regular soap and water,
2. 60% alcohol hand sanitizers (which come as gel, foam and wipes),
3. chlorhexidine antiseptic liquid soap (used by surgeons before surgery)

  • BEWARE: Do NOT use the popular antibacterial soaps (active ingredient triclosan) for hand hygiene because recent research shows that triclosan breeds MORE resistant bacteria.
     
  • Which of these three choices (soap and water, alcohol based sanitizer, liquid antiseptic soap) is best depends on the goal:

1. For the average person in an average non-hospital/non-disease situation, removing regular germs PLUS chemicals PLUS dirt is the goal of hand hygiene. Washing hands with regular soap and water is the best method for achieving this goal. The alcohol hand sanitizers are better than soap and water at specifically removing bacteria but are less successful at removing dirt and chemicals (because removal of chemicals and dirt depends on holding the hands under running water).

2. In the health care setting, removal of bacteria is the main goal. It is very unlikely that a healthcare worker’s hands will have significant amounts of chemicals or dirt on them, so removing chemicals and dirt is not a priority in this setting. Both alcohol based hand sanitizers and liquid chlorhexidine soap are superior to plain soap and water for rapidly killing bacteria. Therefore, in hospital settings, both 60% alcohol sanitizers and chlorhexidine liquid soap are equally recommended over soap and water for hand hygiene.

The 60% alcohol kills bacteria faster, but loses its effect faster than chlorhexidine. Nurses who need to sanitize their hands each time they enter and leave a patient’s room typically use 60% alcohol for hand hygiene because it is faster and more convenient than chlorhexidine and water.

Chlorhexidine kills bacteria almost as rapidly as 60% alcohol, and in addition remains effective for 6 hours (because it binds with the skin). Surgeons wash their hands with chlorhexidine before performing a surgery. Some nurses also prefer chlorhexidine over the alcohol sanitizers.

  • Plan B for the regular consumer: When faced with an absence of soap and water, using an alcohol based hand sanitizer is significantly better than doing nothing. Alcohol based hand sanitizers significantly reduce respiratory and gastrointestinal infection rates.
     
  • NONE of these methods kill viruses, but ALL of them remove some viruses from the hands.
     
  • Nobody recommends using two methods in combination (for example soap and water followed by alcohol sanitizer), possibly because this simply is such an unrealistic recommendation that nobody has bothered recommending it.
     
  • Nobody says that it is WRONG to use two methods in combination fro example, soap and water followed by alcohol sanitizer).
     
  • The biggest problem with achieving hand hygiene through soap and water is that only 5% of people wash their hands in a manner that will remove germs. Given this fact, it probably is reasonable in certain situations of high disease exposure to wash hands with soap and water to remove dirt and chemicals, and follow this with an alcohol based hand sanitizer to remove the excess bacteria. This only makes sense when there is known exposure to disease, for example during a home visit to a sick person or while travelling in areas known to have high disease burdens. An equally good approach is to learn to consistently wash hands correctly with soap and water.
     
  • The biggest problem with alcohol hand sanitizers is that they are not very successful at removing dirt and chemicals. In addition, they will burn on open cuts. Also, trace amounts of alcohol are absorbed, which is a danger in small children who overuse the product a lot (it takes A LOT of overuse). Finally, alcoholics have been known to ingest alcohol hand sanitizers, which can cause death. For this reason, neither alcoholics nor small children should have unsupervised access to alcohol hand sanitizers.
     
  • The biggest problem with chlorhexidine is….nothing. Mostly, it is overkill for the regular home situation, where regular soap and water are good enough. However, chlorhexidine does accomplish removal of chemicals PLUS dirt PLUS bacteria. Products with chlorhexidine can be purchased at amazon.com: Hibiclens Antimicrobial Skin Liquid Soap, 8 Fluid Ounce.