You hear it all the time:
“Wash your hands with soap and water to prevent illness and the spread of germs.”
The Centers for Disease Control recommends that when soap and water isn’t available, that people use a hand sanitizer that contains at least 60% alcohol. As of 2009, roughly 90% of consumer antiseptic rubs use ethanol or ethyl alcohol as their active ingredient. Because of the widespread use of hand sanitizers and concern that some active ingredients may be harmful to certain populations (like pregnant women and children), in 2016, the FDA (Food and Drug Administration) started exploring whether hand sanitizers were effective and safe. Now, the findings have been released; here’s what the FDA concluded:
- 28 active ingredients, including triclosan and benzethonium chloride can no longer be used in consumer antiseptic rubs.
- Further studies will be pursued to review data for three ingredients: alcohol (ethanol or ethyl alcohol) and isopropyl alcohol, and benzalkonium chloride.
- Retailers market a very low number of sanitizers containing benzethonium chloride, and have already stopped selling those with the antibacterial triclosan.
It should be noted that requesting further data on the three ingredients isn’t a ding on their safety, but rather an effort to understand more about how frequent use of the ingredients works with the human body and against germs. At this time, the FDA does not intend to take action to remove hand sanitizers with ethanol, ethyl alcohol, or benzalkonium chloride off the market.
Even though hand sanitizers are a helpful second arm in the fight against spreading disease and germs, opt for soap and water when you can. Not only is this because our hands could use the occasional thorough scrub from dirt, but some organisms aren’t killed by alcohol. For example, the spores of the Clostridium difficile bacteria—also known as C. diff, can cause a diarrheal illness and inflammation of the colon, and soap and water is most effective against the spread of the illness.
Almost every manufacturer of hand sanitzers touts an efficacy rate of killing 99.99% or 99% of germs, but can that be trusted? Some studies show that the ideal condition of lab tests don’t accurately mimic real life scenarios, high-traffic areas or actual human behavior. And, loopholes in what verbiage can be used in marketing allow some manufacturers to highlight a high percent of germ eradication when it just isn’t so. To be able to splash “99.9% effective against germs” on their labels, manufacturers only have to show that the product is effective against a “representative sample of microbes,” the Wall Street Journal reported. Since not all germs can be eradicated by hand sanitizers, if the product can kill most other microbes in their test, the manufacturers can claim that coveted statistic.
The good news is that hand sanitizers that contain at least 60% alcohol are effective against viruses that cause the flu and colds, among other pesky illnesses. And, several studies have also found that for children who have not developed an effective and routine method of hand washing, hand sanitizer was actually more effective in warding off illnesses. One specific study evaluated around 1,000 children that attended daycare. Various methods of hand hygeine were practiced and the general health of the children was monitored. Those that used hand sanitizer were found to have 23% fewer respiratory illnesses over the course of the study.
There is still some concern over the increasing occurrence of some bacteria becoming resistant to alcohol, with some strains surviving until exposed to product with at least 70% alcohol. Various bacteria also showed resistance to alcohol when only exposed to it for a short period of time. One long-term study, spanning from 1997-2015, showed that bacteria evolved to tolerate alcohol better, by as much as 10x more tolerant, by the end of the study. The research is still clear: alcohol-based hand sanitizers are more effective at battling some bacteria, like those causing staph infections. And other bacteria are best cleaned off with simple soap and water.
The bottom line: while hand sanitizers help us maintain hand hygiene, when done correctly, hand washing protects best.