Hand sanitizer

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Hand alcohol in a hospital
A bottle of hand sanitizer

A hand sanitizer, or according to the latest FDA definition a Hand Antiseptic, is a supplement or alternative to hand washing with soap and water. Various preparations are available, including gel, foam, and liquid solutions. The active ingredient in hand sanitizers may be isopropanol, ethanol, or n-propanol. Inactive ingredients in alcohol rubs typically include a thickening agent such as polyacrylic acid for alcohol gels, humectants such as glycerin for liquid rubs, propylene glycol, and essential oils of plants. Alcohol based hand sanitizers are more effective at killing germs than soaps and do not dry out hands as much.[1] Popular alcohol rub brands include Baccide, Purell, Germ-X, Labo, Aqium, Avant, GermOut, and Aquawet. Lysol, and Method Products also produce popular alcohol-based hand sanitizers. Some brands make a non-alcohol sanitizer such as cleanwell.

In recent years, some brands started combining alcohol rubs with natural products and essential oils to provide luxury lines for the growing skin care industry.[2] Such brands include Burt's Bees, EO, Frais, Jao and The Body Shop.

Contents

[edit] Hand alcohol

Hand alcohol, alcohol hand antiseptic agent, is a type of antiseptic agent that is used within health care to avoid transmission of pathogens. Hand alcohol exist in liquid, foam and, easy flowing gel formulations. The level of alcohol varies between 60% to 85%. The most common used level is 70%.

Despite common perceptions, hand alcohol is well-adapted for the skin. Several studies have demonstrated that hand alcohol does not dehydrate the skin [3]. In contrast, hand washing with soap and water significantly decreases epidermis water content compared to use of alcohol-based hand gels [4]. Hand alcohol should be thoroughly rubbed into the hands and on the lower forearm for a duration of at least 30 seconds [5], and then allowed to air dry. Optimal disinfection requires attention to all exposed surfaces such as around the fingernails, between the fingers, on the back of the thumb, and around the wrist. To minimize carryover, jewelery should be removed from hands during use.

Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungus. Alcohol rub sanitizers containing 70% alcohol kill 3.5 log10 (99.9%) of the bacteria on hands 30 seconds after application and 4 to 5 log10 (99.99 to 99.999%) of the bacteria on hands 1 minute after application.[6]

[edit] Uses

When hands are not visibly dirty, the United States Centers for Disease Control and Prevention considers alcohol hand sanitizers as an acceptable alternative to soap and water for hand hygiene.[7] However Dr. Arthur Reingold an infectious disease specialist who has advised on vaccine policy for the World Health Organization, disagrees with authorities who believe they are a help in preventing Swine Flu and other virus diseases. For that purpose he said in an interview with cbcnews.ca. "If they make people feel better, that's okay with me, but I think it's a waste of time and money," Reingold, who is also a medical doctor and head of epidemiology at the School of Public Health, University of California, Berkeley, also points out, "Studies done 40 and 50 years ago pretty much show it's impossible to get influenza through hand-to-hand contact." (CBC News, Consumer Life Online 13 November 2009) Dr. Peter Palese, a professor of medicine and infectious diseases at Mount Sinai School of Medicine in New York City, said hand washing isn't all that helpful against the flu because the flu isn't like other respiratory diseases. "The flu virus isn't very stable on the hand," he said. "The virus has a lipid membrane that flattens out when it's on your hand, and it gets inactivated." The rhinovirus, on the other hand, which causes the common cold, can live quite nicely on someone's hand. "It has a different architecture than a flu virus," he said. "It's much more stable." The flu virus thrives in droplets of water, such as the kind that come out of your mouth when you sneeze or cough. "The lipid membrane stays intact when it's surrounded by a droplet of water that's ten times bigger than the virus itself," Palese says. (CNN Health.com 24 September 2009)

Alcohol concentration must be above 60% for alcohol rubs to be effective in killing microbes. Researchers at East Tennessee State University found that products with alcohol concentrations as low as 40% are available in American stores.[8] For health care settings like hospitals and clinics, optimum alcohol concentration to kill germs is 70% to 95 %.[9][10] Alcohol rubs containing two different germ killers (i.e. alcohol and chlorhexidine gluconate), are significantly more effective as preoperative skin topical antiseptics in hospitals than alcohol alone. [11] Most alcohol rub formulations include a moisturizer to keep hands from drying out.

Some hand sanitizer products use agents other than alcohol, such as triclosan or benzalkonium chloride, to kill germs. However, one uncorroborated laboratory study has shown benzalkonium chloride may be associated with, but not cause, antibiotic resistance in MRSA.[12][13] No mechanism for resistance to alcohol has been described in bacteria.[14] Triclosan has been shown to accumulate in biosolids in the environment, one of the top seven organic contaminants in waste water according to the National Toxicology Program[15] Triclosan leads to various problems with natural biological systems [16], and triclosan, when combined with chlorine e.g. from tap water, produces dioxins, a probable carcinogen in humans.[17] In June, 2009, alcohol-free Clarcon Antimicrobial Hand Sanitizer was pulled from the US market by the FDA which found the product contained high levels of various bacteria, including those which can "cause opportunistic infections of the skin and underlying tissues and could result in medical or surgical attention as well as permanent damage".[18]

[edit] Hospital environment

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Alcohol based hand rubs are extensively used in the hospital environment as an alternative to antiseptic soaps. Alcohol based hand rubs provide a better skin tolerance as compared to antiseptic soap due to the moisturizing and softening agents in the formulation. Hand rubs also prove to have more effective microbiological properties as compared to antiseptic soaps.

[edit] Brands of hospital hand-rubs

The most common brands of alcohol hand rubs include Avant, Aniosgel 85 NPC, Sterillium, Desderman and Allsept S. All hospital hand rubs must conform to certain regulations like EN 12054 for hygienic treatment and surgical disinfection by hand-rubbing. Products with a claim of “99.99% reduction” or 4Log reduction are ineffective in hospital environment, since the reduction must be more than “99.99%”.[citation needed]

[edit] Composition

The same ingredients used in over-the-counter hand-rubs are used in hospital hand-rubs and include alcohols (ethanol, isopropanol, and others), sometimes combined with other compounds like quats (benzalkonium chloride). The use of quats is primarily to increase the antimicrobial effectiveness of the product, but it can cause allergic reactions in some people. However, allergic reactions due to quats are extremely rare, and the benefits of using quats (increased antimicrobial effectiveness) far exceed the risks. The concentration of quats in one well-known hand antiseptic is 200 parts per million. This concentration will never become "sticky" even if applied dozens of times per day. Quats also tend to build up on the skin, and since medical staff use hand rubs heavily during the day, this build up might cause a “sticky effect”. Sanitizing gels used many times a day will leave a "sticky" residue due to the gel. The gel does not evaporate. It stays on the hands until it is removed with soap and water. Hand rubs based solely on alcohol eliminate the sticky effect as well as the risk of allergic reactions. The alcohol in the alcohol gel evaporates, but the gel remains on the hands and can cause allergic reactions.

[edit] Applications in the hospital environment

Hand-rubs in the hospital environment have two applications: hygienic hand rubbing and surgical hand disinfection.

[edit] Surgical hand disinfection by hand-rubbing

Surgical hand disinfection by hand-rubbing is to be practiced before any surgical procedure. Surgical hand-rubbing is to be preceded by hand washing with mild soap. Hand washing prior to hygienic hand rubbing is not necessary unless hands are visibly dirty. Surgical hand disinfection by hand-rubbing generally requires a larger dose of the hand-rub and a longer rubbing time, usually done in two applications.

Both hygienic hand treatment and surgical hand disinfection must be applied and rubbed according to a specific hand-rubbing technique EN 1499 and EN 1500. This technique is specifically designed to ensure that the antiseptic is applied everywhere on the hand surface.

[edit] Dosing systems

Different dosing systems are available for hospital hand-rubs, those are usually dosing systems incorporated into the bottle itself like dosing pumps screwed into the bottle or airless pump systems. The dosing systems are designed to deliver a certain amount of the product, and thus to assist the staff to correctly measure out the correct dose. Application of the hand-rub can also be assisted by placing the bottle in specially designed dispensers, dispensers for surgical hand disinfection are usually equipped with elbow controlled mechanism or infrared sensors to avoid any contact between with the pump. It is strongly recommended use the product in its original packaging and never to pour the product into a dispenser, as the dispenser itself may become the cause of infection.[citation needed] 1


The Centers for Disease Control specifies at least a 62% alcohol content is needed to kill germs. It also recommends that the access to the dispenser be both frequent and prevalent. Newer wrist worn sanitizers are more effective since the supply and access to the sanitizer is worn by the individual. The wearable system should also maintain an antibacterial property and have no less then a Class VI medically approved rating. A system developed by Pure-Go is a wrist worn hand sanitizer dispenser that meets the CDC guidelines. [19]

[edit] Effectiveness

The Centers for Disease Control says the most important way to prevent the transmission of dangerous diseases is to frequently wash your hands with soap and water. If soap and water are not available it is recommended to use a hand sanitizer that contains at least 60 percent alcohol.[20][21] Alcohol rubs kill many different kinds of bacteria, including antibiotic resistant bacteria and TB bacteria. It also has high viricidal activity against many different kinds of viruses, including enveloped viruses such as the flu virus, the common cold virus, and HIV, though is notably ineffective against the rabies virus.[22] [23] [24] Alcohol rubs are not very effective against Norovirus (winter vomiting virus).[25] Alcohol rubs also kill fungi.[26]

According to Rotter (1999), “alcohol rubs are approximately 100 times more effective against viruses than any form of hand washing”. Isopropyl alcohol will instantly kill 99.99 percent or more of all non-spore forming bacteria in less than 30 seconds, both in the laboratory and on human skin.[11][20] A controlled study of 200 workers at FedEx in 2004 showed that placing hand sanitizer dispensers in an office and educating workers about their use resulted in a 21% reduction in absenteeism.[27] Controlled studies showed an even greater reduction in absenteeism (51%) in elementary schools[28] and college dormitories (43%).[29]

The alcohol in hand sanitizers may be ineffective in low quantities or concentrations. Though Isopropyl alcohol is efficient in killing most bacteria, the exposure time required to lyse cells is not met since alcohol tends to evaporate in less than 10–15 seconds.[citation needed] If the correct amount of alcohol rub hand sanitizer is used, it will not evaporate in 10–15 seconds.[citation needed] Mackintosh (1984) found that application of 0.3 milliliters alcohol rub to the hands was no more effective than plain soap-and-water hand washing, but that increasing the volume to 0.5 milliliters increased the effectiveness of alcohols substantially.[1] In environments with high lipids or protein waste (such as food processing), the use of alcohol hand rubs alone may not be sufficient to ensure proper hand hygiene.[citation needed]

Not all pathogens are equally susceptible. Certain bacteria, especially the spore-forming gram positives (e.g. Clostridium difficile) are relatively resistant and remain biologically viable. During the Anthrax attacks on the United States Postal Service, authorities warned that alcohol hand rubs and soap and water would not kill anthrax spores.

Alcohol kills both pathogenic (disease causing) microorganisms as well as resident bacterial flora, which generally do not cause illness. [30] Research shows that alcohol hand sanitizers do not pose any risk by eliminating "good" germs that are naturally present on the skin. The body quickly replenishes the good germs on the hands, often moving them in from just up the arms where there are fewer harmful germs.[31]

Alcohol also strips the skin of the outer layer of oil, which may have negative effects on barrier function of the skin. However, washing with detergents, such as commonly used hand soaps, results in a greater barrier disruption of skin compared to alcohol solutions, suggesting a increased loss of skin lipids [32] [33]

[edit] Safety

Alcohol gel can catch fire, producing a dim blue flame. This is due to the flammable alcohol in the gel. Some hand sanitizer gels may not produce this effect due to a high concentration of water or moisturizing agents. There have been some rare instances where alcohol has been implicated in starting fires in the operating room, including a case where alcohol used as an antiseptic pooled under the surgical drapes in an operating room and caused a fire when a cautery instrument was used. Alcohol gel was not implicated. To minimize the risk of fire, alcohol rub users are instructed to rub their hands until dry, which indicates that the flammable alcohol has evaporated.[34]

The US FDA controls antimicrobial handsoaps and sanitizers as over-the-counter drugs because they are intended for topical anti-microbial use to prevent disease in humans. [35] The FDA requires strict labeling which informs consumers as to proper use of this OTC drug and dangers to avoid, including warning adults not to ingest, not to use in the eyes, to keep out of the reach of children, and to allow children to use only under adult supervision. [36] According to the American Association of Poison Control Centers, there were nearly 12,000 cases of hand sanitizer ingestion in 2006. [37] If ingested, alcohol-based hand sanitizers can cause alcohol poisoning in small children.[38] However, the Centers for Disease Control recommends using hand sanitizer with children to promote good hygiene, under supervision, and furthermore recommends parents pack hand sanitizer for their children when traveling, to avoid their contracting disease from dirty hands. [39]

There have been cases reported of people drinking the gel (with mixers) in prisons and hospitals to become intoxicated leading to its withdrawal from some establishments. [40]

[edit] Image gallery

Alcohol liquid – a type of alcohol rub

Colourless alcohol gel

[edit] Sources

  1. ^ "Alcohol Hand Rub and Hand Hygiene" (PDF). Clinical Excellence Commission, Health, New South Wales, Australia. http://www.cec.health.nsw.gov.au/pdf/AlcoholHandRub061013.pdf. Retrieved 2007-05-18. 
  2. ^ M.O. (March 2009). "Vital Beauty, Soothing Hand Sanitizers". Natural Health Magazine. pp. 22. http://www.naturalhealthmag.com. 
  3. ^ Boyce, John M. (July 2000). "Using Alcohol for Hand Antisepsis: Dispelling Old Myths". Infection Control and Hospital Epidemiology (The University of Chicago Press) 21 (7). http://www.journals.uchicago.edu/doi/abs/10.1086/501784. Retrieved 2009-10-16. 
  4. ^ Boyce, John M.; Kelliher, Susan; Vallande, Nancy (July 2000). "Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel". Infection Control and Hospital Epidemiology (The University of Chicago Press) 21 (7). http://www.journals.uchicago.edu/doi/abs/10.1086/501785. Retrieved 2009-10-16. 
  5. ^ Girou, Emmanuelle; Sabrina Layou, Patrick Legrand, Francoise Oppein, and Christian Brun-Buisson (August 2002). "Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial". British Medical Journal 325 (362). http://www.bmj.com/cgi/content/full/325/7360/362. Retrieved 2009-10-16. 
  6. ^ Rotter M. (1999). "Hand washing and hand disinfection". Hospital epidemiology and infection control 87. 
  7. ^ Template:Cite web.
  8. ^ Reynolds, Scott A.; Foster Levy and Elaine S. Walker (March 2006). "Hand Sanitizer Alert". Emerging Infectious Diseases (Centers for Disease Control and Prevention) 12 (3). http://www.cdc.gov/ncidod/EID/vol12no03/05-0955.htm. Retrieved 2007-02-02. 
  9. ^ Kramer, Axel; Peter Rudolph Gonter Kampf Didier Pittet (2002). "Limited efficacy of alcohol-based hand gels". Lancet 359 (April 27): 1489–1490. doi:10.1016/S0140-6736(02)08426-X. 
  10. ^ Pietsch, Hanns (2001). "Hand Antiseptics: Rubs Versus Scrubs, Alcoholic Solutions Versus Alcoholic Gels". J. Hospital Infection (Hospital Infection Society) 48 (Supl A): S33–S36. doi:10.1016/S0195-6701(01)90010-6. 
  11. ^ a b Hibbard, John S. (May/June 2005). "Analyses Comparing the Antimicrobial Activity and Safety of Current Antiseptic Agents". J. Infusion Nursing (Infusion Nurses Society) 28 (3): 194–207. 
  12. ^ "Increase in Resistance of Methicillin-Resistant Staphylococcus aureus to β-Lactams Caused by Mutations Conferring Resistance to Benzalkonium Chloride, a Disinfectant Widely Used in Hospitals". American Society for Microbiology. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=89614. 
  13. ^ "Antibacterial Household Products: Cause for Concern". Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm. 
  14. ^ Dix, Kathy (December 1, 2002). "CDC's Endorsement of Alcohol Hand Rubs Launches New Era in Hand Hygiene". Infection Control Today. http://www.infectioncontroltoday.com/articles/400/400_2c1feat6.html. 
  15. ^ "Hand NTP Research Concept: Triclosan". National Toxicology Project. http://ntp.niehs.nih.gov/files/Triclosan_Concept_final-100608_508.pdf. Retrieved 2008-11-20. 
  16. ^ McMurry LM, Oethinger M, Levy SB (1998). "Triclosan targets lipid synthesis". Nature 394 (6693): 531–2. doi:10.1038/28970. PMID 9707111. 
  17. ^ "Environmental Emergence of Triclosan" (PDF). Santa Clara Basin Watershed Management Initiative. http://www.scbwmi.org/PDFs/WMI_Triclosan_FinalJan06.pdf. Retrieved 2006-01-01. 
  18. ^ "Consumers Warned Not to Use Clarcon Skin Products". US Federal Drug Administration. June 15, 2009. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm164845.htm. Retrieved 2009-06-15. 
  19. ^ Original news release at http://www.puregohandsanitizer.com. Title:CDC Recommends the Pure-Go Hand Sanitizer Dispenser.
  20. ^ a b CDC- Clean Hands Save Lives
  21. ^ "Dirty Hands Spread Dangerous Diseases like H1N1 (aka swine flu)". San Jose Mercury News. 25 April, 2009. 
  22. ^ Sandora, Thomas J TJ Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention Journal: Pediatrics (Evanston) ISSN: 0031-4005 Date: 06/2008 Volume: 121 Issue: 6 Page: e1555 PMID: 18519460 DOI: 10.1542/peds.2007-2597
  23. ^ Infection Control Campaign brochure
  24. ^ Hand Hygiene
  25. ^ Jimenez L, Chiang M (2006). "Virucidal activity of a quaternary ammonium compound disinfectant against feline calicivirus: a surrogate for norovirus". Am J Infect Control 34 (5): 269–73. doi:10.1016/j.ajic.2005.11.009. PMID 16765204. http://linkinghub.elsevier.com/retrieve/pii/S0196-6553(06)00078-2. 
  26. ^ www.learnwell.org//handhygiene.htm
  27. ^ Arbogast, Ferrazzano-Yaussy, Cartner (2004). "FedEx Custom Critical Outcome Study Executive Update, Interim Report". GOJO Industries, Inc.. 
  28. ^ Guinan, M., M. McGuckin, and Y. Ali. (2002). "The effect of a comprehensive handwashing education program on absenteeism in elementary schools.". American Journal of Infection Control 31: 1-8. 
  29. ^ White, C., R. Kolble, R. Carlson, N. Lipson, M. Dolan, Y. Ali, M. Cline (2003). "The effect of hand hygiene on illness rate among students in university residence halls". American Journal of Infection Control 13: 364-370. 
  30. ^ Hand sanitizers are not substitutes for soap and water
  31. ^ Aiello et al (2007). "Consumer antibacterial soaps: effective or just risky?". Clin Infect Dis. 
  32. ^ Löffler, Harald; Günter Kampf (2008). "Hand disinfection: How irritant are alcohols?". Journal of Hospital Infection 70. 
  33. ^ Pedersen, L.K.; E. Held, J.D. Johansen and T. Agner (2005). "Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection". British Journal of Determatology 153. http://www3.interscience.wiley.com/cgi-bin/fulltext/118683199/HTMLSTART. Retrieved 2009-10-16. 
  34. ^ "Alcohol-Based Hand-Rubs and Fire Safety". Centers for Disease Control and Prevention. September 15, 2003. Archived from the original on 2007-04-03. http://web.archive.org/web/20070403230557/http://www.cdc.gov/handhygiene/firesafety/default.htm. Retrieved 2007-04-26. 
  35. ^ Daniel S. Wagner, Manager of Regulatory Compliance, ISSA (2000). "GENERAL GUIDE TO CHEMICAL CLEANING PRODUCT REGULATION". International Sanitary Supply Association, Inc.. http://www.issa.com/data/files/articles/88/generalchemical.pdf. 
  36. ^ Judith E. Foulke (May 1994). "Decoding the Cosmetic Label". FDA Consumer magazine (U.S. Food and Drug Administration). 
  37. ^ "Paging Dr. Gupta, Hand sanitizer risks". CNN. June 21, 2007. http://www.cnn.com/HEALTH/blogs/paging.dr.gupta/2007/06/hand-sanitizer-on-rocks-please.html. 
  38. ^ "Hand Sanitizers Could Be A Dangerous Poison To Unsupervised Children". NBC News Channel. http://www.firstcoastnews.com/news/health/news-article.aspx?storyid=84913. Retrieved 2007-07-15. 
  39. ^ "International Travel with Infants and Young Children". Travelers' Health - Yellow Book (Centers for Disease Control) 8. March 2009. 
  40. ^ "Prisoner 'drunk on swine flu gel'". BBC news online. http://news.bbc.co.uk/1/hi/england/dorset/8272799.stm. 

[edit] See also

[edit] External links

Retrieved from "http://en.wikipedia.org/wiki/Hand_sanitizer"