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Hand sanitizer

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File:Hand sanitizer with aloe.jpg
One of many brands of alcohol gel, which is a type of alcohol rub

An alcohol rub, also known as a hand sanitizer or healthcare personnel hand wash or a hand antiseptic according to the latest FDA definition, is used as a supplement or alternative to hand washing with soap and water. The active ingredient in alcohol rubs may be isopropanol, ethanol, or (in Europe) n-propanol. A variety of preparations are available, including gels, foam and liquid solutions. Hand sanitizers containing alcohol are more effective at killing germs than soaps and do not dry out hands as much as soaps.[1] Inactive ingredients in alcohol rubs typically include a thickening agent such as Carbomer (a trade name for polyacrylic acid), humectants such as glycerin and propylene glycol, or essential oils of plants. Popular alcohol rub brands include Purell, Germ-X, Aqium, Avant, Germ Out, and Aquawet. 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.

Some hand sanitizer products use agents other than alcohol, such as triclosan or benzalkonium chloride, to kill germs. Cleanwell, Remi-D, Soapopular, Safe Hands, Safe4Hours, Gentle Care, and No Rinse are among non-alcohol hand sanitizer brands. However, one un-collaborated laboratory study has shown benzalkonium chloride may be associated with but not cause antibiotic resistance in MRSA.[3] [4] No mechanism for resistance to alcohol has been described in bacteria”.[5] 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[6] Triclosan leads to various problems with natural biological systems [7], and triclosan, when combined with chlorine e.g. from tap water, produces chloroform, a probable carcinogen in humans.[8]

Uses

When hands are not visibly dirty, the Centers for Disease Control and Prevention considers alcohol hand sanitizers as an acceptable alternative to soap and water for hand hygiene.[9]

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.[10] The optimum alcohol concentration to kill germs is 70 to 95 %. Alcohol gels containing 62 v/v % alcohol are less effective germ killers than alcohol rubs containing at least 70 wt/wt % alcohol.[11][12][13] Alcohol rubs containing two different germ killers, like Germ Out (i.e. alcohol and benzalkonium chloride), are significantly more effective than alcohol alone.[14] Most alcohol rub formulations include a moisturizer to keep hands from drying out.

Effectiveness

Alcohol rubs kill many different kinds of bacteria, including antibiotic resistant bacteria and TB bacteria. Alcohol rubs inactivate many different kinds of viruses, including the flu virus and the common cold virus. Alcohol rubs also kill fungus.

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 would not kill anthrax spores. 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.

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.[15]

If ingested, ethanol based hand sanitizers can cause alcohol poisoning in small children.[16] In the U.S. alone, there have been more than 12,000 cases of children ingesting hand gels in a single year.[16]

Sources

  1. ^ "Alcohol Hand Rub and Hand Hygiene" (PDF). Clinical Excellence Commission, Health, New South Wales, Australia. Retrieved 2007-05-18.
  2. ^ M.O. (March 2009). "Vital Beauty, Soothing Hand Sanitizers". Natural Health Magazine. p. 22.
  3. ^ "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.
  4. ^ "Antibacterial Household Products: Cause for Concern". Centers for Disease Control and Prevention. {{cite web}}: Text "accessdate 2001-06-01" ignored (help)
  5. ^ Dix, Kathy (December 1, 2002). "CDC's Endorsement of Alcohol Hand Rubs Launches New Era in Hand Hygiene". Infection Control Today.
  6. ^ "Hand NTP Research Concept: Triclosan" (PDF). National Toxicology Project. Retrieved 2008-11-20.
  7. ^ McMurry LM, Oethinger M, Levy SB (1998). "Triclosan targets lipid synthesis". Nature. 394 (6693): 531–2. doi:10.1038/28970. PMID 9707111.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ "Environmental Emergence of Triclosan" (PDF). Santa Clara Basin Watershed Management Initiative. Retrieved 2006-01-01.
  9. ^ "Hand Hygiene FAQ". Infection Control in Dental Settings. Centers for Disease Control and Prevention. July 15, 2006. Retrieved 2007-02-01.
  10. ^ Reynolds, Scott A. (2006). "Hand Sanitizer Alert". Emerging Infectious Diseases. 12 (3). Centers for Disease Control and Prevention. Retrieved 2007-02-02. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  11. ^ "Hand Hygiene for Healthcare Workers". LearnWell Resources, Inc. (A California nonprofit public benefit 501(c)(3) corporation. Retrieved 2007-04-27.
  12. ^ Kramer, Axel (2002). "Limited efficacy of alcohol-based hand gels". Lancet. 359 (April 27): 1489–1490. doi:10.1016/S0140-6736(02)08426-X. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ Pietsch, Hanns (2001). "Hand Antiseptics: Rubs Versus Scrubs, Alcoholic Solutions Versus Alcoholic Gels". J. Hospital Infection. 48 (Supl A). Hospital Infection Society: S33–S36. doi:10.1016/S0195-6701(01)90010-6. {{cite journal}}: |access-date= requires |url= (help)
  14. ^ Hibbard, John S. (May/June 2005). "Analyses Comparing the Antimicrobial Activity and Safety of Current Antiseptic Agents". J. Infusion Nursing. 28 (3). Infusion Nurses Society: 194–207. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |date= (help)
  15. ^ "Alcohol-Based Hand-Rubs and Fire Safety". Centers for Disease Control and Prevention. September 15, 2003. Archived from the original on 2007-04-03. Retrieved 2007-04-26.
  16. ^ a b "Hand Sanitizers Could Be A Dangerous Poison To Unsupervised Children". NBC News Channel. Retrieved 2007-07-15.
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