Antibacterial Hand Sanitizers Do they work?

What started out as an informal classroom experiment at East Tennessee State University has turned up disturbing evidence about some alcohol-based instant hand sanitizers — the antiseptic gels and foams that have become popular as a quick way to disinfect hands when soap and water aren't available.

FOR GENERAL USE Some sanitizers can be a good supplement to soap and water.

Many such sanitizers — whether a brand name or a generic version — work well, and are increasingly found in hallway dispensers in hospitals, schools, day care centers and even atop the gangways of cruise ships as one more safeguard against the hand-to-mouth spread of disease. Several studies from such settings have shown that use of the alcohol-based rubs on hands that aren't visibly soiled seems particularly helpful in curbing the spread of bad stomach and intestinal bugs.

But a study published in this month's issue of the journal Emerging Infectious Diseases found that at least one brand of sanitizer found on store shelves, as well as some recipes for homemade versions circulating on Web sites about crafts or directed at parents, contain significantly less than the 60 percent minimum alcohol concentration that health officials deem necessary to kill most harmful bacteria and viruses.

"What this should say to the consumer is that they need to look carefully at the label before they buy any of these products," said Elaine Larson, professor of pharmaceutical and therapeutic research at Columbia's nursing school. "Check the bottle for active ingredients. It might say ethyl alcohol, ethanol, isopropanol or some other variation, and those are all fine. But make sure that whichever of those alcohols is listed, its concentration is between 60 and 95 percent. Less than that isn't enough."

Scott Reynolds, a specialist in infection control at the James H. Quillen Veterans Affairs Medical Center in Mountain Home, Tenn., discovered the problem inadvertently, in the course of giving a simple demonstration on the merits of hand washing to a friend's class of biology students at nearby East Tennessee State.

Mr. Reynolds had the students place their hands on agar plates of growth medium before and after one of several experimental conditions: rubbing their hands briskly under tap water; sudsing with hospital-grade soap and then rinsing with water; or rubbing their hands with a dollop of one of two types of alcohol-based hand sanitizer. The sanitizers used were a foam version from the hospital that contained 62 percent ethanol, and a gel version Mr. Reynolds's wife bought at a local discount store.

The next day, much to Mr. Reynolds's surprise, the culture plates from hands doused and rubbed with the store-bought gel were covered with clumps of bacteria that had, in some cases, formed a visible outline of the student's handprint on the plate.

Only when he flipped the bottle around to read the label on the back did Mr. Reynolds see that the gel's active ingredient was "40 percent ethyl alcohol."

"Otherwise, it looked like all the rest you see in the store," he said. "Same price. Same claims. Same pump bottle."

In a more formal follow-up study, Mr. Reynolds and two colleagues replicated the results, and confirmed that the lack of sufficient alcohol was to blame. If anything, he said, the faulty gel seemed to mobilize the bacteria, spreading them around the hand instead of killing them.

Allison Aiello, an epidemiologist at the University of Michigan who has studied the use and relative effectiveness of alcohol-based gels and antibacterial soaps by consumers as well as hospital workers, said she wasn't surprised by Mr. Reynolds's results from the low-alcohol sanitizer, but she was concerned to read that such a product was on the market.

"I used to work in a virology lab," Dr. Aiello said, "and we knew — it has been known for decades — that an alcohol concentration under 60 percent won't kill the microbes. It's really frightening to think that there are products out there that contain levels lower than that."

Sometimes much lower. One recipe Mr. Reynolds and his colleagues discovered on the Internet for a bubble gum-scented sanitizer aimed at children called for half a -cup of aloe vera gel and a quarter cup of 99 percent rubbing alcohol, with a bit of fragrance. That translates to a concentration of roughly 33 percent alcohol, Dr. Aiello said.

Since 2002, officials at the Centers for Disease Control and Prevention have recommended that health care workers routinely use high quality alcohol-based gels instead of soap and water on their hands when moving from patient to patient — as long the worker's hands aren't visibly soiled.

Alcohol doesn't cut through grime well, so dirt, blood, feces or other body fluids or soil must be wiped or washed away first, if the alcohol in the sanitizer is to be effective. In such cases, hand washing with soap and water is advised.

In October 2005, a committee appointed by the Food and Drug Administration met to discuss, among other things, whether consumers should also be encouraged to use the alcohol-based hand sanitizers.

Dr. Tammy Lundstrom, representing the nonprofit Association for Professionals in Infection Control and Epidemiology, argued that they should. The committee's decision is expected this month.

"About 60 percent of surgery these days is outpatient," Dr. Lundstrom said last week in a phone interview. "We have so many people caring for ill family members at home. Maybe you're without running water because of a hurricane or blackout, or you've got a bad hip and can't move easily to get to the sink as often as you should to wash your hands. What about after you sneeze in the car, or stop to put in contact lenses?"

In all those cases, she said, alcohol-based hand sanitizers — of the correct formulation — could be a godsend, not to replace soap and water, but as an important supplement.

Dr. Aiello sees even more potential uses in the office. "Studies show that the computer keyboard, the phone receiver, and the desk are worse than the bathroom in terms of micro-organisms," she said. "Washing with plain old soap and water should be your first choice. But if you're stuck between meetings and about to grab lunch at your desk, or just use somebody else's keyboard, using a hand sanitizer before and after could be a really good idea."

How much goop should you use? Vigorously rub all sides of your hands with enough antibacterial hand gel or foam to get them wet, and rub them together until they are dry. If your hands are dry within 10 or 15 seconds, according to the C.D.C. guidelines for health care workers, you haven't used enough.

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By DEBORAH FRANKLIN
Published: March 21, 2006

Alcoholic Hand Gel and Swine Flu

Although alcohol is not something known to be good for us, let alone something which protects us from bad consequences, in the case of hand gel it does just this. Not only is it entirely safe for your body, but a product which contains alcohol is far superior at cleaning hands than one without, which is evident by the fact that it is used in hospitals. There is no need to accompany it with any other type of soap as it does all the work itself and shouldn’t dry out your hands.

We all have millions of germs on our hands at any one time, some very dangerous such as swine flu and as the numbers of people contracting swine flu increases and is set to grow fast in the coming months, it is imperative that people are diligent about keeping themselves clean. Touching hands and surfaces which people’s hands have been on is the most common way in which germs are spread. It is not easy to protect yourself or your loved ones from other people’s germs as you cannot be responsible for other people, however you can for yourself. By carrying an alcoholic hand gel and using it frequently, you are doing the best thing possible to protect yourself as alcoholic hand gels are capable of killing up to 99.999% of bad bacteria. Whether you feel threatened or not, it is a worthwhile precaution to own some hand gel in case somebody within your own family or workplace becomes ill.

When looking for a hand gel, it is important not just to make sure that it contains alcohol, but that it is classified as non hazardous and has also passed all the appropriate tests, such as the bacterial activity test, and is approved by the reputable organisations such as the Food and Drug administration and Health and Safety Executive. It is also safer to the environment if it is biodegradable. If you can obtain this sort of information from a package, a website, or the distributor them self, then you can be confident that you are using a completely safe product. You can find some good brands online, such as germ warfare which is a leader in distributing alcoholic hand gel to homes and companies nationally.

Alcoholic hand gel is a big step towards making sure that you are doing all that you can to stay clean and germ free. It is inexpensive and can save you from worrying about your own safety and that of your family.

Article by Mike