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Assessing Sanitizers: Cleaning Up the Confusion

If you believe the ads, we live in a squalid hotbed of menacing microbes. Evil germs are everywhere and out to get us – especially the innocent, well-dressed children playing nearby. The smart ones among us, the marketers tell us, navigate this ominous world armed with the right sanitizing defense. Even the grimiest restroom, the ad images show, can become as innocuous as a sparkling, surgery-ready space if we only have the security of hand sanitizer. Yes, the power of the imagination…

Sure, the marketing gurus make their buck by coaxing rampant, misplaced fear in the populace. (Funny how we don’t seem as terrified by a “Biggie” order of French fries as we do our own door knobs.) However, let’s put aside the cautionary ads and look at the facts. Sales have risen some 70% since last year [7]. Part of it is the whole H1N1 alarm [8], but it’s a general trend as well. Even if the craze [9] isn’t warranted, what about more moderate use of the products? Do these things even work? Do they really keep us healthier? Are we breeding so-called “superbugs” every time we use a squirt or spray? As always, let’s break it down.

The vast majority of hand sanitizers out there are alcohol based (like Purell) with one or more of the typical n-propanol, isopropanol or ethanol. To be effective, they contain anywhere from 60-90% alcohol. The alcohol “kills” (i.e. deactivates) the germs but requires the full drying time to do so. Additionally, sanitizers offer some ongoing, residual protection by making the skin surface inhospitable for bacteria and viruses. Ethanol-based sanitizers do a better job at killing certain viruses like the norovirus [10]. Natural sanitizers like CleanWell use extracts from herbs (thyme being one) with inherent antiseptic properties and show effectiveness rates similar to chemical-based products (PDF Press Release [11]).

Next, are you less likely to get the cold or flu if you use them regularly? Research suggests that college dorm residents [12] (PDF) and elementary students [13] given instruction and ready access to hand sanitizers show fewer overall infections and absentee rates than control groups. (It’s worth noting that the elementary school students used an herbal, alcohol-free sanitizer.) One randomized cross-over comparison [14] of traditional hand-washing measures versus sanitizer use in an elementary school showed similar effectiveness in reducing absenteeism.

What are the cons of these products? Although alcohol-based sanitizers appear to be easier on the skin than soap and water washing, some people react to the products [15]. Aside from the alcohol itself, other ingredients can be suspect, particularly the fragrances used in some formulas. There’s also some concern about the use of ethanol-based sanitizers, particularly on children. A safety review out last year suggested additional research was necessary to confirm topical safety [16] for regular use products. Herbal-based sanitizers don’t dry hands as much as alcohol-based products, and they’re generally viewed as safe options across the board. One up and coming category I’d definitely recommend skipping is the silver nanoparticle sanitizer. The research shows too many risks [17] to make these products worthwhile by a long shot.

As for the risk of encouraging “superbugs,” the whole of the research suggests that sanitizers are in the clear. The real culprit here is triclosan [18] (PDF), an anti-bacterial ingredient found in everything from anti-bacterial soaps to mouthwash to lunch boxes to running shoes (look for the “microban” label). It’s a potent endocrine-disruptor. If you have a choice of washing with a triclosan-based soap or using a regular hand sanitizer, I’d go with the sanitizer – hands down. (Sorry – couldn’t resist.)

Personally, I don’t think sanitizers are necessary for normal, everyday circumstances, but I don’t see too much harm in them, particularly the natural herb-based brands. Maintaining a strong immune system [19] and using good old soap and water are your best defenses [20]. That old advice about not rubbing your eyes, nose or mouth was right on as well. A study published this fall linked nearly one third of flu risk to participants’ hand to face contact [21]. If you’re traveling and worry you might not have access to a washroom, I don’t see a problem with taking along a bottle of natural sanitizer. At worst, it’s simply an unnecessary measure. At best, it might give you some peace of mind. And, of course, if you’re the one who’s sick and you want to exercise some extra precaution/courtesy, go ahead and use it as a backup to hand washing when you need to. All that said, I fear that hand sanitizers represent a growing trend to sterilize anything and everything when sometimes all we need is a little dirt, dust and dishevelment [22].

But let me turn it over to all of you. Do you use sanitizers on an occasional or regular basis? Do you skip them altogether? Let me know what you think. Thanks for reading.