Pediatric Use Of Hand Sanitizers

The use of anti-microbial hand sanitizers has rapidly increased in the past decade. Hand sanitizer is used instead of hand washing when people are on the run or do not have access to soap and water. Hand sanitizer can be found just about everywhere, whether in school, at home or in the grocery store. While its use has steadily increased, its safety, especially when used by children, has been questioned. The research suggests some controversy as to whether hand sanitizer is safe for use by children. The question many parents have is whether the benefits of hand sanitizer outweigh the risks, and what risks are posed if their children use hand sanitizer.

Ingredients

The most common ingredients in hand sanitizers include glycerin, ethyl alcohol, water and vitamin E. Ethyl alcohol is the intoxicating agent in liquors, also known as drinking alcohol. It is used as a solvent and cleaning solution. The alcohol content in hand sanitizers varies depending on the brand and the proportion of other inactive ingredients. Based on FDA recommendations, the alcohol content of hand sanitizer products must be between 60 percent to 95 percent in order to be effective. Glycerin is derived from glycerol, a sweet-tasting syrup alcohol which is used in moisturizers to draw out and absorb water from the air. It is used for its ability to soften the skin. Other alcohol compounds that may be added to hand sanitizers include isopropyl myristate, propylene glycol, tocopheryl acetate and aminomethyl propanol; all of which are alcohols that promote absorption by the skin.

Hand Washing vs. Hand Sanitizing

Many children, whether at home or at school, rely on hand sanitizers for a fast, easy method of washing their hands when conventional soap and water are not accessible. Using mechanical friction, soap and water is useful in removing microorganisms and other contaminants. Alternatively, hand sanitizers prevent the growth of bacteria on the surface of the body by eliminating the outer layer of oil found on our skin. However, it also eliminates the good bacteria found on human skin. In “Comparing Hand Washing to Hand Sanitizers in Reducing Elementary School Students’ Absenteeism,” a study led by Judith Vessey et al. it was found that the use of anti-microbial hand sanitizers were as effective as hand washing. However, the most effective method is to first cleanse the hands with soap and water and then apply the hand sanitizer.

Benefits

According to Thomas Sandora et al. in “A Randomized, Controlled Trial of a Multifaceted Intervention Including Alcohol-Based Hand Sanitizer and Hand-Hygiene Education to Reduce Illness,” the use of alcohol-based hand sanitizers by children significantly reduced the transmission of gastrointestinal disorders. This study also found a positive correlation between increased use of hand sanitizers and decreased risk of respiratory illness not only among children, but also among the child’s family. Hand hygiene programs are an important mechanism for infection control in both the school and home environment. Additionally, hand sanitizers have been shown to kill bacteria such as Staphylococcus aureus, Salmonella, and Streptococcus pneumonia.

Potential Risks

The concern regarding the use of hand sanitizers by children is the frequent hand-to-mouth activity and excessive curiosity of children. Hand sanitizers high alcohol content, usually between 60 percent and 65 percent, is equivalent to approximately 124 proof alcohol. For this reason, ingestion of less than two ounces by a toddler or infant can cause alcohol poisoning and could be fatal. In “Safety Evaluation of Topical Applications of Ethanol on the Skin and Inside the Oral Cavity,” Dirk Lachenmeier reports that even a small amount of hand sanitizer, either ingested or inhaled, can result in disorientation, dizziness, headache, and stomach ache. While hand sanitizers have been proved to be toxic, manufacturers point out that it is safe as long as children rub it on their hands and never put it into their mouths. While most research documents the toxic effect of hand sanitizers, it indicates that the benefits of preventing disease and infection outweigh the hazards, but close supervision is necessary.

Alternative

In recent years, with concerns regarding the alcohol content of most hand sanitizers, manufacturers have created alcohol-free alternatives. The active ingredient is benzalkonium chloride, which is a safe compound used in many cosmetic products to inhibit microorganisms. According to David Dyer et al. in “Alcohol-Free Instant Hand Sanitizers Reduces Elementary School Illness Absenteeism,” the use of hand washing and adjunct alcohol-free hand sanitizers by elementary school children resulted in the same benefits as those seen with alcohol-based solutions. Similarly, there was a reduction in the number of child illness and an associated decrease in absenteeism from school. This study determined that the use of non-alcohol based hand sanitizers by children is just as effective in reducing communicable illness as alcohol-based products.

Considerations

Hand sanitizers have been proved effective in the reduction of childhood illness and are an effective, easy method to cleanse the hands when access to soap and water is limited. However, hand washing with soap and water still is considered superior in the prevention of disease. According to a report by the Food and Drug Administration, hand sanitizers should not replace hand washing, but should rather be used as an adjunct. Additionally, while proven safe for use by children, hand sanitizer use should be monitored and kept out of reach of infants and toddlers.