Although the Centers for Disease Control and Prevention (CDC) recommends soap and water hand washing as the most effective way of removing dirt, bacteria and viruses from your hands, this method of washing is not always convenient or possible. Using a hand sanitizer as an alternative to soap and water requires deciding between products that list alcohol as the active ingredient and those that do not.
Identification
Because food service workers commonly use hand sanitizers, the U.S. Food and Drug Administration Food Code Rules and Regulations classify the active ingredient in any hand sanitizer as a food additive requiring approval before inclusion. Before granting approval, the FDA looks at factors such as composition and properties, amount, health effects and safety. Benzalkonium chloride, a chemical disinfectant; triclosan, an antibiotic; and the organic antibacterial agent thymol, all common in non-alcohol hand sanitizers, have FDA approval.
Criteria
FDA approval is not an endorsement of an ingredient's effectiveness. It only verifies that the ingredient is safe to use. Effectiveness depends on factors such as the context in which you use the product and the type of dirt or microorganisms you are trying to remove. Health care workers, food service workers and the public are classifications used to determine effectiveness. Chemicals react differently according to the composition of the dirt or microorganism commonly encountered within each classification. For example, food service workers commonly come into contact with fecal bacteria and intestinal viruses such as Norovirus.
Expert Insight
In order of preference, the CDC recommends soap-and-water hand washing, followed by alcohol-based hand sanitizers. Despite marketing claims from alcohol-free hand sanitizer manufacturers referring to their products as 99.9 percent effective against common bacteria, germs and fungi, the CDC remains unconvinced. In a May 2010 teleconference, Katherine Ellingson, with the Division of Healthcare Quality Promotion at the CDC, explained that the CDC does not recommend non-alcohol-based hand sanitizers in health care settings because they are “weak to non-effective” against certain types of bacteria. In response to the effectiveness of non-alcohol hand sanitizers against influenza germs, the CDC says only that these types of hand sanitizers “may” be useful. In its statement, the CDC lists a non-alcohol hand sanitizer as appropriate only as a last resort due to a lack of evidence that confirms effectiveness.
Properties
Three properties of non-alcohol hand sanitizers may work to encourage their use. A side effect of more frequent use can be an increase in effectiveness. Alcohol-free hand sanitizers are non-drying, non-irritating and remain on the skin longer before evaporating than alcohol-based products. Alcohol-based sanitizers can have a drying effect on your skin. Overly dry skin can result in painful cracking that also provides an environment for germs to enter the body. Consistent use of alcohol-based sanitizers can irritate the skin, causing you to use them less often. Finally, alcohol ingredients evaporate quickly, limiting effectiveness to a shorter time than non-alcohol sanitizers.
Considerations
Despite the lack of endorsement, it is important to remember that the CDC is not a regulatory agency and has no authority to approve or disapprove any product. Benzalkonium chloride, the active ingredient most often used in non-alcohol hand sanitizers, is also a common ingredient in antiseptic solutions, cleansing towelettes and baby “wet wipes,” lending some degree of credibility to claims of effectiveness.
Member Comments
JRook158 December 8
Some useful information but the information presented is incomplete or inaccurate in several instances. In order of occurrence the following should be undated or corrected. Thymol is not necessarily an organic antibacterial agent as it would depend on how the Thyme was grown. Second, thymol is neither effective or safe. Thymol, (C10H14O), also known as 2-isopropyl-5-methylphenol, 3-Hydroxy-1-methyl-4-isopropyl benzene and 3-Hydroxy-p-cymene is identified as a Bad Actor by the Pesticide Action Network (PAN) and several wellness sites indicate there is no safe exposure level for Thymol in children. Additionally, Thymol is neither approved or regarded as an effective antibacterial agent by the FDA. The FDA Tentative Final Monograph regarding hand sanitizers identifies only alcohol and Benzalkonium Chloride as being effective antiseptics. Benzalkonium Chloride has proven itself both effective and safe over 30 years as the active ingredient in Bactine. The spray on antiseptic has been used on open wounds for generations of children.
JRook158 December 8
The comments by the CDC regarding Benzalkonium Chloride is not routed in science and not consistent with the countless number of studies showing effectiveness equal to or greater than alcohol on the same group of bacteria the Ms. Ellingson would be concerned with. Of particular note Benzalkonium Chloride is one of the first active ingredients to show effectiveness against the H1N1 and NDM-1. Your reference to Benzalkonium Chloride as being a chemical disinfectant is biased in that any antimicrobial active ingredient, including alcohol and thymol would be regarded as pesticides or disinfectants (other than Thymol which is completely ineffective at the levels used in hand sanitizers such as CleanWell. There are other stronger quaternary compounds that used in strong disinfectants, however the benzalkonium chloride used in hand sanitizers in an upgraded, safe version of the active ingredient used in Bactine. The safety comments regarding quaternary compounds misrepresented by one of the companies offering an ineffective, supposedly proprietary version of Thymol are based on high level, occupational exposures to the individuals working in the production of disinfectants. Based on its use in a wide variety of personal care products, including Bactine antiseptic, Benzalkonium Chloride is regarded as one of the safest antiseptics available. When the evaporation, drying effect, stinging, ingestion danger and fire hazard aspects of alcohol are taken into account, benzalkonium chloride is probably the safest and most effective.