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Hand Sanitizers Will Be the Death of Us All

Posted on Apr 28, 2009 by billsimmon in apocalypse now, science, skepticism | 13 Comments

In the last few days I’ve heard a number of folks (on the radio, in person, on TV and online — including on this blog) say that they are going to begin using (or up their usage of) antiseptic hand sanitizers in response to the threat of the potential swine flu pandemic. So this is how the world ends… with the scent of fragrant alcohol.

Now don’t get me wrong, alcohol-based hand sanitizers are fairly innocuous as far as I know (unlike “antibacterial” sanitizers and soaps, which are actively very bad things to use), but they should in no way be considered a replacement for hand-washing. Rinsing with Purell or other ethanol-based hand cleansers is perhaps better than doing nothing at all (or perhaps worse, see below), but don’t go picking your nose or rubbing your eyes with assumed impunity after using a public internet terminal just because you remembered to rinse with a little Purell.

Apparently (from a few Googled articles I read) the FDA says that rinsing with hand sanitizers is an okay addition to hand washing as a means of preventing the spread of infectious diseases, but not a replacement for it. However, I also found this gem on the FDA site…

Plain hand soaps, antimicrobial hand soaps, E2 rated hand soaps (a USDA Classification requiring equivalency to 50 parts per million chlorine), and instant hand sanitizers were evaluated for their effectiveness in reducing bacteria on hands. Results showed that all three types of hand soaps were effective, when using a 20-second wash procedure, in reducing bacteria on hands, with the E2 soaps significantly more effective than the other two types of soaps. The instant hand sanitizers resulted in a significant increase in bacterial numbers on hands.

So the best advice seems to be the old advice: wash you hands. A lot. And don’t just wet them and use a little soap — scrub your hands using soap and hot water for a full 20 seconds (sing Happy Birthday to You or Twinkle Twinkle Little Star all the way through as you scrub). Do this before and after every meal and regularly throughout the day, and then try really hard not to touch your face (this is surprisingly difficult, it turns out).

Some links…

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  1. On April 28, 2009, billsimmon said:

    It occurs to me reading this post that I might have mentioned that the efficacy of any hand washing method in preventing the flu ought not be measured by that method’s effectiveness in killing bacteria. The flu is a virus — a very different critter from bacteria and one that is utterly unaffected by antibacterial agents.

  2. They will be the death of us. I’ve seen, read and heard many doctors and scientists talk about how we are handicapping our immune systems by wiping away every little germ we encounter with these products and the overuse of antibiotics. We never let our systems fight these germs and get up to speed on their defenses.

    Just one article on the subject:

    http://www.associatedcontent.com/article/663377/are_we_ruining_our_immune_systems.html

  3. On April 28, 2009, JIMO said:

    Some viruses, such as rhinoviruses, LIKE alcohol and flourish in it.

    Wash your hands with soap.

    Or go to your room.

    Now.

  4. After seeing so many guys exit restrooms with but a brief splashing of water on hands, if pausing by the sink at all, (and I mean, at the effing HOSPITAL! [Visitors, not doctors]) I’m not sure which of the following conclusions to draw:

    a. Our immune systems are much stronger than we give them credit for being;

    b. Remedial handwashing education is needed at every age level;

    c. We are so very, very doomed.

  5. On April 29, 2009, evening said:

    Sorry, I can’t possibly wash my hands that much. When I do I get itchy bumps under the skin of my palms. I wash them when I come in from being out and about, but not before/after each meal, etc. That’s just too much (no, I don’t wash after every pee break either – I drink a lot of water, and is how I learned I can’t wash my hands too much!).

    I think the hand sanitizer will be good for when you’re running errands and such, touching lots of things. Get back into car and give em a wipe – that or every now and then cleaning the steering wheel with it.

  6. On April 29, 2009, billsimmon said:

    Eve, what causes the itchy bumps? Is that diagnosed? Is it treatable?

    Regarding your conclusion, maybe re-read this bit:

    “The instant hand sanitizers resulted in a significant increase in bacterial numbers on hands.”

    In other words, hand sanitizers may be doing more harm than good.

  7. On April 29, 2009, Molly said:

    This post is quite contrary to everything I’ve been taught about hand hygiene as a hospital employee, Red Cross infection control and first aid instructor, and person living with a severely suppressed immune system.

    1. The Making Light and Treehugger links you posted both advocate hand sanitizers as a supplement to hand washing.

    2. That About.com link and the associated Science Daily article were both written in 2000 regarding the same review written by a Purdue food industry researcher. The FDA site you linked to and quoted from is about food handling safety. Safe food handling procedures are different from hospital and personal protection procedures! They are generally concerned about a different set of “bugs” (pathogenic bacteria, natural toxins, and parasitic protazoa/worms – not viruses) and the procedures are designed around the need to manually remove particles of food from hands, wrists, and forearms. Etc.. Here is the FDA rundown on the differences between food service hand hygiene vs. other settings: http://www.cfsan.fda.gov/~comm/handhyg.html You’ll find plenty of other Science Daily articles proclaiming the efficacy of hand sanitizers in reducing communicable disease transmission in a variety of settings from hospitals to kindergartens.

    3. For most of us, sinks and soap are not as available as we might like them to be to provide adequate washing opportunities. Aside from this, many sinks are in restrooms which require you touch a door handle to exit, immediately redepositing pathogens to your freshly cleaned hands.

    4. The article entitled “Are we ruining our Immune Systems…” is an opinion piece written by a 23 year old amateur journalist/poet whose qualifications are a high school diploma and a BA in history. Not that there’s anything wrong with that, but it hardly makes him an authority on microbiology, immunology, or epidemiology.

    5. Nothing will ever replace a healthy diet, regular exercise, and diligent hand washing as the basic recipe to stay healthy. But hand sanitizers containing at least a 60% alcohol concentration are a wonderful supplement to these basics. It is true that the rhinoviruses (common cold) are invulnerable to alcohol, but many other viruses (and bacteria and other pathogens) are not. For instance, alcohol based hand sanitizers are effective against influenza viruses.

  8. On April 29, 2009, Molly said:

    P.S. Regarding, “The instant hand sanitizers resulted in a significant increase in bacterial numbers on hands.”. There is not nearly enough information contained in this quip to make it valid point of discussion. We don’t know ANYTHING about this study except that it was published fifteen years ago in a dairy/food industry journal. What type of hand sanitizer? Alcohol based? What type of bacteria? What were the methods and conditions of the study? What quantity and exposure period was used? Were these soiled hands or “clean” hands? Was it ever independently verified? Etc., etc..

  9. On April 29, 2009, billsimmon said:

    Thanks for the schooling, Molls. Still, I was reacting to what I perceived as people saying things like “Good thing I don’t have to worry because I use Purell every 5 minutes!” You still have to, you know, wash your hands.

  10. On April 29, 2009, Eric said:

    I want to second what Molly said, and add that any sanitizer you get must have at least 60% alcohol or ethanol. There are a lot of occasions where you just aren’t going to be able to get to a sink (public meetings), and having the Purel on standby is good alternative.

    I remember Bush getting some ridicule for hitting the sanitizer after the handshake with some dignitary, but that’s actually a really good practice, even if it looks anal (!).

  11. On April 29, 2009, evening said:

    Bill – I don’t remember what it is called and it has been hard to find on teh tubes. IIRC, avoidance is the key – wear gloves when washing dishes and the like.

    Plus, I can drink upwards of 13 glasses of water a day, so that’s a lot of peeing. Esp at home, do I *really* need to wash my hands every time, when I’m careful about wiping (which I am b/c of the hand washing thing)? It gets a little ridiculous after a while when there are times you’re going once an hour.

    And thanks for the info, Molly!

  12. On October 29, 2009, B-rye said:

    One thing has always bothered me about hand sanitizers. Here in the lab when we use EtOH to disinfect our lab benches we must have – at least – a 5 minute contact time to achieve an effective kill. That will do for most viruses – bacteria are typically 10 minutes. EtOH based hand sanitizers are on your hands for what like 10 seconds? Also, if your hands are visibly dirty, the organic material will dilute or inactivate at least some of the ethanol. Those of you in labs try this. Get some bacterial culture plates (BAP or nutrient agar), streak one with your non washed finger. Rub on some hand “sanitizer” and then streak a second culture plate. Incubate them both for 48 hours. Guess what – they both grow lots of bacteria. People should keep in mind that we are virtually and constantly swimming in bacteria. They are all around us – were here billions of years before us and will be here long after we’re gone – get used to it!! The only thing that is “sterile” is the stuff that I take out of the autocalve.

    Later,

    B-rye

  13. On November 10, 2009, WallMountedHDD said:

    The amount of misinformation here is staggering. Seriously, people, lock yourselves in your houses. The fountain of smart hasn’t been located yet.

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