Hand sanitisers: To use or not to use, that’s the question

Squirt a few drops of hand sanitizer in your palm, rub your palms together, and then rub over back of hands and fingertips till your hands are dry. Kills 99.99% of germs, say the manufacturers. Hand sanitisers are gels that contain alcohol that are supposed to kill the bacteria and some virus.

So, how useful are hand sanitisers? Should we use them to kill microbes in our hands? Yes and no. Companies that market hand sanitisers, of course, say ‘yes’, but many health experts and consumer advocates say ‘no’.

When to say ‘no’ to hand sanitisers

There are many reasons why they say ‘no’. First, sanitisers are effective only if they have 60 percent alcohol in them. And less pricey sanitisers have alcohol content way below the required levels. Secondly, sanitisers contain ingredients that could be harmful to children or could cause allergies in some people. More importantly, the active ingredient triclosan in hand sanitisers helps create superbugs that are resistant to antibiotics. Check out our article on reasons you should avoid using hand sanitisers.

When to say ‘yes’ to hand sanitisers

Apart from that, hand sanitisers can’t actually remove the dirt. So washing hands with soap and water makes sense. On the other hand if you are a health worker, it is going to be too inconvenient and time-consuming to wash your hands and dry them each and every time you touch a patient. Sanitisers have an advantage over washing because they evaporate when you rub it between your hands, which makes them easy to use after contact with a patient and before touching the next patient or any other object. Most experts believe that hand sanitisers are useful only in hospitals.

What happens if you are not in a hospital situation? Maybe you are in a mall and you decide to grab a bite, say, pizza? Hand sanitizer come in handy, doesn’t it? Rub your hands for at least 30 seconds with a hand sanitizer and you’re ready to eat. In the same way, you could use it –

• Before you insert or remove contact lenses,
• Before you touch a sick or injured person,
• Every time you cough and sneeze into your hands, or blow your nose,
• Handle garbage or something that could be contaminated,
• Change diapers.

What’s better, hand sanitizer or soap and water?

Comparing the efficacy of plain soap, antimicrobial soap, and hand sanitisers, the World Health Organization in their guidelines on hand (alcohol) sanitisers revealed that ‘antiseptic detergents are usually more efficacious than plain soap and that alcohol-based rubs are more efficacious than antiseptic detergents’. [1] These guidelines were formulated based on hundreds of researches done on various aspects of alcohol-containing hand sanitisers.

For example, in one study, the researchers found that alcohol hand sanitisers were significantly more effective than hand washing with soap and water for removal of detectable human rhinovirus (HRV), which causes common cold, from the hands. Furthermore, the sanitisers could significantly reduce virus recovery from the hands and rhinovirus infection for up to 4 hours after application. However, the sanitisers couldn’t prevent the viral infection. [2]

On the flip side, research also shows that alcohol-based hand sanitisers are not always better than soap and water. For example, a study published in the journal Infection Control and Hospital Epidemiology reported that handwashing with soap and water better removed the bacterium Clostridium difficile and should be performed preferentially over the use of alcohol-based hand-rubs when contact with C. difficile is suspected or likely. Clostridium difficile is the pathogen that causes diarrhoea and more serious intestinal disorders such as Clostridium difficile colitis. [4]

Again, another study found that using alcohol-based hand sanitisers could greatly reduce the exposure of family members to gastroenteritis causing pathogens, viz., bacteria such as E.coli and virus such as norovirus. [3]

It is a definite ‘yes’ if you have diabetes and you are self-monitoring blood glucose levels. People with diabetes need to clean their skin prior to self-monitoring of blood glucose to remove any dirt or food residue that might affect the reading. Although washing hands with warm water and soap has the advantage of enhancing blood flow and producing larger blood volumes, it does not guarantee uncompromised glucose meter test results. If skin is not dry, the blood sample might become diluted with water. In addition, skin-surface water can adversely affect the test strip chemical reaction. Therefore, users should ensure that their skin is both clean and dry prior to testing.Researchers from California found that alcohol-based hand sanitisers are compatible with the blood glucose monitoring system, and hand sanitizer does not cross-react or otherwise interfere with test strip chemistry or glucose meter results[5].

When should you use and not to use alcohol-based hand sanitisers instead of soap and water?

There is no hard and fast rule as to when to use or when not to use hand sanitisers. Data from research is conflicting and in many cases confusing. The best way to go about it is to use your discretion.

You might like to use hand sanitisers –

• If the hand sanitizer contains more than 60% alcohol and contains moisturisers;
• At those times when you don’t have access to soap and water;
• After using the toilet [especially for children, who are not that into soap and water];
• During the cold and flu season when you are susceptible to human rhinovirus;
• If you have diabetes and use self-monitoring for blood glucose levels;
• If someone in your family / home has been infected with E. coli or intestinal virus;
• If you are a health worker or a food worker.

Alcohol-based hand sanitisers don’t serve the purpose –

• When your hand sanitizer contains less than 60% alcohol;
• If the hand sanitizer doesn’t contain moisturisers;
• When your hands are visibly soiled with dirt and cooking oil;
• If you come in contact with a person suffering from colitis or other bacterial gut infections.

Ultimately it is up to your choice and judgment!

You may also like to read:

• 25-Question hygiene challenge every Indian will fail
• How dirty is your phone?
• 8 annoying things women should STOP doing in public toilets!

Photo source: Shutterstock

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Reference:

1. WHO Guidelines On Hand Hygiene In Health Care. 1st ed.; 2009:38. Available at: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.
2. Turner RB, Fuls JL, Rodgers ND. Effectiveness of Hand Sanitisers with and without Organic Acids for Removal of Rhinovirus from Hands  . Antimicrobial Agents and Chemotherapy. 2010;54(3):1363-1364. doi:10.1128/AAC.01498-09.
3. Tamimi AH, Carlino S, Edmonds S, Gerba CP. Impact of an Alcohol-Based Hand Sanitizer Intervention on the Spread of Viruses in Homes. Food and Environmental Virology. 2014;6(2):140-144. doi:10.1007/s12560-014-9141-9.
4. Oughton MT, et al. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infection Control and Hospital Epidemiology. 2009Oct;30(10):939-44. doi: 10.1086/605322.
5. Mahoney JJ, Ellison JM, Glaeser D, Price D. The Effect of an Instant Hand Sanitizer on Blood Glucose Monitoring Results. Journal of Diabetes Science and Technology. 2011;5(6):1444-1448.