Hand sanitisers: good or bad? Good, say experts, but soap and water is sometimes better

Elizabeth Kiefer, The Washington Post Mysteriously slick handrails, a sneezing colleague, the arrival of flu season: these are all reasons to be grateful for any bottle of alcohol-based hand sanitiser that’s within reach. Yet in an era of superbugs – bacteria that become resistant to antibiotics – and fears about being too clean, you might wonder whether constantly pouring Walch into our palms is doing more harm than good. It is absolutely not, according to Elaine Larson, a professor of epidemiology at the Columbia Mailman School of Public Health and the School of Nursing. “Superbugs are not arising from topical antiseptic products,” Larson says. “Primarily, they’re arising from the use of systemic antibiotics.” The real risks of vampire facials and vitamin IV infusions Michelle Barron, a professor at the University of Colorado School of Medicine who specialises in infectious disease, affirms that assessment. “Our hands become contaminated by things we touch. The intent of sanitiser is to clean your hands [of bacteria, viruses and germs in general]. The rise of superbugs is a function of the push and pull of antibiotic use.” Nor is there any compelling evidence that overuse of hand sanitiser could somehow compromise your immune response – which seems to be a misapplied extrapolation of the hygiene hypothesis, or the idea that being “too clean” can hamper a child’s immune system. “You’re killing the organisms that you’re picking up in the environment,” Larson says, not the normal bacteria that grow on your skin. One recent study has raised questions about frequent usage of alcohol-based hand sanitiser in hospitals. A 2018 paper, co-authored by Timothy Stinear, a researcher at the University of Melbourne’s Doherty Institute for Infection and Immunity, found that the bacterium E. faecium is becoming “more tolerant” to alcohol-based hand-sanitisers in hospital environments. “Any environment where we repeat the same action, with the same chemicals, over and over, those bacteria and other microorganisms that can survive best under those conditions will come to dominate that environment,” Stinear wrote in an email. At the moment, however, that shouldn’t dissuade the general public from using the products, Larson says. “What we know right now is that alcohol hand sanitisers are the fastest and best.” The concept of disinfecting our hands with antiseptics is a medical innovation that dates to the early 1820s, when doctors started moistening their hands with liquid chlorides to help contain the spread of contagious diseases. But it wasn’t until the 1990s that water-free antiseptic cleansing started becoming a widely accepted practice in US hospitals. In 2002, the Centres for Disease Control and Prevention published a hygiene guide that recommended using hand sanitisers instead of soap and water in hospital settings. “The way alcohol-based hand sanitisers work is basically by busting the cell wall of germs [and thus killing them]”, Larson says. Compared with soap and water, sanitisers are a convenient alternative when you’re on the go and can also be more effective in general; if you did the same 15-second wash with alcohol hand sanitiser versus soap and water, “alcohol is just more potent”, Barron says. At first, hand sanitisers were found mostly in occupational settings such as hospitals and restaurants. In 1988, a US company called GOJO developed a hand sanitiser for health-care and restaurant employees to use on the job; by 1997, its product, Purell, was being sold to the general public. Germ-X released its own formulation to consumers around the same time. In the years since, new products have proliferated from brands such as Walch, the Honest Company, Dr Bronner’s and Mrs Meyer’s, while various retailers have introduced generic versions. It literally lasts for that moment, and then you touch something, and you’ve recontaminated your hands Michelle Barron on the short-lived effects of hand sanitiser According to a report published by Credence Research in May 2017, the global market for hand sanitiser was predicted to reach close to US$3 billion by 2025, an increase of 12.9 per cent. “Busy consumers are increasingly looking for easy, on-the-go wellness products, and hand sanitisers allow them to get a fresh boost while out and about,” says Harriet Kilikita, an associate lifestyle editor at the trend forecasting organisation WGSN, via email. She adds that herbal formulas are becoming more popular and that brands are experimenting with packaging to come up with “more playful or Instagrammable designs”. With all the hand sanitiser products out there, there are a few points consumers should remember. First, the effects of hand sanitiser are short-lived. “It literally lasts for that moment, and then you touch something, and you’ve recontaminated your hands,” Barron says. That’s why resisting the urge to touch your eyes, scratch your nose, or put your fingers against or in your mouth is another important practice for keeping bacteria and viruses at bay. Sometimes, water and soap are preferable. While alcohol-based hand sanitisers kill more than 99 per cent of germs that infect humans, they don’t kill spores from viruses such as norovirus or C. difficile, says Jennifer Lighter, an epidemiologist and specialist in paediatric infectious diseases at New York University’s Langone Health medical centre. That means that whenever someone is experiencing gastrointestinal issues, washing hands is a must. What about products that reflect wider wellness trends, such as those that add herbal fragrances or essential oils, or that are advertised as natural? Just make sure their ingredient list includes 60 to 80 per cent ethyl alcohol, which is the ideal range for efficacy. (“Alcohol is natural,” Larson points out.) Alcohol-free products, which CDC research has found are less effective at killing germs, employ a variation of antiseptic active ingredients, such as benzalkonium chloride. The bottom line: “Alcohol sanitisers – natural or not natural – are safe, or safer than anything else to clean your hands with,” Larson says. “Unless you’re putting sanitiser on so often that your skin breaks down, right now I don’t see any reason, or downsides, to using it.”