Soap vs Sanitizers

hand-sanitizerYou squirt it on your hands as you enter the grocery store, and then again on your way out. You have bottles in your car, on your desk and in your home too – and you use them often.

And no, you’re not a germophobe, it’s just that your hand-sanitizer habit is helping to protect you from colds and flu and other nasty’s, that are wet, sticky and not yours!

And even if it doesn’t, it’s harmless. Right?

Not so fast! Word on the street has it that despite how clean your hands feel after using a hand sanitizer, they’re actually still dirty.  Worse still, they’re potentially toxic and might actually lower your resistance to disease.

So are these rumors true?!  Let’s take a look at the evidence.

hand-sanitizer-triclosanWhen it comes to safety and effectiveness, the main concern with hand sanitizers is triclosan, – the main antibacterial ingredient used in non-alcoholic hand sanitizers.

There’s no good evidence that triclosan-containing products have a benefit,” says Allison Aiello PhD, associate professor of epidemiology at the University of Michigan. In fact, hospitals in Europe and the United States, won’t even use them because it’s thought that they don’t reduce infections or illness.

Dr. Anna Bowen, an epidemiologist at The Centers for Disease Control and Prevention, says, “Triclosan-containing products don’t provide any disease protection beyond what you get from washing with soap and water.”

Research has shown that triclosan can disrupt the endocrine system, amplifying testosterone. In animal studies, it reduced muscle strength. It may also harm the immune system. Whether these findings add up to human toxicity isn’t established yet, but the FDA is currently reviewing the issue.

A more established concern: “When you expose bacteria to triclosan, it can elicit antibiotic resistance,” says Aiello. “Once the resistance is transferred, pathogenic bacteria can become resistant to many types of antibiotics.”   She also points out that quaternary ammonium, another antibacterial found in nonalcoholic hand sanitizers, has been shown to elicit antibiotic resistance.

The main concern with triclosan, that it’s an anti-bacterial, meaning it doesn’t protect against viruses or fungi.  Which means, colds and flu are not destroyed because they are caused by viruses, not bacteria.

Alcohol-based sanitizers, on the other hand, are fairly effective and safe. Those that contain  60% alcohol are good at killing bacterial pathogens and can also kill some viruses though not all of them.  Norovirus, for example, the bug responsible for the recent cruise-ship outbreaks is not affected.

If you can’t get to a sink quickly, an alcohol-based sanitizer is a good alternative to washing with soap and water,” says Aiello.

One caveat: They don’t work on visibly dirty hands.  The alcohol can’t get past the dirt.

handwashing_355pxSo how does soap and water match up?   First, they are both safe and effective. That’s right. Good old-fashioned hand washing before you prepare food or after you go to the toilet has been shown to drastically reduce the risk of diarrhea.

Hand-washing campaigns reduce absenteeism in schools,” says Bowen, “and that means parents miss fewer days of work, too.”

But, and it’s a big but – you have to wash your hands correctly.

According to the CDC you need to wash for about 24 seconds to remove bacteria and viruses from your hands. You need to cover all parts of your hands, front and back and under your nails and then dry your hands well.

have u washedHow long is 24 seconds? Apparently it’s about as long as it takes to sing two verses of Happy Birthday.  However, as I always tell my infection control students, if you’re in public, sing it with your inner voice …or you could have more than germs to worry about!

Bottom line –  soap and water beats sanitizers hands-down.  Suds up and stay safe this cold and flu season.

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2 thoughts on “Soap vs Sanitizers

  1. Judi, I actually forwarded this one to my family. very interesting.

    Michael A Kaliner, MD Medical Director, Institute for Asthma and Allergy

  2. Thank You Dr Kaliner. Feel free to share with your patients too! Over-use of alcohol based hand-sanitizers in this cold weather is even more problematic. The alcohol will dry the already dry-skin on your hands and make them crack, opening up access to even more germs. If you really must use a hand-sanitizer, moisturize afterwards.

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