Ask the Chemist Mom: What are the Best Hand Sanitizers?

Health & Wellness on 02.21.11
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Photo: House of Sims/Creative Commons 

“What are the best hand sanitizers/hand soaps to use?...Most seem pretty "chemically" at first glance,” Parentables reader Julie asks. That is a good question, and it goes to the heart of the dilemma we face in better living through chemistry. We want a hand sanitizer that kills germs. But it must remain harmless to humans, especially our children.

There are basically four categories of hand sanitizer: Old-fashioned soap and water, alcohol-based sanitizers, preparations that contain anti-bacterial drugs like triclosan or benzalkonium chloride, and new formulations aimed at concerned parents like Julie. To make this an easier discussion, let’s rule out a couple of these quickly.

What Can Be Ruled Out

If you want to do your kids a favor, don’t contaminate their environment with anti-bacterial drugs that will promote the emergence of drug resistance. In fact, read your labels and don’t buy any soaps or products that tout their anti-bacterial additives. The EPA ordered additional studies on potential carcinogenicity of Triclosan and will review the approval of this chemical in 2013, ten years earlier than originally planned due to current concerns about the estrogen-mimicking  and thyroid effects. Conversely, Benzalkonium chloride has been deemed so safe for use by humans that the safety factor intended to protect infants and children from residual pesticide exposure is not applied to this chemical under the Food Quality Protection Act. But concerns remain about the effect of this drug on resistance in germs. Don't get me wrong -- there are places, such as hospitals, where anti-bacterials are a boon to mankind. But the risk outweighs the benefit when these drugs become a marketing device.

The alternative products, like CleanWell are costly and the natural ingredients are, in fact, chemicals that plants have evolved to combat a variety of ills. Since these products are out of the budget range of most day-care centers, schools, or businesses, we will take a closer look at CleanWell and Co. at a later time.

That leaves hand-washing and alcohol-based sanitizers. Since the question is not “how can I get my child to wash their hands thoroughly?,” we will leave hand-washing out of this discussion with two small caveats: Hand sanitizers are not effective on dirty hands, as the bacteria and germs can survive in their protective cove of soil, fecal matter, or proteins and fats on the hands – so that convenient squeeze of the pump is still no substitute for teaching children good hygiene by hand washing. Also, respected health authorities and medical studies indicate that hand washing alone (the real-life type of hand-washing as opposed to the theoretical two minutes of throrough scrubbing) is not as effective at preventing illnesses.

The Chemist Recommends

This may come as a bit of a surprise, but this chemist recommends an alcohol-based hand sanitizer. If you read the label of hand sanitizers commonly available, you will find that the "chemically" stuff in them is not so bad. And if you want to really control all the variables, you can use a do-it-yourself alcohol-based hand sanitizer.

If you are surprised by this recommendation, it is probably because the web is full of warnings to keep alcohol-based hand sanitizers out of the reach of children.  Yes, alcohol poisoning is a risk. But the American Association of Poison Control Centers (pdf) emphasizes that the benefits of hand sanitizer outweigh the risks. From their 2009 alert:

In 2005, poison centers reported 9,527 exposures to ethanol-containing hand sanitizers, including 7,772 calls related to children under the age of six. In 2006, poison centers reported 11,914 exposures to ethanol-containing hand sanitizers, including 9,607 related to children under the age of six.

During both years, none of the calls resulted in death, and only two cases, both related to adults, resulted in a major medical outcome.

Among children under the age of six, the vast majority of cases -– 9,524 – resulted in little or no effect.

 In professional chemical risk management, “reduce” is the first by-word for controlling risk. Unfortunately, reducing alcohol content in hand sanitizer is a no-go.  The CDC has issued warnings that hand sanitizer with less than 60% alcohol cannot be deemed effective. Furthermore, if the alcohol evaporates and leaves your hands dry in less than 15 seconds, you have not used enough of the sanitizer (about 1.5mL should do the trick)

So your best bet is risk control: medical professionals indicate that children cannot get alcohol poisoning from licking their hands after hand sanitizer treatment, but children under 5 should use sanitizer only with supervision, especially to ensure that the children rub their hands for 15 seconds, at which point the ethanol has largely evaporated. Do not buy sanitizers that have flavors your child associates with food or candy. And if your child does drink hand sanitizer, contact a poison control center immediately.

Reduce will work on another front, though, and probably to your child’s benefit. There are concerns that the constant use of hand sanitizers may reduce the normal human immune responsiveness, partly by removing natural oils and leaving hands less protected. So bring out the hand sanitizer when someone in the child’s circle starts showing symptoms, or during the height of the flu season when the threat is high. Try to get by with soap and water when you are at home among healthy family members.


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