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Ever since COVID-19 entered the United States like an off-rails runaway train, protective gear—namely hand sanitizer—has essentially become an extra appendage for many Americans. It's such a hot ticket item, in fact, as of late March 2020 drug stores were placing limits on the amount of bottles you can purchase at once. And because supplies are sparing, the FDA encouraged pharmacists and physicians to make batches to keep up with demand. Photos of empty shelves once stocked with bottles of sanitizer were likely driving consumers to panic-buy, even causing them to turn to sites like eBay for price-gouged bottles upwards of $100 (eBay has since banned the selling of hand sanitizer and face masks). An item we once thoughtlessly tossed into our bags or our work desks is now a limited, precious good. But is the sanitizer craze actually worth worrying about or investing in, and if so, are consumers being smart about how they use it? We spoke with several physicians for their thoughts, and their insights might surprise you.
First things first, is hand sanitizer better than washing with soap and water?
If there's one thing you take away from this article, let it be that hand-washing is in fact more effective at removing germs and grime than hand sanitizer. "Hand sanitizer kills the germs but does not remove them from your hands," says dermatopathologist Gretchen Frieling, MD. "The action of physically washing your hands properly is what removes the germs physically and down the drain." Frieling notes that in instances where you don't have access to water and soap, sanitizer serves as a good alternative, but it won't beat an old fashioned hand-wash.
Another reason hand-washing is more effective is because mucus (say from sneezing, coughing, or blowing your nose) encases viruses and forms a protective barrier against ethanol and therefore cannot be deactivated by hand sanitizer until the mucus is completely dry, according to research from the Kyoto Profectural University of Medicine. The study found that washing hands, even just with water, was proven to deactivate the influenza A virus within 30 seconds while mucus was still wet. But the act of using soap is still important: Soap contains fat-like substances called amphiphiles, similar to the lipid membrane that surrounds a virus, so when you wash your hands, the fat from the soap binds with the virus' membrane causing it to disconnect from the virus, making it essentially fall apart. So if you want to effectively clean your hands, the CDC says you should wash them thoroughly for 20 seconds in warm (or cold) water with soap, being sure to get in-between your fingers, on the backs of your hands, and underneath fingernails. The type of soap is not essential, either: Antibacterial soap isn't necessary for preventing COVID-19 as it's a virus (not bacteria), according to NYC-based dermatologist Hadley King, MD.
Is there any danger in using hand sanitizer?
You've probably noticed your hands feeling drier and rougher after routinely spritzing and pumping sanitizer of late. This is because of the high alcohol content (an effective sanitizer should have at least 60% ethyl alcohol), which can actually be damaging to your skin. "There have been studies in the past about how hand sanitizers may disrupt your healthy microbiome and actually leave you more vulnerable to some kind of infections," says King. And by breaking down the skin, leaving it cracked and chapped, germs might enter these crevices, making sanitizing more of an issue than a reactive measure.
The physicians we interviewed stress the importance of applying moisturizer to your hands to combat the dryness and irritation from frequent hand-washing and sanitizing.
Aside from the high alcohol content, added ingredients may cause harm to the skin. King notes essential oils, which she says may cause irritation, and recommends doing a patch test first. Dermatologist Caren Campbell, MD recommends avoiding fragrances as well since "the fragrances in [hand sanitizers] can cause rashes/irritation to the skin."
Lastly, user error could also be to blame for negative reactions to sanitizer. "Ensure that the hands are dry after using the sanitizer, and more importantly, avoid rubbing the eyes as eye irritation is the most common issue with hand sanitizers," says Campbell.
Is it possible to absorb hand sanitizer into your bloodstream?
As we question certain skincare ingredients and their longterm effects on our systems, why shouldn't we question the effects of a product as potent as hand sanitizer? "Hand sanitizers contain about 65 percent ethyl alcohol, and some of it is absorbed into the skin," says Niket Sonpal, MD, a New York-based internist and gastroenterologist. "Research has found alcohol in the bloodstream of people who used hand sanitizers. Alcohol from the sanitizers can also be absorbed through inhaling its vapors, which there is no logical reason to do." However, you'd have to apply a lot of hand sanitizer topically in order to see an internal effect—researchers at the University of Florida had 11 participants apply sanitizer every five minutes, 10-hours a day for three days, and found that each had alcohol metabolites consistent with drinking alcohol. But again, that is an excessive amount of sanitizer.
Is it bad to apply hand sanitizer before touching your food?
In today's climate, how often do you pump sanitizer before consuming food? According to our experts, you're likely not going about it correctly and could be unknowingly causing harm. In fact, according to Sonpal, you should be washing your hands after sanitizing. "You must wash your hands immediately after using hand sanitizer, and before handling food—it will not diminish the virus killing effects," he says. "It's vital because washing your hands removes chemicals and other fragrances that exist in commercially produced hand sanitizers that could make you and your family sick. The exception is situations where food products are not handled by hand, such as when products are sealed."
If you aren't near a water source, Sonpal warns that you should make sure the sanitizer is fully dry before touching food. It's unlikely you'll ingest enough sanitizer to be dangerous, though: "You shouldn't pour so much hand sanitizer on your hands that you would be ingesting a toxic amount of it," says Sonpal. A 2016 study showed that 2-3 mL of sanitizer are needed to effectively cover most hand sizes.
Can you become immune to hand sanitizer?
"This is a good question, but a misconception," says Frieling. "Although the overuse of antibiotics creates resistance, if a hand sanitizer is alcohol-based, it does not create 'superbugs' or exacerbate the spread of antibiotic-resistant bacteria," she explains. In other words, this isn't the same concept as taking antibiotics orally and worrying about developing an immunity. "The reason why alcohol is so vital in hand sanitizer is that it kills germs in seconds by destroying the cell membrane and bacterial proteins. Because of how rapid it is, there is no system where germs can become resistant to hand sanitizer, and there is no way we can adapt to it."
Is it wise to make your own hand sanitizer?
DIY hand sanitizer recipes have been circulating the internet in response to the in-store shortage, but doctors aren't too keen on people making their own concoctions at home. "Though you can find various formulas online to make your own alcohol, it is important to let consumers know that it is a more secure option to buy your sanitizer at a pharmacy or retailer," says Frieling. "Making your own hand sanitizer can be complex, and recipes vary. The CDC recommends that a hand sanitizer be made up of at least 60% alcohol, but 70% is generally considered best. This is why 70 percent is more commonplace in popular brands. You have to then do the calculations clearly determining how you are mixing the ingredients, which include the alcohol, the gel, and the hydrogen peroxide, to minimize contamination while using sterile utensils and containers. You must also keep in mind that the alcohol you use for your formula needs to be 91% isopropyl rubbing alcohol. This is so that the mixture is properly concentrated. So overall, it can be confusing for many consumers, and if they create mixtures that are not effective, it can lead to them operating blind to the fact that they are, in fact, vulnerable."
What should you look for on the label of a hand sanitizer?
If you're in a situation where you're unable to wash your hands and want to use sanitizer as a defense, Frieling says the most important thing to keep in mind is using a product sold by a verified retailer. "You want to look for formulas with at least 60 percent alcohol, and up to 95 percent. In times of outbreak, you want to make sure you have something to neutralize germs." The key here is alcohol, such as ethyl alcohol or ethanol. King says popular non-alcohol alternatives like benzalkonium chloride are "not as good because we don’t know as much about it," whereas the science supports that alcohol kills coronaviruses.
Also, keep in mind that sanitizer does in fact expire, so your old trusty bottle from years ago won't cut it. "Usually, sanitizers expire approximately three years from the date of manufacturing," explains Sonpal. "Many brands have products with alcohol levels of 60% or more. The issue is that the alcohol in the mixture evaporates over time, and if it reaches below 60 percent, the solution becomes less effective."
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Centers for Disease Control and Prevention. When and how to wash your hands. Updated November 24, 2020.
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