I have always been sensitive to both the fumes of alcohol based hand sanitizer and the essential oils in many of the natural based versions. When I transitioned to my current office space, which requires me to use hand sanitizer, I opted for an alcohol free version. However, in doing a podcast with NVSL Magazine Editor-in-Chief about natural immune support for the winter season (I will share the link when this is published), she asked a great question, I paraphrase: “is there really any benefit to these alcohol based hand sanitizers?” I knew from years of working in a medical setting, that they are widely accepted as a replacement to hand washing in most situations based on the research. However, what about these for personal and family usage, do they have any risks? Do they have any benefits? My gut on this was that of course hand washing is better, but I wanted to check the evidence. I was really surprised by the positive findings of alcohol based hand sanitizers that made me re-examine my resistance to them for personal and family use. For work use I definitely plan to switch over from the non-alcohol based to alcohol based hand sanitizer.
Don’t be fooled by branding
I typically pride myself on being resistant to advertising and researching the ingredients in the personal care products for safety. However, in the case of my hand sanitizer I was duped for sure. How could a product that is fully branded as baby safe and organic, possibly be the opposite of this! In 2016 I was stoked when the FDA changed the status of 19 ingredients that used to be labeled “Generally Recognized as Safe” to “Not Generally Recognized as Safe and Effective”, as manufacturers could not prove their effectiveness (1, 2). This effectively put a ban on these ingredients in hand sanitizers, including chemicals triclosan and triclorocarban. However, these chemicals have been replaced with benzalkonium chloride, benzethonium chloride, and chloroxyleneol that are past due for similar review by the FDA (1).
We the Public Really are 100,000 Guinea Pigs
Unfortunately, there is evidence that these chemicals are more toxic than triclosan and triclorocarban at dilute levels in at least two animal models (2). Although we can’t really transpose this animal research to risk in humans, it is a shameful that proper research hasn’t been done on many of these chemicals that are ubiquitous in personal care products and that the FDA leaves the margin of proof of safety and evidence of benefit, largely to the manufactures and outside researchers to prove. Even though we are all exposed to these chemicals in one way or another, the American government doesn’t require pre-market testing or health studies in personal care products (3). In other words, we the public really are 100,000 guinea pigs. There are resources I appreciate, specifically, Environmental Working Group’s Skin Deep database, that makes the safety data on chemicals in these products readily available to the public (3). This is a great resource to help make informed decisions on what personal care products are thought to be most safe for you, your family and the environment.
Recent clinical research was summarized in the Journal of the American Medical Association showed a significant reduction in respiratory track infections in day care settings where the staff, children and parents used alcohol based hand sanitizers when compared side by side to hand washing. In fact, there was found to be 23% fewer respiratory infections and 30% fewer antibiotic prescriptions (4). This is pretty remarkable and has helped me transition my position alcohol based hand sanitizers. Likewise, another study done on alcohol based hand sanitizer demonstrated that home use can significantly reduce the transfer of a viruses (5). By and large alcohol based hand sanitizers have been shown to be effective and safe (6). `
Evidence Informed Decision
Consequently, after considering the questions and evidence of alcohol based hand sanitizers for personal and home use, I think it is probably better to use them, especially since they so significantly reduce the risk of repeated courses of antibiotics, which can have adverse effects. Hand-washing in the home setting is perfectly fine, but if out in about in a public setting, there is pretty significant benefit and no evidence of harm from using these alcohol based hand sanitizers. I definitely recommend the alcohol based hand rubs that have either no added fragrance or that use essential oil added for fragrance instead of the synthetic fragrance that has its own safety concerns.
Are We Too Clean?
On the other hand, there is discussion to be had about our culture being overly sanitized and this cleanliness compromising our immune health. Some regular exposure to germs helps to build the immune system. I think this overly sanitized issue stems from not letting kids be kids and play in the dirt, social isolation/ children not being allowed to play with other children or animals, or avoiding public settings out of "fear of germs", and the overuse of sanitizing cleaning agents in the home. Balance needs to be had, especially in between cold and flu season or when around those who are immune compromised, such as when visiting hospitals. I think we need to have some balance and be mindful of exposures. Probably now after looking into this topic further I will not be so shy about applying a basic alcohol based hand sanitizer to my little one's hands after he is done playing in a public setting, he'll still have gotten plenty of exposure to microbes, just by playing in that setting.
A Little About Dr. Sarah
Dr. Sarah Giardenelli is a naturopathic doctor, acupuncturist, and the owner of Collective Health Center. She is a proponent of environmental health and enjoys the role as doctor as teacher, helping patients understand how to reduce their body burden of common toxicants. If you are interested in learning more, please fill out the contact form at the bottom of the page.
- Food and Drug Administration. Topical Antiseptic Products Hand Sanitizers and Antibacterial Soaps. Last updated 12.19.17. Accessed 1.16.19. https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm444681.htm
- Sreevidya, VS et al. Benzalkonium chloride, benzethonium chloride, and chloroxylenol – Three replacement antimicrobials are more toxic than triclosan and triclocarban in two model organisms.Environ Pollut. 2018 Apr;235:814-824. doi: 10.1016/j.envpol.2017.12.108. https://www.ncbi.nlm.nih.gov/pubmed
- Environmental Working Group, Skin Deep Database. Accessed 1.25.19. https://www.ewg.org/skindeep/why-skin-deep/
- Slomski A. Hand Sanitizer Combated Sickness in Day Care Centers. JAMA. 2018;320(24):2521. doi:10.1001/jama.2018.20158. https://www.ncbi.nlm.nih.gov/pubmed/30575877
- Tamimi, A.H., Carlino, S., Edmonds, S. et al. Impact of an Alcohol-Based Hand Sanitizer Intervention on the Spread of Viruses in Homes. Food Environ Virol. 2014; 6: 140. https://doi.org/10.1007/s12560-014-9141-9
- Bolon, Maureen K. Hand Hygiene. Infectious Disease Clinics. 2016. 30(3):591 – 607. DOI: https://doi.org/10.1016/j.idc.2016.04.007.