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LAS VEGAS, NEVADA - JUNE 01: A kiosk at a table gaming area dispenses complimentary masks, hand sanitizer and gloves at Bellagio Resort & Casino as the Las Vegas Strip property, which has been closed since March 17 in response to the coronavirus pandemic, prepares to reopen on June 1, 2020 in Las Vegas, Nevada. Hotel-casinos throughout the state will be able to reopen on June 4 as part of a phased reopening of the economy with social distancing guidelines and other restrictions in place. MGM Resorts International plans to reopen Bellagio, New York-New York Hotel & Casino, MGM Grand Hotel & Casino and The Signature on Thursday. (Photo by Ethan Miller/Getty Images)

Last decade, we were warned by health experts that our obsession with hand sanitizer could threaten our existence as our use of antimicrobial gels could spur the growth of “superbugs”. Now our use appears to have jumped exponentially as a result of COVID and reopening guidelines urging “hand sanitizing” stations to be readily available.

Although proper hand washing has been urged by most health officials to help fight the spread of disease, hand sanitizers provide a convenient and quick way to “wash up” and appear to be more popular than the tedious trip to the bathroom. Hand sanitizer may have anywhere from 60-95% alcohol base, which is toxic to many pathogens. Ethanol can be an effective toxin to viruses and isopropyl alcohol is also very effective at killing bacteria. But are they the safest, wisest choice in hand hygiene?

Although hand sanitizers may be considered heroes to some, others have criticized them for the following:

They can give rise to “superbugs”

A superbug is a pathogen, most commonly bacteria, that can survive antibiotics that most species would buckle under.  Its resistance could be caused by a variety of factors.  Maybe it has a mutation that makes it stronger.  Maybe its genetic material shields it from the toxic medicine.  Maybe it’s luck.  So shortly after it celebrates surviving the antibiotic assault, it divides to reproduce, making more bacteria.  If this progeny bacteria maintain the same genetic material as its parent, or if included, mutation, they can be now be resistant to the antibiotics as well.

study published in Science Tranlsational Medicine in 2018 found a multi-drug resistant strain of the bacteria, Enterococcus faecium, to be resistant to hospital grade hand sanitizers as as well.

The same can hold true with viral pathogens and fungi.

According to the CDC: Each year in the United States, at least 2.8 million people become infected with bacteria that are resistant to antibiotics and at least 35,000 people die each year as a direct result of these infections.

Some brands may cause methanol poisoning

The FDA released a warning to consumers to avoid the following brands of hand sanitizer manufactured by Eskbiochem SA de CV in Mexico, as they may contain methanol instead of ethanol and can therefore cause methanol poisoning. These include:

  • All-Clean Hand Sanitizer (NDC: 74589-002-01)
  • Esk Biochem Hand Sanitizer (NDC: 74589-007-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-008-04)
  • Lavar 70 Gel Hand Sanitizer (NDC: 74589-006-01)
  • The Good Gel Antibacterial Gel Hand Sanitizer (NDC: 74589-010-10)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-005-03)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-009-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-003-01)
  • Saniderm Advanced Hand Sanitizer (NDC: 74589-001-01)

Signs of methanol poisoning may include:

  • headache
  • blurred vision
  • nausea
  • vomiting
  • dizziness
  • drowsiness
  • confusion
  • seizures
  • nerve damage
  • coma
  • death

The bottles of “sanitizer” one comes across may have contaminants or undisclosed products

When the COVID pandemic began, consumers flocked to stores to purchase hand sanitizer and supplies ran out almost immediately. The WHO offered instructions on DIY hand sanitizer. Slowly supply is coming back but at a steep price for businesses trying to reopen.

So for those businesses eager to open up and needing ample supply of sanitizer, they may be utilizing DIY recipes.

Many business establishments have generic containers offering “hand sanitizer” that reportedly leave a smell of vodka or tequila once applied.

Reports on social media are fueling speculation that some large businesses are using alcohol to create enough supply to meet the sanitizing demands of their customers.

Name brand bottles could also be reused as many companies create their own. Hence if there is no regulation of the product and its efficacy, concerns rise as to how protective the product is.

Frequent hand sanitizer use may cause severe skin conditions

Alcohol is a desiccant, which means it dehydrates, or dries. For those of us with delicate skin or conditions such as eczema, judicious hand sanitizer use can cause painful flare ups.

Dry, cracked skin can cause a breakdown in the barrier that the skin provides, hence infection can ensue. Yep hand sanitizer designed to prevent infection can put dry skin at risk for infection.

Chemicals within some hand sanitizers could pose health risks

Fragrances or products within hand sanitizers could cause allergies or disruption in one’s metabolism. Triclosan, for example, although not used in most products today, has been known to affect thyroid hormone levels.

Many apply hand sanitizer incorrectly

For those who choose to swap hand swashing with soap and water for a couple quick pumps of hand sanitizer, they may be missing out on some good cleansing.

The World Health Organization recommends the following steps to be taken when using hand sanitizer:

  1. Fill entire palm with hand sanitizer
  2. Rub both palms together
  3. Put right hand over left and interlace fingers
  4. Put left hand over right and interlace fingers
  5. Interlock fingers to get under the nails
  6. Rotation rubbing to clean the thumb
  7. Hands are clean once alcohol has dried
The process takes about 30 seconds.  However, in a study released last year, researchers from the University Hospital Basel found that if all steps were taken but performed in 15 seconds, the same results will be obtained.  However, if fewer steps were taken, more bacteria/viruses/pathogens would remain on the hands.

Hence if someone avoided an effective means to clean one’s hands such as hand-washing with soap and water for slip shot sanitizing they could be doing themselves and others a disservice.

There’s no doubt it’s going to take some heavy weapons to fight COVID-19….we just need to make sure the treatment is not worse than the disease itself.

Daliah Wachs, MD, FAAF