Although the Centers for Disease Control and Prevention (CDC) recommends soap and water hand washing as the most effective way of removing dirt, bacteria and viruses from your hands, this method of washing is not always convenient or possible. Using a hand sanitizer as an alternative to soap and water requires deciding between products that list alcohol as the active ingredient and those that do not.
Because food service workers commonly use hand sanitizers, the U.S. Food and Drug Administration Food Code Rules and Regulations classify the active ingredient in any hand sanitizer as a food additive requiring approval before inclusion. Before granting approval, the FDA looks at factors such as composition and properties, amount, health effects and safety. Benzalkonium chloride, a chemical disinfectant; triclosan, an antibiotic; and the organic antibacterial agent thymol, all common in non-alcohol hand sanitizers, have FDA approval.
FDA approval is not an endorsement of an ingredient's effectiveness. It only verifies that the ingredient is safe to use. Effectiveness depends on factors such as the context in which you use the product and the type of dirt or microorganisms you are trying to remove. Health care workers, food service workers and the public are classifications used to determine effectiveness. Chemicals react differently according to the composition of the dirt or microorganism commonly encountered within each classification. For example, food service workers commonly come into contact with fecal bacteria and intestinal viruses such as Norovirus.
In order of preference, the CDC recommends soap-and-water hand washing, followed by alcohol-based hand sanitizers. Despite marketing claims from alcohol-free hand sanitizer manufacturers referring to their products as 99.9 percent effective against common bacteria, germs and fungi, the CDC remains unconvinced. In a May 2010 teleconference, Katherine Ellingson, with the Division of Healthcare Quality Promotion at the CDC, explained that the CDC does not recommend non-alcohol-based hand sanitizers in health care settings because they are “weak to non-effective” against certain types of bacteria. In response to the effectiveness of non-alcohol hand sanitizers against influenza germs, the CDC says only that these types of hand sanitizers “may” be useful. In its statement, the CDC lists a non-alcohol hand sanitizer as appropriate only as a last resort due to a lack of evidence that confirms effectiveness.
Three properties of non-alcohol hand sanitizers may work to encourage their use. A side effect of more frequent use can be an increase in effectiveness. Alcohol-free hand sanitizers are non-drying, non-irritating and remain on the skin longer before evaporating than alcohol-based products. Alcohol-based sanitizers can have a drying effect on your skin. Overly dry skin can result in painful cracking that also provides an environment for germs to enter the body. Consistent use of alcohol-based sanitizers can irritate the skin, causing you to use them less often. Finally, alcohol ingredients evaporate quickly, limiting effectiveness to a shorter time than non-alcohol sanitizers.
Despite the lack of endorsement, it is important to remember that the CDC is not a regulatory agency and has no authority to approve or disapprove any product. Benzalkonium chloride, the active ingredient most often used in non-alcohol hand sanitizers, is also a common ingredient in antiseptic solutions, cleansing towelettes and baby “wet wipes,” lending some degree of credibility to claims of effectiveness.