Hand Sanitizers...Do They Really Work?

Originally Posted by The BoidSmith

Deb,

Hand sanitizers are mostly alcohol-based. Because of this reason they will in effect remove the oil from your skin (fat is soluble in alcohol) but at the same will kill in one minute nearly all bacteria and viruses by disrupting the cell membrane.
Best

What research showed that?
Thanks.

Here's an article from the British Journal of Medicine:

BMJ. 2003 January 4; 326(7379): 50. PMCID: PMC1124940

Copyright © 2003, BMJ Publishing Group Ltd
Alcohol handrubs v soap
Finnish experience shows that alcohol rubs are good for hands
Juhani Ojajarvi, senior medical officer
National Agency for Medicines, Medical Devices Centre, PO Box 55, F-00301 Helsinki, Finland ; Email: juhani.ojajarvi@nam.fi Editor—Girou et al compared the use of alcohol based handrubs with standard handwashing.1 Such handrubs have been used in Finland since the 1980s, and handrubbing is the preferred choice for hand hygiene in health care.Healthcare workers have accepted the method, and complaints of dry skin are fewer than with using other hand hygiene products.2,3 Alcoholic preparations must of course contain skin emollients such as 1-2% glycerol to prevent drying of the skin.References1. Girou E, Loyeau S, Legrand P, Oppein F, Brun-Boisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ. 2002;325:362. . (17 August.) [PMC free article] [PubMed]
2. Ojajärvi J, Mäkelä P, Rantasalo I. Failure of hand disinfection with frequent hand washing: a need for profield studies. J Hyg. 1977;79:107–119. [PMC free article] [PubMed]
3. Ojajärvi J. Handwashing in Finland. J Hosp Infect. 1991;18(suppl B):35–40. [PubMed]
BMJ. 2003 January 4; 326(7379): 50. > Response
Copyright © 2003, BMJ Publishing Group Ltd
Alcohol handrub removes methicillin resistant Staphylococcus aureus
Arti Thakerar, fourth year medical student
Barts and the Royal London Hospitals and School of Medicine, London E1 2AD ; Email: arti_thakerar@doctorsworld.comCollin Goodbourn, consultant microbiologist
Whipps Cross University Hospital NHS Trust, London E11 1NR Editor—Girou et al showed that handrubbing with an alcohol based solution is significantly more efficient than handwashing with antiseptic soap in reducing hand contamination during routine patient care.1-1 We conducted a similar study of the efficacy of an alcohol handrub (70% ethanol, carbomer, isopropyl myristate, glycerine, monopropylene glycol, vitamin E, and demineralised water; Guest Medical, Kent, UK) in eliminating methicillin resistant Staphylococcus aureus from the fingertips of hospital staff at work.The study was conducted in a large district general hospital in north London in December 2001. Altogether, 110 healthcare staff including doctors, nurses, occupational therapists, healthcare support workers, administrators, and porters were approached at random in their area of work on a single day and invited to take part anonymously. There was no prior knowledge of the study. Each member of staff was asked to place prints of their dominant thumb, index finger, and middle finger onto a plate of Baird Parker agar (selective for S aureus). Two squirts (around 0.5 ml in total) from a 50 ml pocket size dispenser of the alcohol handrub were then sprayed onto their hands, and they were asked to apply this as they would normally—with no extra instruction. After the alcohol was allowed to dry fully, fingerprints were taken again in the same way onto a fresh agar plate. Plates were incubated at 37°C for 48 hours.Typical colonies were confirmed as S aureus and checked for methicillin sensitivity in the normal way. We found that before using the handrub 25 of the 110 staff formed one or more colony forming units of methicillin resistant S aureus from their fingerprints. Most grades of staff had some positive results, although most of the positive results were from those working in two or three specific areas in the hospital. After using handrub only three members of staff grew colonies from their fingerprints.This illustrates the efficacy of an alcohol handrub in reducing hand contamination with methicillin resistant S aureus at work. We plan to repeat the exercise every quarter both as surveillance and as a useful practical educational tool for staff.References1-1. Girou E, Loyeau S, Legrand P, Oppein F, Brun-Boisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ. 2002;325:362. . (17 August.) [PMC free article] [PubMed]

Originally Posted by Lucille

at least some people are showing enough concern that they are thinking about the consequences of going to shows and possibl handling various critters, and then returning home to their collections.

People should be concerned...and it isn't something that is just happening now. It is an awakening that comes with time, experience, and awareness.

As far as hand sanitizers - one of the biggest benefits is convenience, and the improved compliance that may bring. I've been in healthcare since before hand sanitizers were the standard, and initially a lot of people were resistant and doubting...it was change, after all. Over time, and with education - as well as a significant increase in the placement of dispensers - more people (staff, patients, and visitors) are using them routinely. The compliance rate is much higher than with soap & water; and, realistically, sanitizers are easier to use effectively.

Originally Posted by Jerry

I just doubt that they are as effective as we are led to believe.

That comes back to proper technique...and realistic expectations.

Deb,

Here's research from the CDC. The key is the concentration. Sanitizers with 30-40% water work better than 100% alcohol as they penetrate easily inside bacteria.

Hand Sanitizer Alert
Scott A. Reynolds,* Foster Levy,† and Elaine S. Walker*†
*James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee, USA; and †East Tennessee State University, Johnson City, Tennessee, USA

Suggested citation for this article


--------------------------------------------------------------------------------

To the Editor: Community-based epidemiologic studies have shown beneficial effects of hand sanitizers. Hand sanitizers were effective in reducing gastrointestinal illnesses in households (1), in curbing absentee rates in elementary schools (2), and in reducing illnesses in university dormitories (3). An Internet search retrieved recommendations for hand hygiene from schools, daycare centers, outdoor guides, and animal shelters.

To reduce infections in healthcare settings, alcohol-based hand sanitizers are recommended as a component of hand hygiene (4). For alcohol-based hand sanitizers, the Food and Drug Administration (FDA) (5) recommends a concentration of 60% to 95% ethanol or isopropanol, the concentration range of greatest germicidal efficacy. While nonhealthcare groups also recommend alcohol-based hand sanitizers, they usually do not specify an appropriate concentration of alcohol.

Some products marketed to the public as antimicrobial hand sanitizers are not effective in reducing bacterial counts on hands. In the course of a classroom demonstration of the comparative efficacy of hospital-grade antimicrobial soap and alcohol-based sanitizers, a product with 40% ethanol as the active ingredient was purchased at a retail discount store. Despite a label claim of reducing "germs and harmful bacteria" by 99.9%, we observed an apparent increase in the concentration of bacteria in handprints impressed on agar plates after cleansing. None of the other hand cleaners showed such an effect.

Subsequently, we conducted more formal handwashing trials to verify the preliminary finding. Our goal was not to test the products by using the FDA tentative final monograph standard (5) but to determine whether a marketed product fails as an antiseptic because of its low alcohol content. To test whether the relatively low concentration of ethanol was the source of treatment failure, we included trials with laboratory-formulated 40% ethanol; we also supplemented the suspect gel with ethanol to a final concentration of 62%. Five hand hygiene treatments were compared: tap water (4 trials), 40% ethanol (5 trials), commercial gels with active ingredients of either 40% or 62% ethanol (9 trials each), and commercial 40% gel supplemented to 62% (5 trials).

At the beginning of each work day, the dominant hand of each volunteer was placed on 150-mm tryptic soy agar plates for 5 s, followed by hand treatment. Each alcohol-based hand treatment involved wetting the hands with 1.5 mL test product followed by vigorously rubbing hands together for 15 s. The tap water treatment differed in that hands were held under running water and vigorously rubbed together for 15 s, followed by air drying. After hands were dry, they were reapplied to a fresh plate for 5 s. Participants were assigned to treatments randomly, but each had to complete each treatment in a week. CFU counts before and after treatment were log transformed to normalize data and compared by using paired t tests.

Tap water, 40% ethanol, and 40% ethanol gel yielded no significant reductions in CFU (Table). The 40% gel supplemented with ethanol to a final concentration of 62% reduced the mean CFU by 90%, a level of reduction similar to that of the 62% ethanol gel. Moreover, the 62% gel and the supplemented 40% gel reduced CFU by >50% on all participants. In contrast, only one third of participants showed >50% reductions with 40% gel, one fifth with 40% ethanol, and none with tap water. Differences in pretreatment CFU were not significant (analysis of variance F = 1.81, df = 4, 27, p = 0.16). In addition to failing to decrease CFU, colonies were more evenly distributed on postwash plates after use of 40% gel. The even postwash colony distribution may be caused by dispersion of aggregates of microbes without sufficient killing.

Qualitative colony assessment suggested 40% gel and 40% ethanol were as effective as 62% gel against fungi; in contrast, bacterial CFU tended to show little change or increases. The most prevalent bacteria were staphylococci, including those with characteristics of Staphylococcus aureus.

After conducting experiments, a survey of 6 local retail chains found no substandard products. In the fall of 2005, a more extensive survey of 18 retail chains (supermarkets, drug stores, general retailers, specialty shops) uncovered a substandard product at all 3 stores of 1 deep-discount chain. The marketing profile of deep-discount chains suggests that poorer segments of the population may be more at risk of purchasing inadequate antiseptic gels. Moreover, 40% ethanol products may be stockpiled in homes and offices. An extensive Internet survey identified no additional substandard commercial products. However, the alcohol content of less-common brands was not always available online, and several Internet sites provide recipes for a bubble gum–scented children's hand sanitizer that contains 33% isopropanol as the sole active ingredient. Educational efforts should emphasize that effective sanitizers must be of a sufficient alcohol concentration.

The efficacy experiments reported here reinforce what has been known for >50 years: 40% ethanol is a less effective bacterial antiseptic than 60% ethanol (6). Consumers should be alerted to check the alcohol concentration in hand sanitizers because substandard products may be marketed to the public.

Acknowledgments
We thank Brandi Earp and Dathia Reynolds for assistance with retail store surveys.

This material is the result of work supported with resources and facilities at the James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee.

References
Sandora TJ, Taveras EM, Shih M-C, Resnick EA, Lee GM, Ross-Degnan D, et al. Hand sanitizer reduces illness transmission in the home [abstract 106]. In: Abstracts of the 42nd annual meeting of the Infectious Disease Society of America; Boston, Massachusetts; 2004 Sept 30–Oct 3. Alexandria (VA): Infectious Disease Society of America; 2004.
Hammond B, Ali Y, Fendler E, Dolan M, Donovan S. Effect of hand sanitizer use on elementary school absenteeism. Am J Infect Control. 2000;28:340–6.
White C, Kolble R, Carlson R, Lipson N, Dolan M, Ali Y, et al. The effect of hand hygiene on illness rate among students in university residence halls. Am J Infect Control. 2003;31:364–70.
Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51(RR-16):1–45.
Food and Drug Administration. Topical antimicrobial products for over-the-counter use; tentative final monograph for healthcare antiseptic drug products. Federal Register. 1994;59:31221–2.
Price PB. Ethyl alcohol as a germicide. Arch Surg. 1939;38:528–42.


Table. CFU per plate before and after treatment with various concentrations of ethanol


--------------------------------------------------------------------------------

Treatment
Mean pretreatment CFU (range)
Mean posttreatment CFU (range)
No. trials
|t|*
p*
Mean change (%)


--------------------------------------------------------------------------------

Tap water
175 (117–234)
206 (100–321)
4
1.25
0.30
+10

40% ethanol
531 (132–1,413)
621 (75–1,733)
5
0.30
0.39
+3

40% gel
246 (51–602)
232 (56–693)
9
0.61
0.56
+53

62% gel
171 (33–563)
12 (1–24)
9
5.73
<0.001
–82

40%→62% gel
473 (114–1,257)
26 (10–48)
5
6.21
0.003
–90


--------------------------------------------------------------------------------

*|t| = result of paired t test; p = probability of |t|.

Originally Posted by Harald

That comes back to proper technique...and realistic expectations.

True. I use a pretty good squirt each time and get in between fingers, etc. The whole conversation with my pet store guy came about because after he showed a ball python to a young couple he just did a cursory tap on the hand sanitizer and then wiped it off quickly. I asked him if he really thought that did much good.

Excellent, Dan! I will go over the research in detail. Thanks! This research may aid consumers in knowing which brand is actually more effective?

Originally Posted by deborahbroadus

Excellent, Dan! I will go over the research in detail. Thanks! This research may aid consumers in knowing which brand is actually more effective?

I haven't given up, but I am stalled. I haven't found a way to compare researches. On the one hand, the research I offered was done here in America.

The opposing rebuttal was a Finnish/British research done outside of the US.

I don't know if it makes a difference, BUT..I do know that different countries have different controls that may impact the outcome of the results? Probably not explaining it very well...

Originally Posted by deborahbroadus

I haven't given up, but I am stalled. I haven't found a way to compare researches. On the one hand, the research I offered was done here in America.

The opposing rebuttal was a Finnish/British research done outside of the US.

I don't know if it makes a difference, BUT..I do know that different countries have different controls that may impact the outcome of the results? Probably not explaining it very well...

For example..Our Food and Drug Admin states "Tenative" on the British research footnote.

Food and Drug Administration. Topical antimicrobial products for over-the-counter use; tentative final monograph for healthcare antiseptic drug products. Federal Register. 1994;59:31221–2.
Price PB. Ethyl alcohol as a germicide. Arch Surg. 1939;38:528–42.

Here’s a report from the Harvard School of Medicine, let’s hope this one meets your zest for knowledge.


Committee Assignments Wash your hands
Human skin — even in the most healthy of us — is teeming with bacteria. Most of those bacteria only cause disease under special circumstances. But everyone also carries potentially dangerous germs from time to time, such as staph, strep, and the intestinal bacteria that cause food poisoning and diarrhea. Sad to say, health care personnel — including your doctors and nurses — are particularly likely to carry the most troublesome bacteria, especially on their hands. And although viruses don’t set up shop on the skin the way bacteria do, the viruses that cause diarrhea and respiratory infections — from the sniffles to the flu — can hang around on the hands long enough to spread from person to person.
If your skin is covered with so many bacteria, why don’t they make you sick more often? Although the skin is a hospitable resting place for bacteria, it is also a tough barrier that prevents hostile bugs from reaching the body’s vulnerable internal tissues. Ironically, perhaps, some of the traditional methods of removing bacteria from the skin can disrupt the skin’s own defenses. Scrubbing can produce tiny abrasions that allow bacteria to sneak into your tissues. Detergents and even plain water can remove the skin’s oils, which have important antibacterial properties.
Good handwashing, then, involves two potentially conflicting goals, removing microbes while still keeping your skin healthy.
Preached but not practiced
Handwashing is good advice — but do Americans follow it?
Often, we don’t. When investigators surveyed public restrooms around the country, they found that only 83% of people washed up after using the toilet. Do posted reminders to “Please Wash Your Hands” help? When researchers tested this simple strategy, they found that handwashing improved in women but not in men.
The gender gap applies to hospitals, too. In one study, female physicians washed their hands after 88% of patient contacts, but male doctors washed after just 54%.
Does it work?
Yes. Just 30 seconds of simple handwashing with soap and water reduces the bacterial count on health care workers’ hands by 58%. And there is an even better way: Alcohol-based handrubs reduce counts by 83%.
What’s best?
Soap and water is the time-honored technique, and it does work. In fact, it’s still the best way to remove visible soilage and particulate material. But as the public has become concerned about the risk of infection, soaps with antibacterial additives have gradually taken over 45% of the market. It’s understandable, but it’s not helpful; antibacterial soap is no better than ordinary soap, and the additives actually increase the risk of allergic reactions and other side effects.
Plain soap will do the job — and so will plain water. Tap water is excellent, and cool or lukewarm temperatures serve as well as hot water. If soap and water are not available, antibacterial wipes can help. Although they are not as effective, they will reduce bacterial counts. Washing with soap and water is the best way to remove dirt, but waterless, alcohol-based handrubs are even better at killing germs. Handrubbing is faster and more convenient than handwashing, and it’s also easier on the skin. Hospitals are switching to handrubs because they kill more bacteria and viruses and they are used more regularly.
When and how
How should you wash? Wet your hands with water, then apply the soap to your palms. Rub your hands together briskly for at least 15 seconds before rinsing.
Wash your hands before each trip to the dining room and after each trip to the bathroom. Wash after handling diapers and animals. Wash before and after you handle food. Wash after you take out the trash, work in the yard, clean the house, repair the car, or do other messy chores. Wash before and after sex. Wash after you come in contact with anyone who is sick. If you follow reasonable guidelines you’ll be washing often, but you won’t become obsessive or compulsive. Be careful, not fearful.
August 2006 Update

Yeah, I can be like that.

I have an abhorbence for swallowing anything told to me without making that knowledge MY own..meaning I have to know it. I have to know where it came from.

I am too old to be saying.."So-and-so told me" when asked for a resource of my knowledge.

Originally Posted by The BoidSmith

Here’s a report from the Harvard School of Medicine, let’s hope this one meets your zest for knowledge.


Committee Assignments Wash your hands
Human skin — even in the most healthy of us — is teeming with bacteria. Most of those bacteria only cause disease under special circumstances. But everyone also carries potentially dangerous germs from time to time, such as staph, strep, and the intestinal bacteria that cause food poisoning and diarrhea. Sad to say, health care personnel — including your doctors and nurses — are particularly likely to carry the most troublesome bacteria, especially on their hands. And although viruses don’t set up shop on the skin the way bacteria do, the viruses that cause diarrhea and respiratory infections — from the sniffles to the flu — can hang around on the hands long enough to spread from person to person.
If your skin is covered with so many bacteria, why don’t they make you sick more often? Although the skin is a hospitable resting place for bacteria, it is also a tough barrier that prevents hostile bugs from reaching the body’s vulnerable internal tissues. Ironically, perhaps, some of the traditional methods of removing bacteria from the skin can disrupt the skin’s own defenses. Scrubbing can produce tiny abrasions that allow bacteria to sneak into your tissues. Detergents and even plain water can remove the skin’s oils, which have important antibacterial properties.
Good handwashing, then, involves two potentially conflicting goals, removing microbes while still keeping your skin healthy.
Preached but not practiced
Handwashing is good advice — but do Americans follow it?
Often, we don’t. When investigators surveyed public restrooms around the country, they found that only 83% of people washed up after using the toilet. Do posted reminders to “Please Wash Your Hands” help? When researchers tested this simple strategy, they found that handwashing improved in women but not in men.
The gender gap applies to hospitals, too. In one study, female physicians washed their hands after 88% of patient contacts, but male doctors washed after just 54%.
Does it work?
Yes. Just 30 seconds of simple handwashing with soap and water reduces the bacterial count on health care workers’ hands by 58%. And there is an even better way: Alcohol-based handrubs reduce counts by 83%.
What’s best?
Soap and water is the time-honored technique, and it does work. In fact, it’s still the best way to remove visible soilage and particulate material. But as the public has become concerned about the risk of infection, soaps with antibacterial additives have gradually taken over 45% of the market. It’s understandable, but it’s not helpful; antibacterial soap is no better than ordinary soap, and the additives actually increase the risk of allergic reactions and other side effects.
Plain soap will do the job — and so will plain water. Tap water is excellent, and cool or lukewarm temperatures serve as well as hot water. If soap and water are not available, antibacterial wipes can help. Although they are not as effective, they will reduce bacterial counts. Washing with soap and water is the best way to remove dirt, but waterless, alcohol-based handrubs are even better at killing germs. Handrubbing is faster and more convenient than handwashing, and it’s also easier on the skin. Hospitals are switching to handrubs because they kill more bacteria and viruses and they are used more regularly.
When and how
How should you wash? Wet your hands with water, then apply the soap to your palms. Rub your hands together briskly for at least 15 seconds before rinsing.
Wash your hands before each trip to the dining room and after each trip to the bathroom. Wash after handling diapers and animals. Wash before and after you handle food. Wash after you take out the trash, work in the yard, clean the house, repair the car, or do other messy chores. Wash before and after sex. Wash after you come in contact with anyone who is sick. If you follow reasonable guidelines you’ll be washing often, but you won’t become obsessive or compulsive. Be careful, not fearful.
August 2006 Update