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SANITIZER VS SOAP: ARE YOUR HANDS CLEAN?
- WYO, Inc.
- Jan 23, 2022
- 5 min read
Updated: Mar 2, 2022
In the early days of the covid-19 pandemic, before the advent of vaccines and therapeutics, when it was not yet clear how the virus was transmitted, the CDC, WHO and others advised wearing a mask, social distancing and handwashing with soap and/or an alcohol-based sanitizer (ABHS) as the most effective mitigation strategies. Needless to say, of the three dodges, masks were and continue to be the most controversial. Social distancing comes in at a distant second. On the other hand, handwashing has been the subject of little or no push back. And when you think about it, that makes absolute sense. Handwashing was already an integral part of our daily, personal hygiene protocol, as routine as showering or brushing our teeth. And this is borne out in multiple surveys, including one from 2009, conducted by the American Cleaning Institute, where respondents reported washing their hands as many as 10 times a day. By April 2021, 78% of participants in the Bradley Corporation’s Healthy Hand Washing Survey said they washed their hands up to 15 times a day. Not surprisingly, this hyper-hand-hygiene behavior included an increased reliance on ABHSs, a trend that reinvigorated the sanitizer vs soap debate. Which one does a better job of cleaning your hands
The Tale of Two Labels
Hand sanitizer actually has its origin a product called Gojo. It was the brainchild of Jerry Lippman and Clarence Cook, professor of chemistry at Kent State University, in Akron Ohio. The two men invented the creamy hand cleaner in 1946, as a healthier alternative to the harsh chemicals rubber
factory workers were using to remove the graphite and carbon black from their hands. Lippman and his wife Goldie went on to found the Gojo company, to market the first-of-its-kind, one-step, rinse off hand hygiene product. The original Gojo was less than 5% alcohol. It was and remains a favorite, especially in manufacturing and/or industrial settings. Not inclined to rest on its laurels, the company introduced its second disruptive hand hygiene product in 1988. And after enjoying initial success in the so-called away-from-home market, including hospitals and schools, Purell hand sanitizer emerged as the best-selling product in the category, in the world (Huddleston, 2020). With up to 74% ethyl and isopropyl alcohol, Purell, and any number of other brands for that matter, claim to “kill 99.99% of germs. In the years since, Gojo has expanded its product line to include a variety of liquid and foaming soaps, for which it makes similar assertions regarding their effectiveness. However, the tale of the two labels pictured here is that the one that appears on the soap products purports to remove 99% of both dirt and germs from the hands. That is to say that ABHS does not work on as well on dirty hands. A platitude you say? Maybe. But one man’s platitude just might be another man’s epiphany.
Getting A (Door) Handle On Sanitizer
In hindsight, healthcare facilities were the perfect test bed for ABHS. Their combined employee and patient and population numbers in the hundreds, if not thousands, include multiple cohorts, living, albeit transiently, and working in in an environment awash in malevolent microbes. Hand sanitizer was seen as a convenient and effective way to quickly decontaminate the hands and minimize the risk of person-to-person transmission of bacteria and viruses. So when the CDC revised it hand hygiene guidance in 2002, to include ABHS as an option, for both healthcare workers and the general public alike, sanitizer dispensers were deployed throughout medical facilities around the world, even in door handles.
The results were mixed. On the one hand access to hand sanitizer led to an increase in hand hygiene compliance. On the other hand, evidence started to emerged that ABHS was not the panacea it was perceived to be, nor was it an effective substitute for handwashing. As it turns out, the alcoholic gel works as advertised against some germs like E. coli and SARS-Cov2, the virus that causes Covid-19. But with other pathogens it is not just ineffective, ABHS may even increase the risk of outbreak of highly contagious bacteria and viruses, especially in healthcare settings (Vogel, 2011). Such is the case with Clostridioides difficile (C. diff) and norovirus. These germs are uncovered.
Uncovered Germs
Norovirus and C. diff come from a class of parasites, respectively known as non-enveloped and spore-forming. They are both essentially genetic material unbounded by a fragile biological membrane. As such, they are less sensitive to heat, dryness and simple disinfectants, ie. alcohol (AMBOSS: Medical Knowledge Distilled, 2018: Study Force, ). Needless to say this an over-simplification of a relatively complex subject. And yet this is not where the similarity between norovirus and C. diff ends. They are both highly infectious, particularly for children and the elderly. They are the leading causes of infectious gastroenteritis. They can occur simultaneously in a single patient. They present some of the same symptoms, including diarrhea, nausea, abdominal pain, and fever (Stokely, et al., 2016). They can be fatal. Together they account for approximately 30,000 deaths per year. And the best way to remove them from the hands is by handwashing with soap.
To be clear, there is no evidence that ABHS causes gastroenteritis or any other disease for that matter. What the research does suggest is that ABHS is only 70% effective against C.diff (Gerding, Muto, & Owens, 2008). Researchers have also reported an increased risk of norvirus outbreaks, in hospitals where ABHS use is preferred over handwash with soap (Vogel, 2011). AHBS can also cause contact dermatitis, especially in the 540 million people on the planet, deficient in aldehyde dehydrogenase (ALDH), an enzyme needed to metabolize alcohol (Lachenmeier, 2008) (Brooks, Enoch, Goldman, & Yokoyama, 2009).
Finally, lest I be accused of demonizing ABHS, I am not. As I mentioned above, they are very effective against the corona virus. AHBS is convenient and do not require water. I am saying that in those situation where you are forced to use hand sanitizer, you should ask yourself if your hands are clean. Then, as soon as possible, you should wash your hands with soap and water, as soon as possible, to make sure they are.
How Much Water Does The Average Person Use Per Day Nearly half a million Americans suffered from Clostridium difficile infections in a single year
Works Cited
[AMBOSS: Medical Knowledge Distilled]. (2018, July, 25). Viruses – Part 1: Enveloped and Non-Enveloped Viruses [Video]. YouTube. https://www.youtube.com/watch?v=miOPtXTeHYE
Brooks, P. J., Enoch, M.-A., Goldman, D. L.-K., & Yokoyama, A. (2009, March 24). The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption. Retrieved from Pubmed.gov: https://pubmed.ncbi.nlm.nih.gov/19320537/
Gerding, D. N., Muto, C. A., & Owens, R. C. (2008). Measures to Control and Prevent Clostridium difficile. Journal of Infectious Diseases, 43-49.
Huddleston, T. J. (2020, March 28). Make It. Retrieved from onnbc.com: https://www.cnbc.com/2020/03/27/coronavirus-the-history-of-hand-sanitizer-and-why-its-important.htm
Lachenmeier, D. W. (2008). Safety Evaluation of Topical Applications of Ethanol on the Skin and Inside Oral Cavity. Journal of Occupational Medicine and Toxicology.
Stokely, J. N., Niendof, S., Taubes, S., Hoehne, M., Young, V. B., Rogers, M. A., & Wobus, C. E. (2016). Prevalence of human norovirus and Clostridium difficile coinfections in adult hospitalized patients. Clinical Epidemiology, 253-260.
[Study Force]. (n/a). Bacterial Spore Formation Animation Video [Video] YouTube. https://www.youtube.com/watch?v=NAcowliknPs&t=8s
Vogel, L. (2011). Hand sanitizers may increase norovirus risk. Canadian Medical Association Journal, 799-800.
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