Hand Sanitizer Hazards

Hand Sanitizer Hazards: Why You Should Still Wash Your Hands

We saw a mad rush for hand sanitizer this year with concern about spread of germs due to the pandemic. But while hand sanitizer may be a good alternative when soap and water are not available, frequent use of hand sanitizer can create issues such as dry skin or dermatitis, alter the microbiome, expose you to hazardous chemicals, and in some cases it is just not as effective as washing your hands. Is hand sanitizer really the key to keeping us healthy?

Even before Covid-19, my children’s schools were consistently requesting that we bring in additional cleaning wipes and hand sanitizers in efforts to reduce the spread of illness. As a physician and public health professional, I wholeheartedly agree with proper sanitation, and it must be done in a safe and rational manner.

We have already seen the damage from accidents from grossly improper use of cleaners and antiseptics. And there are dangers from smaller amounts of chemicals as well – even in our hand sanitizers. It wasn’t too long ago that we learned of the health hazards of anti-bacterial soaps – with harmful ingredients like triclosan and triclocarban present in most of our anti-bacterial products. Will we learn similar lessons about hand sanitizers?

Why Use Hand Sanitizer?

The premise behind using hand sanitizer is that we touch many things (including our own bodies) that can harbor germs that can potentially make us sick. If we then touch our hands to our faces (nose, mouth, eyes) those germs can potentially enter our body which is often the first step in getting an infection. So keeping our hands clean is important, and washing with regular soap and water generally does the job (see “21. Wash Your Hands, but Forget the Antibacterial Soap” in Resilient Health: How to Thrive in Our Toxic World).

When soap and water are not readily available, hand sanitizer can be helpful until we can get to a place where we can properly wash our hands. However, hand sanitizer is not ideal in some instances such as removing harmful chemicals, food, greasy/fatty substances, and blood. And washing with soap and water is the right thing to do when your hands are visibly dirty, you just used the restroom or changed a dirty diaper, or you are handling food.

What’s in Hand Sanitizer?

Hand sanitizers often have a form of alcohol, such as ethyl alcohol (ethanol) or isopropyl alcohol, as an active ingredient. The CDC recommends using an alcohol-based hand sanitizer that contains at least 60 percent alcohol. Most over-the-counter hand sanitizers contain these ingredients or benzalkonium chloride (which is associated with allergic and irritant issues) as the active ingredient. In addition, hand sanitizers often contain other chemicals – including “fragrance” which can sometimes cause problems as well as impurities.

Why Am I Concerned?

With the hand-sanitizer shortage causing manufacturers to ramp up production as well as find other sources for ingredients, there have been instances recently where microbes, harmful chemicals and other impurities have been found in hand sanitizer products. For instance a voluntary recall was issued by the FDA for certain products in June 2020 due to high levels of disease-causing bacteria found during a recent inspection.

Changes in sourcing and relaxation of regulations can also lead to presence of harmful chemicals such as the carcinogen (cancer-causing agent) benzene. As the need for the ingredient ethanol increased and the use of ethanol for fuel decreased, fuel ethanol manufacturers started shifting their production to meet the increased needs for hand sanitizers. Unfortunately, impurities from the fuel-industry such as benzene and gasoline may be present because of use certain chemicals, equipment or containers in these processes that were not ordinarily used pre-pandemic. Therefore, the FDA stated it would temporarily permit manufacturers to make sanitizers containing small quantities of impurities such as these, including those that cause cancer, to meet the needs during the pandemic.

People become exposed to benzene through inhalation and absorption through the skin. In addition to cancer risk, I have seen elevated benzene levels in those with weight issues as well as autoimmune illness – not as an isolated finding, but part of a greater picture of toxicity. And certain people are genetically predisposed to not be able to process these chemicals efficiently, leading to an increased risk in those individuals. So be aware that these hazardous chemicals may now be in hand sanitizers as per the FDA.

Why does the EWG Give Purell Hand Sanitizer a Moderate Hazard Score?

Even before these toxic impurities were allowed, in the last several years it became known that some active ingredients in topical antiseptics can be absorbed through the skin and may pose hazards themselves. And even the FDA warns that “Very small amounts of hand sanitizer can be toxic, even lethal, to young children. Therefore, it is advisable that children should use such sanitizers with adult supervision.”

Taking a look at one of the major brands, Purell Hand Sanitizer (Original) scores in the Moderate Hazard zone by the Environmental Working Group (EWG) mostly due to its high score for Allergies and Immunotoxicity. The EWG evaluates this category by: “Ingredients linked to harm to the immune system, a class of health problems that manifest as allergic reactions or an impaired capacity to fight disease and repair damaged tissue in the body.” Although there were no current concerns relating to cancer or developmental and reproductive toxicity, the product did score high for irritation and moderate for endocrine (hormone disruption) and non-reproductive organ system toxicity as well as contamination concerns.

The “fragrance” in Purell’s hand sanitizer, however, is the worst offending ingredient with a hazard score of 8/10 related to allergies/immunotoxicity,irritation, endocrine disruption, and non-reproductive organ system toxicity. Many other brands of hand sanitizers also receive higher hazard scores because of the fragrances (synthetic as well as natural) that they use (see Resilient Health Tip #29: What’s that Smell?) As my mentor and environmental health expert, Dr. Walter Crinnion,would say “If it smells ‘clean,’ it’s probably not good for you.” I see many people who have reactions to fragrances causing issues like headaches, brain fog, or respiratory issues. What exactly is “fragrance?” We often do not know as manufacturers are permitted to keep these formulations as trade secrets.

What Effect Does Hand Sanitizer Have on the Microbiome?

On average, there are more than 150 bacterial species found on the hands in normal situations. A recent review of hand microbiome research likened hands to a busy intersection, connecting our microbiome with that of other people, places, and things. And while we are still learning about the skin microbiome, we know that it is an important first line of defense against injury and infections. We also know that this microbiome can be damaged by soaps, incorrect or overuse of antibiotics, harsh skincare products, and other environmental factors. A study evaluating the hands of healthcare workers found those with less microbial diversity (likely due to more frequent hand hygiene) were more likely to harbor disease-causing microorganisms on the hands. So I wonder if we are doing ourselves a dis-service by keeping our hands too clean? As scientists learn more about the microbiome, perhaps we will learn the answer.

My Takeaway

The first-line defense for hand hygiene should be washing with plain soap and water for at least 20 seconds whenever possible. Unless you are in a health-care situation, antibacterial soaps are not necessary and may contribute to other problems, and I do not recommend using them for normal hand hygiene. I recommend only using hand-sanitizer when soap and water are not available and that you check your product for potential hazards using the EWG Skindeep database. And to avoid benzene and other fuel-related impurities, stick to formulations using isopropyl alcohol which has the lowest hazard score.

Selected References:

https://www.cdc.gov/handwashing/

https://www.fda.gov/drugs/information-drug-class/topical-antiseptic-products-hand-sanitizers-and-antibacterial-soaps

https://www.infectioncontroltoday.com/hand-hygiene/fda-warns-about-bacterial-contamination-skin-products-made-clarcon

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-takes-action-protect-public-health-increase-supply-alcohol-based

https://www.ewg.org/skindeep/products/882259-Purell_Hand_Sanitizer_Original/

https://www.ewg.org/skindeep/understanding_skin_deep_ratings/

https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/triclosan/faq-20057861

https://www.cdc.gov/handwashing/pdf/hand-sanitizer-factsheet.pdf

https://www.sciencedirect.com/science/article/pii/S0923181115300268

https://www.scopus.com/record/display.uri?eid=2-s2.0-84895859888&origin=inward&txGid=7a0f49e9d68262db35423effdae0fecc