Since the 1990s, alcohol-based hand sanitizers have become the gold standard for quick disinfection. They are used daily by people looking for ways to avoid colds and flu. But they have an important drawback: although they kill most bacteria and viruses, they quickly evaporate and have no lasting effect. That means you can almost immediately pick up more germs from the next object you touch.
In addition, some users complain that alcohol-based sanitizers cause dryness and irritation.
Now there’s a new generation of non-alcohol hand sanitizers, most of which contain the active ingredient benzalkonium chloride. This antimicrobial chemical is touted as being tough on germs, safe on skin, and effective for up to six hours after a single application.
So which hand sanitizers are best?
“That’s pretty easy: alcohol-based hand sanitizers,” says Jason Tetro, a microbiologist who has established a media presence as “the germ guy.”
Tetro works in a lab at the University of Ottawa in Ontario, Canada, that tests the effectiveness of hand sanitizers.
High Kill Rate
“Alcohol has a wider spectrum of kill,” says Tetro. “Most non-alcohol hand sanitizers are effective against bacteria, but they don’t do so well against viruses like the norovirus (the usual cause of gastrointestinal outbreaks aboard cruise ships), the common cold viruses, and the hepatitis viruses, mainly hepatitis A.”
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Tetro allows that non-alcohol hand sanitizers have a residual effect in carefully controlled studies. But he’s not convinced that they stay protective in the real world.
“If your hands are relatively clean and you’re only touching one thing between uses, then there’s a possibility that this persistence will work,” he says. “But if you get oil or dirt or anything else on your hands, it’s going to cover the product and therefore take away its ability to maintain that persistence.”
Another drawback of non-alcohol hand sanitizers, he adds, is that repeated use without hand washing tends to form a noticeable layer of “gunk” on the hands. “The beauty of alcohol-based hand sanitizers is that you can use them repeatedly and each time they evaporate after 20-30 seconds.”
Alcohol-based hand sanitizers have been better-studied than non-alcohol in real-world settings such as clinics and hospitals, where they have been shown to reduce infections. For that reason, organizations such as the CDC and the World Health Organization (WHO) recommend that healthcare workers frequently wash their hands and use an alcohol-based hand sanitizer each time after touching an object.
“Alcohol is drying,” says Tetro, who cites research showing that 40 of every 3,000 users of alcohol-based hand sanitizers may develop skin problems such as contact dermatitis. But he says that in most cases the dryness is not severe.
Preventing alcohol-based hand sanitizer-related dryness and irritation is easy. Use a moisturizer, Tetro says: “When I start noticing some redness and patchy areas, I run for the Aveeno.”
For now, simple economics favor the use of alcohol-based hand sanitizers. An 8-ounce bottle can be had for as little as $1, while an 8-ounce bottle of benzethonium chloride-based hand sanitizer costs as much as $10.
Tetro recommends that everyone carry an alcohol-based hand sanitizer and use it often. “I always do,” he says. “Everybody should have hand sanitizer with them. I think people are realizing it’s not necessarily just for flu but for all sorts of different viruses.”
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