The Dirty Little Secrets of Hand Sanitizers

By Jo Ann LeQuang

Hand sanitizers have become a $190 million industry, but there is a lot of confusion about them. Among healthcare professionals, hand sanitizers are considered both “as good” and “not nearly as good” as soap-and-water washing. Reading online, I learned that hand sanitizers should “always” or “never” be used after washing hands with soap and water. Some of us believe that hand sanitizers kill every bad germ, while the Food and Drug Administration (FDA) in 2011 warned Procter & Gamble not to claim its hand sanitizer killed cold germs. In the U.S., hand sanitizers are an over-the-counter drug, sort of like acetaminophen or allergy pills. This means the FDA gets to make the rules about them. But unlike high-dollar, high-stakes pharmaceutical products, no one is willing to pay for major clinical trials that would allow the hand sanitizers to make specific claims, like whether or not they killed the flu virus or the super-bug MRSA. The FDA has gingerly allowed hand sanitizers to use this wording on their labels: “these products help reduce bacteria that potentially can cause disease.” Not much of a brand promise! But do not jump to the conclusion that these products must not kill germs because the FDA has restricted their package labeling. These products just have not undergone the type of clinical trials that are needed to make such specific claims. The testing is not necessary to market them; in fact, the FDA will let many of these products go to market without certain so-called efficacy tests. It is also not clear to the public how and when hand sanitizers are to be used, because even the experts disagree. The Centers for Disease Control and Prevention (CDC) in Atlanta recommend that plenty of good old-fashioned soap and water is the mainstay of your hand hygiene program with sanitizer used only intermittently and sparingly. The reason for this is that some hand sanitizers have a gel-like substance which actually can trap germs. In other words, the gel kills the germs first but then lingers and attracts future germs. Yet some hospitals and other healthcare systems mandate their use.