How to use hand sanitizers effectively

Can hand sanitizers replace hand washing? The answer lies in looking closely at your hands

By Dr Vasundhra Atre

Our hands carry millions of microorganisms, not all of whom are bad. Dr Shehnaz Arsiwala, Consultant Dermatologist, Cosmetic Dermatosurgeon and Laser Specialist, Saifee Hospital and Prince Aly khan Hospital, explains, “Some are commensals and harmless, others are transient while some are abnormal, pathogenic and have a propensity to cause infections and diseases.”

Bacteria or pathogens are responsible for the transmission of disease. Proper hand hygiene is integral to reducing bacterial transmission, by helping to kill the surface contaminants and reduce risk of infections.

Handwashing and antibacterial soaps

Hand washing is a standard recommended practice in health care industry before surgeries, examination of patients and handling patients in a health care set up by all medical and paramedical personnel and nursing staff. Antimicrobial soaps contain an antiseptic agent to help lower the number of microbes, in addition to mechanical removal. The length of time they are left on the skin is an important key factor in the effectiveness of these antibacterial soaps.

Are hand sanitizers the future?

Conventional hand washing is being replaced by the use of hand sanitizers. Dr Shehnaz explains, “The hand sanitizers available are either alcohol based or non-alcoholic. They are placed as liquid, foam or gel on the palm and rubbed into the skin. Alcohol sanitizers have 65- 80% alcohol content and are instant disinfectants and kill 99.9% bacteria, certain fungi and viruses, all within a minute of application. Non-alcohol sanitizers are surfactants and are slightly less effective than alcoholic ones. The antimicrobial activity of alcohol is its ability to change proteins in microorganisms. Additives like moisturizers are added to sanitizers to prevent excess drying of the skin.”

Is it for everyone?

Though hand sanitizers are effectively and popularly used in health care industry by paramedical, medical and nursing staff, it does not replace traditional hand washing and cannot be used as a standalone method for antisepsis. Professionals and workers in health industry must routinely cleanse their hands numerable times while moving between patients. Adherence to hand hygiene amidst the staff improves drastically by the use of alcohol gels due to time saved over traditional hand washing methods. However, the guidelines apply only to hospitals and clinics. These are not appropriate for and do NOT apply to those people working in foodservice settings or with the general public.”

Concerns about hand sanitizers

There is increasing concern that usage of these sanitizers may increase the risk of bacterial resistance. The incidence of bacterial resistance is on the rise and more and more resistant strains have been emerging. The indiscriminate use of antibiotics has resulted in the emergence of resistant strains and so maybe the case with overuse of hand sanitizers.

Five points to keep in mind when you use hand sanitizers

Dr Shehnaz cautions, “Research has shown that efficacy of hand sanitizers equal to hand washing only in certain situations.

  1. The effectiveness of a sanitizer may be hampered by presence or absence of soil contaminant on the hands. Presence of dirt, food, or anything else on the hands can make the alcohol in sanitizers less effective. It is important to first wash the hands with soap and water.
  2. Contaminant food proteins and fatty materials can significantly reduce the effectiveness of an alcohol gel. Therefore, soap, friction, and running water still remain the most effective way to remove certain types of pathogens from the hand.
  3. When hands are not visibly dirty, the Centers for Disease Control and Prevention and many other world public health authorities recommend alcohol hand sanitizers as an acceptable alternative
  4. If the hands are visibly dirty, recommendation is to wash with soap and water.
  5. Alcohol-free hand sanitizers may be effective immediately while on the skin, but the solutions themselves can become contaminated because alcohol is an in-solution preservative and without it, the alcohol-free solution itself is susceptible to contamination. However even alcohol containing hand sanitizers can become contaminated if the alcohol content is not properly controlled or the sanitizer is grossly contaminated with microorganisms during manufacture.”

Generally hand sanitization is encouraged when:

  • Having direct physical contact with someone respiratory, skin infections or diarrhea
  • Handling high risk to infection groups like extremely old or young (new burns) and people with compromised immunity
  • Workers in food industry, crèches, and child care firms, crowded living conditions, prisons, preschools etc due to increased risk of hand transmission of infections.

Dr Shehnaz says, “It is wiser for one to resort to traditional hand washing followed by hand sanitizers in situations where one is dealing with high risk to infections.”

Traditional hand washing with soap and water is the best way of maintaining proper hand hygiene. Hand sanitizers should primarily be used only as an optional follow-up to except in situations where soap and water are not available. In those instances, use of an alcohol gel is certainly better than no hand hygiene at all!

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