Whether you're worried about the third wave or the upcoming flu season, hand hygiene is a critical part of preventing infection. Our latest blog post takes a look at whether alcohol or non-alcohol based hand sanitisers are better at preventing illnesses.
We've known for well over a century that hands can be instrumental in transmitting diseases, but getting people to actually practice good hand hygiene (even in hospitals) has been surprisingly difficult. Among the general public, surveys repeatedly showed low levels of awareness around the importance of hand hygiene, particularly after using the bathroom.
Enter the global Coronavirus pandemic and suddenly all eyes are on hand hygiene.
COVID-19 pandemic and hand hygiene:
After more than a year of lockdown measures as a response to the COVID-19 pandemic, virtually everyone in the world is now aware that hand hygiene is a critical part of preventing the spread of the Coronavirus. The WHO and local governments have heavily promoted the need for regular hand washing with soap and hand sanitising to prevent the transmission of the virus.
Should we wash or sanitise?
Hand washing with soap and water (using the correct technique for at least 20 seconds) is still the preferred method of cleaning hands, and is recommended by WHO and national health authorities. You can find out why in our previous blog post: Why we Love Soap.
But there are times when hand washing is not practical, or soap and water are not available, and then rubbing with hand sanitiser is a far safer alternative than doing nothing. (You may also be interested in finding out what to look for in a hand sanitiser)
The Coronavirus pandemic saw the demand for hand sanitiser surge in 2020. Prices skyrocketed, and at times supply was under pressure. There was also substantial media coverage related to ‘off-the-shelf’ sanitisers that did not conform to health and safety standards, with consumers complaining of eczema caused by unregulated products. We even wrote an open letter to retailers, asking them to standardise the hand sanitisers used at their entrances.
Government regulations for hand sanitisers:
As a result, the South African Government recently released guidelines stating that alcohol hand sanitisers must have a minimum concentration of 70% alcohol for the purposes of eliminating the COVID-19 virus, and the South African Bureau of Standards (SABS) amended SANS 490: their requirements for all alcohol-based hand sanitisers and hand rub.
These local changes have been driven by guidelines from both the World Health Organisation (WHO) and the South African Health Products Regulatory Authority (SAHPRA) in their fight against the Coronavirus pandemic.
But to understand whether alcohol is really better, let's take a closer look at both types of sanitiser: alcohol-based sanitisers and non-alcohol sanitisers.
Alcohol-based hand sanitisers
Enveloped viruses such as Zika, Ebola, and Coronaviruses (SARS, MERS) are effectively inactivated by sanitisers with alcohol levels meeting the WHO guidelines.
H1N1 flu and Hepatitis C are more resistant to sanitiser than the other enveloped viruses, while non-enveloped viruses - such as norovirus, poliovirus and adenovirus - show far higher resistance to alcohol-based sanitisers.
Effect on skin:
Comparisons of repeated exposure to alcohol-based disinfectant and a detergent found the alcohol disinfectant caused less skin irritation and disruption to the skin barrier. Frequent use of alcohol-based hand sanitisers can, however, cause skin dryness, so humectants (moisture retainers) or skin conditioners are added - the most common of which is glycerin.
The more humectant that is added, the greater the effect, but there has to be a balance between how humectant changes the efficacy, the feel of the sanitiser, and the humectant properties of the sanitiser. High concentrations of humectant slow down the sanitiser's drying time and make it feel sticky, especially when used repeatedly.
I'm sure you've experienced different formulations of alcohol sanitiser: some are very runny, drip off the hands and around the sanitiser station and evaporate quickly, while others feel sticky and leave a dirty residue on the hands. This is caused by the different amounts of humectant and gel. Runny sanitisers have reduced contact time on the hands, making them less effective.
More importantly, however, glycerin lowers the antimicrobial activity of the alcohol in the sanitiser. The first WHO formula used a concentration of 1.45%, but this was found to give inadequate protection. The concentration of glycerine was halved, which enabled it to comply with efficacy standards (EN12791) for antimicrobial activity while still giving the skin some protection from the drying effect of alcohol.
Non-alcohol sanitisers are not as well-known as alcohol-based ones, and the fact that the WHO and our local government guidelines specify an alcohol content of 70% has understandably made the public wary of non-alcohol sanitisers.
There is good evidence, however, that other compounds are effective against not only the more well-known – pre-pandemic – bacteria, viruses and fungi, but also Coronaviruses, including SARS-CoV-2.
The EU has several standards for testing the efficacy of hand sanitisers (termed hand rubs) against bacteria, viruses, yeasts, fungal spores and mycobacteria, so non-alcohol sanitisers can be laboratory-tested and legally marketed with claims of efficacy. The UK adopted the EU REACH regulations covering the use of household and industrial chemicals in January 2021.
Quaternary ammonium compounds, including benzalkonium chloride (called quats or QATs) and chlorhexidine are detergents that have good antimicrobial properties. They are widely used as disinfectants and as ingredients in household products such as mouthwash. The EPA even lists them as approved ingredients for disinfectants suitable for use against SARS-CoV-2
And a new Brigham Young University (BYU) study, recently published in The Journal of Hospital Infection, finds that alcohol-free hand sanitizer is just as effective at disinfecting surfaces from the COVID-19 virus as alcohol-based products.
“Our results indicate that alcohol-free hand sanitizer works just as well, so we could, maybe even should, be using it to control COVID,” said BYU graduate student Benjamin Ogilvie, who originally conceived the idea for the study.
Alcohol-free hand sanitisers, which are also effective against common cold and flu viruses, have a number of advantages over their alcohol-based counterparts, Ogilvie explained.
Effects on skin:
“Benzalkonium chloride can be used in much lower concentrations and does not cause the familiar ‘burn’ feeling you might know from using alcohol hand sanitizer. It can make life easier for people who have to sanitise hands a lot, like healthcare workers, and maybe even increase compliance with sanitising guidelines.”
A big advantage of quats is their persistence on the skin and surfaces after application. A study found benzalkonium chloride had good antibacterial activity on the skin up to four hours after application (the study only tested up to four hours), while an alcohol sanitiser showed little effect only one hour after application.
So which is better?
Both types of hand sanitiser can provide an effective and convenient product for killing or inactivating microorganisms, as long as they are used properly: which means using the right quantity, covering the hands properly and for the right length of time on the skin (for alcohol-based formulae).
Even with sufficient alcohol concentration, the other ingredients can affect the effectiveness of alcohol-based sanitisers. The formulation can make them too runny, too sticky and less effective in antimicrobial activity. Alcohol is a fire hazard and also a poisoning hazard, especially for small children who may be able to consume toxic quantities from larger containers.
Non-alcohol sanitisers are a viable alternative to the ubiquitous alcohol-based products. They are as effective against microorganisms, but have the advantage of providing longer-lasting protection on the skin, are kind to the skin and are safer overall. They can also reduce the pressure on supplies of alcohol.
Initial is proud to advise customers that we offer a range of sanitisers, including 70% pure alcohol, 60% Isopropyl alcohol combined with active ingredient additives, and non-alcohol based hand sanitisers. Download your Ultimate Guide to Bathroom Hygiene, or why not contact us to book a Hygiene Survey with our team of hygiene experts.
You may also be interested in finding out what goes into our range of sanisters - download more information here.