Alcohol hand sanitizers have been actively in use in the U.S. since the mid-1990s. Initially they were implemented in the food industry to help satisfy HACCP requirements to reduce hand to food contamination. Research indicated that even washing one’s hands with an anti-microbial soap was not sufficient in eliminating cross-contamination. The problem was mostly due to not using proper technique. People would have a tendency to massage their palms when washing their hands and neglecting key areas such as the nails and cuticles, which according to the CDC can account to up to 30-40 percent of transmittable skin flora. With the implementation of hand sanitizers in conjunction with a hand washing program, bacteria levels on hands were shown to drop significantly.

Today, in addition to a significant usage in cleanroom and pharmaceutical applications, many businesses in all sectors are implementing a hand sanitizer program to help protect their employees as well as their products. Over the past few years we have read stories about SARS, flu vaccine shortage, norovirus, pandemic fears from avian flu, and most recently about the spread of MRSA outside of the hospital environment.

The healthcare industry in the U.S. was a little slower to adopt the alcohol hand sanitizer. There was always a fear that if it were adopted, there would be a drop in hand washing compliance that would then lead to a significant increase in nosocomial infections. However as infections from poor hand hygiene compliance continued to grow, even with significant awareness and training, there were indications from Europe and Asia (particularly Japan), that by including alcohol hand sanitizers as part of the hand hygiene program, there would be a significant reduction in infections. After considerable discussion, the CDC decided to recommend the use of alcohol hand sanitizers in medical facilities. When used properly, they were shown to be very effective. The hope was to not only reduce hospital acquired infections, but to also reduce healthcare workers skin problems caused by multiple hand washings while using harsh anti-microbial soaps. It was concluded that if patients had visible soils on the hands, the healthcare worker needed to wash with soap and water. When no visible soils were present, using the alcohol sanitizer was preferable.

There are many types of hand sanitizers including foams, gels, and atomizing sprays. Some include special emollients to protect the skin from drying if they are to be used on bare hands, while some require products without additives for use on gloved hands because of potential transference to products. Generally a solution of 60-70 percent of either ethanol or IPA is considered to be effective against most transient flora. It should be noted, however, that alcohol is not effective against bacterial spores, and in special circumstances such as in certain cleanroom environments, gamma radiation may be required for additional protection.

One final thing that should be noted is that the alcohol will only be effective if it gets to where the bacteria and viruses reside. As with the figure showing missed areas from hand washing, using a similar technique with hand sanitizers will also leave incomplete results. However, there is new “touchless” technology, both foot and electronic eye operated that can be used in conjunction with liquid formulas that allow the sanitizer to be atomized into a wide pattern that offers a more complete coverage, even saturating the nails and cuticles. The bottom line is that the user needs to be aware of their own particular needs and select a sanitizer and dispenser that accomplish what they want. Don’t assume that because you have washed and sanitized that your hands are bacterial free.