Recently news coverage has focused on the dangers of hand sanitizer, or the over-zealous use of it, in both the healthcare and home environments. It is a product the now seems so commonplace that we hardly notice it when the dispenser is mounted to the wall in a mall outlet or airport terminal. Any ride on the San Francisco Muni system displays a hilarious rush of hands into purses as the passengers unload, all leading to the retrieval of small plastic bottles of sanitizers, and quick squirts of purification from the taint of public transportation. People even offer their supply of sanitizer to strangers and I usually see it gratefully accepted. On a visit to UCSF Hospital you will see sanitizer used everywhere, in addition to constant hand washing and clean sterile technique, and I admit it is comforting to see when you are a patient. It, like the white walls and muted music tones, makes the environment feel safe, clean and protected from the world of invisible bacteria that lurks around us.
Is all this use of chemical sanitizers without risk? Are their merits more valuable than their potential drawbacks? Let’s start by looking at what is in many hand sanitizers.
Triclosan is a commonly used anti-bacterial agent in hand sanitizers. It does work well to kill bacteria but some animal studies have found it to be a hormone disruptor leading to endocrine issues in the animals. While animal studies often do no translate into the same effect in human bodies there have been enough of these animal studies done to raise the attention of the FDA which is looking into re-examining Triclosan as a safe ingredient.
Parabens are used in a wide variety of liquid products in the home and can be found in a number of hand sanitizer brands. Parabens have long been suspected of being linked to cancers and disruptions in the reproductive and endocrine systems of humans. You can look for any ingredients on the labels of your products ending in the suffix ‘paraben’.
Fragrances are included in many products to give them a pleasant smell. Something we often crave with hand products so that we have a re-assurance of the clean factor with a clean smell. Fragrances in any product are far removed from natural smells we might find in our environment and are recreated through a concoction of chemicals which are hard to even pronounce.
What about the health care setting? I think it is the best option that we have in many settings for the prevention of disease in crowded clinic environments. While there may be drawbacks to the use or make up of sanitizers they are still needed and valuable to the health worker. Think about field hospitals with no running water, battlefield environments, clinics without access to running water. These are all setting that need and should have access to hand sanitizer because they lack the traditional hot water and soap option that hospitals have.
Should we be using sanitizer during the day while we go about our errands or play with our children? I think the verdict is still out on that and each person needs to decide for themselves about the costs and benefits. We do know that bacterial resistance is growing all over the world and hand sanitizers are contributing to this. We know that children grow stronger through the gradual exposure to the many illness and bacteria in the environment and if we do too much to deny them this exposure they actually become more vulnerable to infection I the future and respond more slowly to medications.
It is a complicated issue that I hope the FDA will continue to review and each person should do there best to get all their options from accredited websites like the CDC, NIH or FDA and not from general websites, even this one. Go do your own research and decide for yourself what is best for you and your family in good health.
