There are no studies to back me up. Despite this, I'm convinced that the use of hand sanitizer in a non-institutional setting causes people to get sick more frequently. In institutional settings (i.e. hospitals or long term care facilities), studies have definitively shown that the use of hand sanitizer dramatically reduces the risk of spreading infections from patient to patient. However, to my knowledge, the use of hand sanitizer has never been studied in the general public. Just like we have different guidelines for treating community vs. hospital acquired pneumonia, I believe the use of hand sanitizer works differently in the community than in a hospital.
In hospitals, most of the patients are already immunocompromised. They're sick. They have open wounds, catheters, tubes, and other entry points into the body that aren't in your average person walking the streets. Hospital workers must frequently wash and/or sanitize their hands in order to prevent resistant bugs from being spread patient to patient.
In the community, people are relatively healthy. They generally aren't immunocompromised in the ways that hospital patients are. In addition, a healthy person is covered from head to toe in bacteria. Lots and lots of bacteria. However, this is not a bad thing. The normal flora covering your skin and mucosal linings help keep you healthy. The presence of this normal bacteria prevent more dangerous bacteria from adhering and forming growing colonies.
I postulate that hand sanitizer in a community setting is bad for you because it does exactly what it claims to do. It kills 99.9% of bacteria on contact. The only problem is that it doesn't discriminate between bad and good bacteria. It just kills 99.9% of everything on your skin. Therefore, upon eliminating the normal flora on your skin, bad bacteria are better able to latch on and replicate unimpeded.
People seem to have this idea that we should live in a sterile environment. They spend an inordinate amount of time cleaning and sanitizing themselves and every surface they might ever touch. It's next to impossible to convince these people that they actually have an immune system, and it does fight off germs if you let it. However, when you kill off your normal flora with sanitizers, you're weakening one of your body's primary defenses against infections.
I just wish someone would do a study on this. I'm almost positive that it would show people who use hand sanitizer regularly get sick more often than people who don't.
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If hand sanitizer is so harsh that it dries or irritates the skin, causing rashes, and dermal cracking, then, of course one of the primary lines of defense, skin integrity, is compromised. A toss-up which is better? Non-irritating soap, friction, and water sounds like common sense. Recently (in the past couple years) the hospital where I work has encouraged washing dirt off hands with soap and water, but use of alcohol foam sanitizer to quickly go from room to room. I guess the rationale was the time it takes to wash thoroughly with soap and water could be decreased by using the sanitizer handwash technique, so practically which way was going to prove the most used.
When I work retail, what surprises me is various policies on eating food. Some places allow no water or even cans of soda (that to me is wrong, because we don't get enough hydration normally, anyway, and the company is just trying to limit bathroom breaks!) But, food is another idea, especially non-contained food, like things that are packaged in a way that requires touching the food item with the fingers to consume. Wrapped items in which there is no hand contact seem readily unavailable. It's a bit of an irritation to see someone eat chips with their fingers, wipe them off on a paper towel and go on about their business.
Any ideas?
We're constantly reminded that overuse of antibiotics causes resistant strains of bacteria to emerge. But we're told that frequent use of hand sanitizer does not lead to resistance. But how can it not? If we kill 99.9% what about the 0.1% that survive? And 0.1% of the bacteria on your hands is still a lot of bugs. Of course, nobody will see this as a problem until its too big to manage.
It was certainly interesting for me to read the article. Thanx for it. I like such themes and everything connected to this matter. I definitely want to read more on that blog soon.
Another great post Mike. There are studies suggesting links between more sterile environments and increases in immune diseases such as Type I diabetes. This is a topic that hits close to home with me as I wonder if all those years under an IV hood impacted my family or if it was just random bad luck.
Not only the bacterial part, but I always believe that there's still dirt on your hands when you get done sanitizing. And you're still spreading that around. Just use soap and water, and lotion when your hands dry out.
I really doubt hand sanitizer in any setting is bad for you. The only difference between hand washing and sanitation is that you're washing germs off vs killing them. When you wash you also get rid of good bacteria.
I agree with you. I think we keep our environments too free from germs in many cases. Especially for our children. I believe they are more prone to illnesses since they do not play outside as much, play in the dirt and the trees. Lack of exposure to some of these very benign germs when the immune system is developing may not be helpful.
ThePharmacyIdealist
http://pharmacyidealist.wordpress.com/
My wife and I have had severe vomitting and diarrhea (4 times in the last 6 months), after using Walgreen's hand sanitizer. We've spoilt 4 vacations thanks to this product. Now the pattern is very clear- if we use the hand sanitizer and eat we get an infection type of reaction in our stomach's! Don't know if this is happening only to us or to many people and they just don't understand why they are falling ill so often (we didn't realize this pattern for 6 months)!
There are actually several studies of the use of hand sanitizer in school settings and, in all cases, absenteeism of both students and teachers decreased between active groups and controls. When you think of your hands as a vehicle of transmission in that everything you touch, whether your mouth, eyes, nose, another object, etc can essentially be contaminated with whatever is on your hands, it makes sense to keep them clean. In addition, the process is dynamic, not static. So hand washing and hand sanitizer must be repeated frequently or at least as much as you feel you are exposed to pathogenic microbes in order to be effective. The issue with excessive hand washing or use of alcohol santiziers is that the skin barrier function can be compromised and cracks, etc can form in the skin, allowing the microbe to DIRECTLY enter the body rather than through the more traditional hand to mucus membrane route.
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