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Hand sanitizer: side effect of overuse to prevent COVID-19

Side effect of hand sanitizer over use to prevent COVID-19

Hand sanitizer: side effect of overuse to prevent COVID-19



COVID-19 outbreak around the world  surges demand and panic buying of hand sanitizer. The declaration of a global pandemic by the World Health Organization (WHO) and the publication of basic preventive measures also helped people to take precautions against COVID-19, then populations started to use more disinfectant for hands. In urban areas, almost all people now very often use an alcohol-based hand sanitizer to prevent infections.
There are several reasons and modes of spread of the infectious agent, but the main reason is physical contact with the hands, knowingly or unknowingly,  physical contact when peoples touching anything which possess COVID-19 or other infectious. To prevent the spread of infectious agents, frequent thorough hand washing is essential and, traditionally, peoples used water and soap, however, it is not always convenient, which encouraged the use of an alcohol-based hand sanitizer.
But the excess of everything is bad. Overuse of an alcohol-based hand sanitizer has several side effects, s0 we must reduce its use.
If we see the history of the hand sanitizer, it was not made for the general public and was limited to physicians only.


How peoples started overuse of hand sanitizer

Fear of the COVID-19 epidemic and suggestions from various healthcare agencies around the world surges the use of hand sanitizer, preferably alcohol based. The message was clear that we must maintain the hygiene and wash the hand frequently to prevent spread of infectious agent. Health care agencies have suggested washing hands with soap and water whenever possible, but in the absence of water and soap, it is best to use a hand sanitizer that contains minimum 60% alcohol. Healthcare agencies have also published guidelines for effective hand washing with water and soap as well and the safe use of hand sanitizers. They also suggested that alcohol-based hand sanitizers are the most effective at killing most infectious but cannot eliminate all types.
People forget to understand the exact use of hand sanitizer, it is not for hand cleaning, but it is made to kill the infectious agent which can be transmitted by person to person contact, directly or indirectly.
It is human tendency, if they know something beneficial for them and easier to use, they start to use and then overuse to expect more than 100% result. They adopt the practices that suit them best and, most preferably, shortcuts, they don’t have time to access the soap and water, then wipe or dry their hands, which also takes a lot of time. Compare to traditional hand washing with water and soap, the alcohol-based hand sanitizer takes less time and is easier to use.
Parents have also started enforcing their children to use hand sanitizers without knowing the side effects.
Thus, the combine effect of fear of COVID-19 and repeated recommendations from health experts increases the overuse of alcohol-based hand sanitizers.

Ingredients of hand sanitizer

There are mainly two types of hand sanitizers, alcohol based and nonalcohol based.
Ingredients of alcohol-based hand sanitizer
These type of hand sanitizers are mostly containing about 60% to 95% isopropyl or ethyl alcohol as primary ingredient mixed with distilled water, hydrogen peroxide and gels like glycol. In some sanitizer, Glycerin is added to prevent dryness of skin. Some fragrances also added by some manufacture for making hand sanitizers.
Non-alcohol-based hand sanitizer
Non-alcohol based hand sanitizers may contains triclosan or benzalkonium chloride, chlorhexidine, quaternary ammonium derivatives, hydrogen peroxide, emollients, gel, foaming agent, fragrances and distilled water.

Hand sanitizer effectiveness
Hand sanitizers are effective at killing the infectious agent, but not at cleaning the hands. Non-alcohol based hand sanitizers are less effective than alcohol-based hand sanitizer. The effectiveness of hand sanitizer depends on percentage of alcohol and should be 60% to 95%. Alcohol based hand sanitizer having less than 60 % alcohol is not effective to kill several types of infectious agents but can reduce their growth only.
Initially alcohol-based hand sanitizers made for physician and health workers for use in hospitals or clinics only where different patients are dealing and there is more risk of transmission of infectious agent via health workers hand. Of course, their hands  are not heavily soiled or greasy and frequent use of water, soap and towel is not feasible for them.
Uses of hand sanitizer is not much important for general public as they are not treating infected peoples, even not coming in contact with others frequently and most of the time they gets infected by catching respiratory viruses from direct contact with peoples. So, most of the peoples are getting infected by respiratory track where hand sanitizers won't do anything. Therefore, just washing your hands with soap and water is sufficient.
Alcohol based hand sanitizers are more effective for killing bacteria like AR and TB bacteria, many viruses causing flue, cold, corona viruses and HIV within 30 seconds except some norovirus and clostridium difficile. But still it is ineffective for food processing workers, to ensure proper hand hygiene
As we already discussed, hand sanitizers are made for physician for their use in the hospital because physician are handling many infected cases and sanitizers help them to prevent the transmission of infectious agents from one patient to another. For general public, use of alcohol-based hand sanitizer with more percentage of glycerin and other moisturizing gels effective for killing the infectious as well as preventing dryness of skin and leaving more moisture in the epidermis.

When sanitizer not effective

Hand sanitizer is not made for cleaning the hands but is for killing the infectious agent. Alcohol based hand sanitizers may not be much effective for hands those are visibly dirty or greasy, contaminated with fluids or other chemicals, for example hands of peoples those handles food, construction worker, sportsmen, garden worker or doing gardening, handling mud, playing outdoor games, farmers those are using pesticides, etc. Also, it is ineffective to remove harmful chemicals, like pesticides and heavy metals, from hands.  The general use of non-alcohol-based sanitizer is less effective even alcohol based also, you cannot use for hand washing after toilet or other mechanical workshop work.
Even some hand sanitizers having alcohol concentration less than 95% are ineffective to remove Cryptosporidium parasites , bacterial spores of Clostridioides difficile and norovirus.

Hand sanitizer overuse side effects

Human skin is made up of numbers of layers where outer three layers are most important to provide the barrier against penetration of infectious agent into our body. Stratum corneum and lucidum are the outer layers of our hand skin, which play an important protective role. This layer help to prevent penetration of viruses, bacteria, and fungi to deeper layers of the skin. Below these two layers i.e Stratum and lucidum, there is third layer called stratum granulosum is responsible to produce lipids and has natural moisturizing factor that makes our skin to hold moisture. Overuse of alcohol-based hand sanitizer can damage this important layer.

Dryness of skin and early ageing
Hand sanitizer overuse side effects
Dryness of skin due to overuse of hand sanitizer
Alcohol is volatile substance and when it comes into contact with skin, it absorbs the body temperature along with moisture to convert from liquid phase to vapour phase thus causing minor cold burn to our skin.  Frequent/ repeated use of alcohol-based hand sanitizer may damage the outer layer of our skin by deprives oil and water thus skin dryness and dehydration may cause callous formation, flaky skin, wrinkles and cracks. Frequent use also not allowing the skin to heal naturally and increasing the dryness.
It is one of the reasons why our skin become dry after repeatedly use of hand sanitizer.

Skin irritation
Over use of alcohol based hand sanitizer may cause chronic skin irritation due to damage of skin barrier function and becomes more vulnerable to other bacterial and fungal infections as dry and damaged skin cannot restrict the entry of bacteria and some viruses entering the body.

Weaken natural body immune system
Overuse of sanitizer removes skin oily contents, which may affect barrier function of the skin and increases the loss of skin lipids and thus overuse of hand sanitizer increases the risk of infection via skin disorders.
Repeated use of alcohol-based sanitizer causes dryness of skin, not allowing skin to heal naturally and damages the natural barrier against germs also dehydrate cells increase the risk of contact dermatitis.
Hand sanitizer: side effect of overuse to prevent COVID-19
Over use of hand sanitizer - weaken natural skin immune system
Too much use of sanitizer to maintain the extra hygiene may be responsible for weaken our natural immunity system against attack on bacteria or viruses because our immune system becomes jobless and then gives less performance.
Those peoples are maintaining more hygiene since early stage of life, it contributes to weaker defense by immune system at the later stage. Disturbance in natural defense system of skin may cause some chronic risk over time.

Hormonal disruption
Overuse of hand sanitizer may weaken your resistance power and oppositely strengthen infectious agent like bacteria then bacteria become more and more powerful and then your body fails to resist it.
Stratum corneum and lucidum are the outer layers of our hand skin, which play an important protective role. This layer help to prevent penetration of viruses, bacteria, and fungi to deeper layers of the skin. Long term use of sanitizers may be responsible for bacterial resistance or hormonal effects.
Non-alcohol based hand sanitizers may contains triclosan and it may cause hormonal disruption in body as this compound cause bacteria to adapt to its antimicrobial conditions and antibiotic-resistant strain leading to hormonal fluctuations in body and  hormonal imbalance can lead to infections and diseases.

Allergic effect
Some hand sanitizers contain various fragrances and possess risk of allergic reactions.

How to use hand sanitizer safely and effectively

Apply the sanitizer to the palm of one hand in correct amount as suggested by manufacture based on % of alcohol and rub it all over the surfaces of your hands until your hands are dry. Sanitizer must cover all surfaces of your both hands. Do not use large volume of hand sanitizers and don’t wipe it off before dried well. 
To ensure the effectiveness of hand sanitizer,  It should be thoroughly rubbed into the hands to cover lower forearm,  around the wrist, around the fingernails, between the fingers and thumb for at least 30 seconds and then allowed to air dry.

How to reduce the overuse of hand sanitizer

Water and soap are more effective than hand sanitizers to remove certain kinds of infectious agents, viz. norovirus, clostridium difficile, cryptosporidium, etc. Therefore, when there is well availability of water and soap, do not make the practice of sanitizer use unnecessary. When your hands are visibly soiled/ dirty, greasy and contaminated with chemicals then sanitizer is not effective, you must wash the hands with water and soap only.
History tells that alcohol-based hand sanitizer was made for physician or health workers only and not for public use therefore, washing hands with water and soap is preferable outside the healthcare center.
As we already discussed, hand sanitizers are made for physician for their use in the hospital because physician are handling many infected cases and sanitizers help them to prevent the transmission of infectious agent from one patient to another.
Uses of hand sanitizer is not much important for general public as they are getting infected by catching respiratory viruses from direct contact with peoples. So, most of the peoples are getting infected by respiratory track where hand sanitizers won't do anything. Therefore, just washing the hands with soap and water is sufficient for public.
Our body is covered with good and bad bacteria both. Good bacteria help us to keep the bad bacteria away and when we apply sanitizer, it kills both types. Therefore, hand sanitizer is effective to kill bacteria but ideal for everyday use or overuse.
Most of the health agencies are suggesting to wash your hands thoroughly with soap and water for more than 30 seconds to remove maximum percentage of bacteria when your hands are visibly dirty or contaminated with chemical because hand sanitizer is not for cleaning but it is only for killing the germs.

Can I use expired hand sanitizer?

Typically, alcohol-based hand sanitizer containing mainly about 60% to 95% isopropyl or ethyl alcohol as primary ingredient mixed with distilled water, hydrogen peroxide and gels like glycol and distill water  and if we see, alcohol have no expiration period. Therefore, using an expired hand sanitizer is no problem.
Other non-alcohol based sanitizers contain triclosan or benzalkonium chloride, chlorhexidine, quaternary ammonium derivatives, hydrogen peroxide, emollients, gel, foaming agent, fragrances and distilled water, therefore, there is also no problem for using the expired sanitizer, but the effectiveness may be reduced, therefore no sense to use it. So, in summery there is no problem for alcohol-based sanitizer, but non-alcohol-based sanitizer would not be effective after they expire.


Conclusion

Hand sanitizer is not suitable for cleaning the hands as it is made for killing the infectious agent which can be transmitted via person to person contact, directly or indirectly.
Alcohol-based hand sanitizer contains about 60% to 95% isopropyl or ethyl alcohol are best for killing most of the infectious agent including COVID-19, but best suited for physicians, health workers because they treat different patients and use of water and soap is not feasible for them. It helps them to prevent the transmission of infectious agent from one patient to another and for their own health safety. Mostly, Physicians or health workers uses these alcohol-based hand sanitizers on their hand gloves and less frequently direct contact with the skin.
Alcohol based hand sanitizers are not made for general public for regular use, but off course they can be used occasionally where there is non-availability of soap and water. But overuse of sanitizer should be limited due to its side effect like dry skin, aging, weakening of the body’s natural immune system, alcohol poisoning, etc.

Excess of everything is bad, using a hand sanitizer is best to protect yourself from infectious agent, but overuse can cause many side effects.

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