Hand sanitizer: side effect of overuse 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
| 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.
| 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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