Abstract

Hand sanitizer is the best choice to maintain the hand hygiene and stopping the spread of infectious diseases. The active ingredient in traditional hand sanitizers is usually alcohol, but worries about flammability, skin irritation, and possible abuse have prompted the creation and growing popularity of alcohol-free substitutes. The purpose of this review is to objectively assess the safety, effectiveness, and usefulness of alcohol-free hand sanitizers. To successfully eradicate germs, alcohol-free hand sanitizers rely on substitute active ingredients, such as triclosan, quaternary ammonium compounds, or benzalkonium chloride. Research evaluating the performance of alcohol-free sanitizers against their alcohol-based equivalents has yielded inconsistent findings; some have demonstrated that the two types of sanitizers are equally successful in lowering bacterial counts, while others have highlighted variations in the range and duration of action. Additionally, issues with microbial resistance and the durability of antimicrobial agents on skin have been brought up. Alcohol-free hand sanitizers depend on different active ingredients, like triclosan, quaternary ammonium compounds, or benzalkonium chloride, to effectively kill germs. Research evaluating the performance of alcohol-free sanitizers against their alcohol-based equivalents has yielded inconsistent findings; some have demonstrated that the two types of sanitizers are equally successful in lowering bacterial counts, while others have highlighted variations in the range and duration of action. Additionally, worries have been raised regarding the potential for bacterial resistance and the persistence of antimicrobial agent residue on skin. Safety concerns are quite important, especially when it comes to potential allergies and skin irritation. Formulations without alcohol tend to be less drying and irritating than those with alcohol, which makes them appropriate for daily use for people with sensitive skin. To ascertain the long-term consequences of consistent exposure to various active ingredients, more study is necessary. The practical ramifications encompass evaluations of affordability, usability, and accessibility. In places like hospitals, schools, and other sectors where alcohol-based products are prohibited or unwelcome, alcohol-free hand sanitizers are advantageous. Still, there are obstacles in the way of gaining broad acceptance and guaranteeing adherence to hand hygiene protocols. In comparison to conventional alcohol-based formulations, alcohol-free hand sanitizers show promise as a viable substitute, providing similar effectiveness with maybe less safety risks. To clarify their long-term effects and adjust their formulation for optimal efficacy and consumer acceptance, more research is necessary.

Keyworde: Hand hygiene, sanitizer, alcohol, infections, microbial resistance

Full Text PDF

Refrences:

1. Singh P, Potlia I, Malhotra S, Dubey H, Chauhan H. Hand sanitizer an alternative to hand washing—
a review of literature. J Adv Oral Res. 2020;11(2):137–42.
2. Kumar S, Das A. Hand sanitizers: Science and rationale. Indian J Dermatol Venereol Leprol.
2021;87(2):309–14.
3. Srinivasan S, Cui H, Gao Z, Liu M, Lu S, Mkandawire W, et al. Structural genomics of SARS-CoV-
2 indicates evolutionary conserved functional regions of viral proteins. Viruses. 2020;12(4):360.
4. Duane B, Pilling J, Saget S, Ashley P, Pinhas AR, Lyne A. Hand hygiene with hand sanitizer versus
handwashing: what are the planetary health consequences? Environ Sci Pollut Res Int.
2022;29(32):48736–47.
5. Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, Dekay K, Hoffmann KK, et al.
SHEA/IDSA/APIC practice recommendation: Strategies to prevent healthcare-associated
infections through hand hygiene: 2022 update. Infect Control Hosp Epidemiol. 2023;44(3):355–76.
6. Marumure J, Makuvara Z, Alufasi R, Chapungu L, Gufe C. Effectiveness of hand sanitizers in the
prevention of COVID-19 and related public health concerns: A review. Cogent Public Health.
2022;9(1):2060904.
7. Huddleston JT. The history of hand sanitizer—how the coronavirus staple went from mechanic
shops to consumer shelves [Internet]. 2020. Available from:
https://www.cnbc.com/2020/03/27/coronavirus-the-history-of-hand-sanitizer-and-why-its-
important.html
8. Bedi J. Lupe Hernandez and the invention of hand sanitizer. Lemelson Center Study Invention
Innov [Internet]. 2020. Available from: https://invention.si.edu/lupe-hernandez-and-invention-
hand-sanitizer
9. Gold NA, Mirza TM, Avva U. Alcohol Sanitizer. In: StatPearls [Internet]. StatPearls Publishing;
2023. Available from: https://pubmed.ncbi.nlm.nih.gov/30020626/
10. Greenaway RE, Ormandy K, Fellows C, Hollowood T. Impact of hand sanitizer format
(gel/foam/liquid) and dose amount on its sensory properties and acceptability for improving hand
hygiene compliance. J Hosp Infect. 2018;100(2):195–201.
11. Song X, Vossebein L, Zille A. Efficacy of disinfectant-impregnated wipes used for surface
disinfection in hospitals: a review. Antimicrob Resist Infect Control. 2019;8:1–4.
12. World Health Organization. WHO guidelines on hand hygiene in health care. First global patient
safety challenge: Clean care is safer care [Internet]. 2009. Available from:
https://pubmed.ncbi.nlm.nih.gov/23805438/
13. Block SS, editor. Disinfection, sterilization, and preservation. Philadelphia: Lippincott Williams &
Wilkins; 2001.
14. Lilly HA, Lowbury EJ, Wilkins MD, Zaggy A. Delayed antimicrobial effects of skin disinfection
by alcohol. Epidemiol Infect. 1979;82(3):497–500.
15. MacGibeny MA, Wassef C. Preventing adverse cutaneous reactions from amplified hygiene
practices during the COVID-19 pandemic: How dermatologists can help through anticipatory
guidance. Arch Dermatol Res. 2021;313(6):501–3.
16. Pandey S. Has the increased use of hand sanitizers during the pandemic impacted antimicrobial
resistance? Microbiol Soc. 2021.
17. O’Donoghue M, Ho JM, Pittet D, Suen LK. Acceptability and tolerability of alcohol-based hand
hygiene products for elderly residents in long-term care: A crossover study. Antimicrob Resist Infect
Control. 2019;8:1–10.
18. Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, Dekay K, Hoffmann KK, et al.
SHEA/IDSA/APIC practice recommendation: Strategies to prevent healthcare-associated
infections through hand hygiene: 2022 update. Infect Control Hosp Epidemiol. 2023;44(3):355–76.
19. Sandoval CJ, Cain PA, Diamond SF, Love JC, Smith SE, Nabipour S, et al. Legal education during
the COVID-19 pandemic: Put health, safety, and equity first. Santa Clara Law Rev. 2020;61:367–
94.
20. Fu L, Le T, Liu Z, Wang L, Guo H, Yang J, et al. Different efficacies of common disinfection
methods against Candida auris and other Candida species. J Infect Public Health. 2020;13(5):730–
6.
21. Sanitizer AB. Hand sanitizer use out and about. [Internet]. 2021. Available from:
https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
22. Kramer A, Below H, Bieber N, Kampf G, Toma CD, Huebner NO, et al. Quantity of ethanol
absorption after excessive hand disinfection using three commercially available hand rubs is
minimal and below toxic levels for humans. BMC Infect Dis. 2007;7:1–2.
23. Fire Safety Support. Is hand sanitizer flammable? [Internet]. Available from:
24. Allan M, Lièvre M, Laurenson-Schafer H, de Barros S, Jinnai Y, Andrews S, et al. The World Health
Organization COVID-19 surveillance database. Int J Equity Health. 2022;21(Suppl 3):167.
25. Saha T, Khadka P, Das SC. Alcohol-based hand sanitizer–composition, proper use, and precautions.
Germs. 2021;11(3):408.
26. Pope V, Ousley L. Irritant contact dermatitis caused by hand sanitizer use and handwashing during
the COVID-19 pandemic. Consultant. 2020;60(7).
27. Lachenmeier DW. Safety evaluation of topical applications of ethanol on the skin and inside the
oral cavity. J Occup Med Toxicol. 2008;3:1–6.
28. Booq RY, Alshehri AA, Almughem FA, Zaidan NM, Aburayan WS, Bakr AA, et al. Formulation
and evaluation of alcohol-free hand sanitizer gels to prevent the spread of infections during
pandemics. Int J Environ Res Public Health. 2021;18(12):6252.
29. Ogilvie BH, Solis-Leal A, Lopez JB, Poole BD, Robison RA, Berges BK. Alcohol-free hand
30. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces
and their inactivation with biocidal agents. J Hosp Infect. 2020;104(3):246–51.
31. Santos C. Reported adverse health effects in children from ingestion of alcohol-based hand
sanitizers—United States, 2011–2014. MMWR Morb Mortal Wkly Rep. 2017;66.
32. Diepgen TL, Coenraads PJ. The epidemiology of occupational contact dermatitis. Int Arch Occup
Environ Health. 1999;72:496–506.
33. Jing JL, Pei Yi T, Bose RJ, McCarthy JR, Tharmalingam N, Madheswaran T. Hand sanitizers: A
review on formulation aspects, adverse effects, and regulations. Int J Environ Res Public Health.
2020;17(9):3326.
34. Singh D, Joshi K, Samuel A, Patra J, Mahindroo N. Alcohol-based hand sanitizers as first line of
defence against SARS-CoV-2: A review of biology, chemistry, and formulations. Epidemiol Infect.
2020;148.
35. Merchel Piovesan Pereira B, Tagkopoulos I. Benzalkonium chlorides: Uses, regulatory status, and
microbial resistance. Appl Environ Microbiol. 2019;85(13).
36. Chin AW, Chu JT, Perera MR, Hui KP, Yen HL, Chan MC, et al. Stability of SARS-CoV-2 in
different environmental conditions. Lancet Microbe. 2020;1(1).
37. Lindberg S. How to make your own hand sanitizer. [Internet]. 2020. Available from:
https://www.healthline.com/health/how-to-make-hand-sanitizer
38. Kolhapure SA. Evaluation of the antimicrobial efficacy and safety of PureHands herbal hand
sanitizer in hand hygiene and on inanimate objects. Antiseptic. 2004;101(2):55–7.
39. Alghamdi HA. A need to combat COVID-19; herbal disinfection techniques, formulations and
preparations of human health-friendly hand sanitizers. Saudi J Biol Sci. 2021;28(7):3943–7.
40. Chang A. Cleaning and disinfectant chemical exposures and temporal associations with COVID-
19—National poison data system, United States, January 1, 2020–March 31, 2020. MMWR Morb Mortal Wkly Rep. 2020;69.
41. Ganjhu RK, Mudgal PP, Maity H, Dowarha D, Devadiga S, Nag S, et al. Herbal plants and plant
preparations as remedial approach for viral diseases. Virusdisease. 2015;26:225–36.
42. Hammer KA, Carson CF, Riley TV. Antimicrobial activity of essential oils and other plant extracts.
J Appl Microbiol. 1999;86(6):985–90.
43. Aodah AH, Bakr AA, Booq RY, Rahman MJ, Alzahrani DA, Alsulami KA, et al. Preparation and
evaluation of benzalkonium chloride hand sanitizer as a potential alternative for alcohol-based hand
gels. Saudi Pharm J. 2021;29(8):807–14.
44. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 annual report of the American
Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd annual report.
Clin Toxicol (Phila). 2015;53(10):962–1147.
45. Golin AP, Choi D, Ghahary A. Hand sanitizers: A review of ingredients, mechanisms of action,
modes of delivery, and efficacy against coronaviruses. Am J Infect Control. 2020;48(9):1062–7.
46. Berardi A, Perinelli DR, Merchant HA, Bisharat L, Basheti IA, Bonacucina G, et al. Hand sanitisers
amid COVID-19: A critical review of alcohol-based products on the market and formulation
approaches to respond to increasing demand. Int J Pharm. 2020;584:119431.
47. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J
Antimicrob Agents. 2020;55(3):105924.
48. World Health Organization. Guide to local production: WHO-recommended handrub formulations.
World Health Organization; 2010.
49. Prajapati P, Desai H, Chandarana C. Hand sanitizers as a preventive measure in COVID-19
pandemic: Its characteristics and harmful effects. J Egypt Public Health Assoc. 2022;97(1):6.
50. Ascenzi JM. Handbook of disinfectants and antiseptics. CRC Press; 1995.