Hand sanitizer (also known as hand antiseptic, hand disinfectant, hand rub, or handrub) is a liquid, gel, or foam used to kill viruses, bacteria, and other microorganisms on the hands. It can also come in the form of a cream, spray, or wipe. While hand washing with soap and water is generally preferred, hand sanitizer is a convenient alternative in settings where soap and water are unavailable. However, it is less effective against certain pathogens like norovirus and Clostridioides difficile and cannot physically remove harmful chemicals. Improper use, such as wiping off sanitizer before it dries, can also reduce its effectiveness, and some sanitizers with low alcohol concentrations are less effective. Additionally, frequent use of hand sanitizer may disrupt the skin's microbiome and cause dermatitis. Alcohol-based hand sanitizers, which contain at least 60% alcohol (ethanol or isopropyl alcohol), are recommended by the United States Centers for Disease Control and Prevention (CDC) when soap and water are not available. In healthcare settings, these sanitizers are often preferred over hand washing with soap and water because they are more effective at reducing bacteria and are better tolerated by the skin. However, hand washing should still be performed if contamination is visible or after using the toilet. Non-alcohol-based hand sanitizers, which may contain benzalkonium chloride or triclosan, are less effective and generally not recommended, though they are not flammable. The formulation of alcohol-based hand sanitizers typically includes a combination of isopropyl alcohol, ethanol, or n-propanol, with alcohol concentrations ranging from 60% to 95% being the most effective. These sanitizers are flammable and work against a wide variety of microorganisms, but not spores. To prevent skin dryness, compounds such as glycerol may be added, and some formulations include fragrances, though these are discouraged due to the risk of allergic reactions. Non-alcohol-based versions are less effective and should be used with caution. The use of alcohol as an antiseptic dates back to at least 1363, with evidence supporting its use emerging in the late 1800s. Alcohol-based hand sanitizers became commonly used in Europe by the 1980s and have since been included on the World Health Organization's List of Essential Medicines.
Uses
General public Alcohol-based hand sanitizers may not be effective if the hands are slimy, greasy or visibly soiled. In hospitals, the hands of healthcare workers are often contaminated with pathogens, but rarely soiled or greasy. Some commercially available hand sanitizers (and online recipes for homemade rubs) have alcohol concentrations that are too low. This makes them less effective at killing germs. Poorer people in developed countries and people in developing countries may find it harder to get a hand sanitizer with an effective alcohol concentration. Fraudulent labelling of alcohol concentrations has been a problem in Guyana.
Schools The current evidence that the effectiveness of school hand hygiene interventions is of poor quality. In a 2020 Cochrane review comparing rinse-free hand washing to conventional soap and water techniques and the subsequent impact on school absenteeism found a small but beneficial effect on rinse-free hand washing on illness related absenteeism.
Health care
Hand sanitizers were first introduced in 1966 in medical settings such as hospitals and healthcare facilities. The product was popularized in the early 1990s. Alcohol-based hand sanitizer is more convenient compared to hand washing with soap and water in most situations in the healthcare setting. Among healthcare workers, it is generally more effective for hand antisepsis, and better tolerated than soap and water. Hand washing should still be carried out if contamination can be seen or following the use of the toilet. Hand sanitizer that contains at least 60% alcohol or contains a "persistent antiseptic" should be used. Alcohol rubs kill many different kinds of bacteria, including antibiotic resistant bacteria and TB bacteria. They also kill many kinds of viruses, including the flu virus, the common cold virus, coronaviruses, and HIV. 90% alcohol rubs are more effective against viruses than most other forms of hand washing. Isopropyl alcohol will kill 99.99% or more of all non-spore forming bacteria in less than 30 seconds, both in the laboratory and on human skin. In too low quantities (0.3 ml) or concentrations (below 60%), the alcohol in hand sanitizers may not have the 10–15 seconds exposure time required to denature proteins and lyse cells. In environments with high lipids or protein waste (such as food processing), the use of alcohol hand rubs alone may not be sufficient to ensure proper hand hygiene. For health care settings, like hospitals and clinics, optimum alcohol concentration to kill bacteria is 70% to 95%. Products with alcohol concentrations as low as 40% are available in American stores, according to researchers at East Tennessee State University. Alcohol rub sanitizers kill most bacteria, and fungi, and stop some viruses. Alcohol rub sanitizers containing at least 70% alcohol (mainly ethyl alcohol) kill 99.9% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% in one minute. For health care, optimal disinfection requires attention to all exposed surfaces such as around the fingernails, between the fingers, on the back of the thumb, and around the wrist. Hand alcohol should be thoroughly rubbed into the hands and on the lower forearm for a duration of at least 30 seconds and then allowed to air dry. Use of alcohol-based hand gels dries skin less, leaving more moisture in the epidermis, than hand washing with antiseptic/antimicrobial soap and water. Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungi. Alcohol rub sanitizers containing 70% alcohol kill 99.97% (3.5 log reduction, similar to 35 decibel reduction) of the bacteria on hands 30 seconds after application and 99.99% to 99.999% (4 to 5 log reduction) of the bacteria on hands 1 minute after application.
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