For a product that has only been widely available to the public since the late 1990's, we sure have taken to hand sanitizers. Invented by Lupe Hernandez of Bakersfield, California in 1966, when she was studying to become an RN, the product has become ubiquitous of late. I don't remember a single "back to school" classroom supplies list where my children were not either reminded to pack their own hand sanitizer for daily use or asked to bring some as a classroom supplies contribution. This week, I have noticed alcohol-based hand sanitizers of all sorts prominently displayed in advertising flyers for back to school supplies, so I suspect the trend continues.
Industry analysts track the rise of interest in and use of hand sanitizers to increased consumer awareness of the need for good hand hygiene in containing some communicable diseases and in increased media coverage of infectious disease outbreaks. The problem with this is that even alcohol-based hand sanitizers are a poor second to good thorough hand washing. Hand washing, done right, means water, soap, and a good multi-directional scrubbing of sufficient duration. Anyone who has spent more than a moment in a public restroom knows how little hand washing, done right, occurs there. Perhaps it is this knowledge that the producers of alcohol based hand sanitizers tap into when promoting the product.
The problem with this is that there are risks and costs as well as benefits associated with significant alcohol based sanitizer use. These I would describe as two fold, raising two kinds of questions about alcohol-based hand sanitizers. First, what if they don't work as believed or hoped? And, second, what if they do more than believed? The latter concerns both the fear that overuse (yet to be defined in the literature, though it is easy to imagine exceeding usage of more than four or five times a day in many settings) of alcohol based sanitizers may harm the user, a particular concern for children or women who are pregnant and the concern that overuse of hand sanitizers may connect in some way to antibiotic resistance. The former concerns the idea that use of these products is a substitute for hand washing, done right.
As if all of this isn't troubling enough, there is the sense of false safety plentiful displays of alcohol-based hand sanitizer seems to imply. And complacency, particularly concerning the diseases alcohol based hand sanitizer cannot address as nearly as well as they might be addressed by hand washing, done right — such as c difficile — may be the greatest health threat of all.
With only a little dryness, I note in my now-published paper: "Managing Our Microbial Mark: What We Can Learn About Pay for Performance From Ebola's Arrival At Our Shores" that how we became persuaded that alcohol-based hand sanitizer would save us from all communicable diseases in an increasingly small world, may be the greatest misperception aggressive marketing of the product has promoted.
As of late June of this year, the FDA has asked the antiseptic gels manufacturers to submit studies and data on the efficacy of these products as well as data and studies on risks to children and pregnant women.
Let the hand wringing — I mean, hand washing — begin.