All guest blog posts only reflect the views of the writer and are not necessarily the positions or views of HASA.
Image by Ketut Subiyanko
By Elsabé Brits
Everyone has been using extraordinary amounts of alcohol-based sanitizer on our hands for more than two years, but do we still need them?
A security guard is positioned at the entrance of a shop. He forces everyone to sanitise their hands and prevents anyone from entering if they don’t comply. Within the space of an hour, on a busy list of errands, you could be sprayed with various unlabelled, strong-smelling concoction, between, say the pharmacy, the stationer’s and the grocer. Repeat the next day, and days following.
Recently a study was published in Nature which reported: “Unfortunately, many media and anecdotal reports indicate that many alcohol-based hand sanitisers sold in South Africa are substandard and some contain potentially toxic ingredients.” https://www.nature.com/articles/s41598-022-08117-z. The study aimed to identify hand sanitisers used in the Johannesburg area during the CoViD-19 pandemic that do not contain the recommended alcohol concentration of at least 70% propanol or 60% ethanol, and that do contain traces of toxic ingredients. Hand sanitizers randomly collected from various traders around Johannesburg were analyzed. Of the 94 hand sanitiser samples collected, three preparations contained no alcohol, whereas the rest contained either ethanol, 2-propanol or 1-propanol or a combination of two alcohols. Of the alcohol-containing hand sanitizers, 37 (41%) contained less than 60% alcohol. Ethyl acetate, isobutanol and other non-recommended alcohols (methanol and 3-methyl-butanol) were also identified.
Consumers are therefore warned that among the many brands of hand sanitizers found around Johannesburg, there are some substandard preparations and some that contain traces of toxic ingredients. They are not fit for human use.
“The tendency for unscrupulous manufacturers in South Africa is to mislead the public by labelling their products as “SABS Approved” yet not carrying the SABS Mark Scheme number. The SABS provides on its website the information that must be available on every container of approved hand sanitizer sold in South Africa,” according to the study.
I am all for proper hand hygiene, by washing hands more regularly, especially to prevent the spread of influenza. It is a scientifically proven fact that regular hand-washing and good hygienic habits are associated with a reduced risk of influenza infection.
According to the Centers of Disease Control and Prevention, soap and water are more effective than hand sanitisers at removing certain kinds of germs, like Cryptosporidium, norovirus, and Clostridium difficile Although alcohol-based hand sanitisers can inactivate many types of microbes very effectively when used correctly people may not use a large enough volume of the sanitisers or may wipe it off before it has dried. They add that many studies show that hand sanitizers work well in clinical settings like hospitals, where hands come into contact with germs but generally are not heavily soiled or greasy. Some data also shows that hand sanitisers may work well against certain types of germs on slightly soiled hands. However, hands may become very greasy or soiled in community settings, such as after people handle food, play sports or work in the garden, or go camping or fishing. When hands are heavily soiled or greasy, hand sanitizers may not work well. Handwashing with soap and water is recommended in such circumstances.
Despite the benefits of sanitisers against Covid-19, use can lead to dry skin and alcohol poisoning. Children are considered more prone to alcohol poisoning and which is other major health concern. One sometimes sees the smallest of children holding their hands out to be sanitised, but is it necessary for a toddler to be sprayed with such a solution several times a day? The question should be raised and answered.
It has been observed that excessive use of alcohol- based hand sanitisers can lead to drug resistance, Repeated exposure of disinfectants, antibiotics, or other genotoxic chemicals to microorganisms can cause them to mutate through natural processes, making them resistant to repeated use of hand sanitiser, according to a study in Current Research of Toxicology. (see https://www.sciencedirect.com/science/article/pii/S2666027X2100013X) Bacteria can also develop resistance to certain cleaning chemicals if they are repeatedly exposed to a lower concentration or if use is infrequent. Diluting the chemical, or irregular use can provide a survival advantage to the most resistant strains, which ultimately leads to an increase in the overall resistance of the microbial population.
Much research has already shown that some disinfectants are less effective against some strains of bacteria, and resistance is increasing every day. Given all the above, while there is an undoubted use and definite benefits to sanitiser use, perhaps we ought to revisit our use of them and ask whether we are gaining the full benefits we wish for, and let us simultaneously reconsider the as-important benefits of soap and water: let’s return to, and include more, such tried and tested methods. Wash your hands for a full 20-30 seconds.