Hand sanitizers reduce the microbial load on hands without the need for soap and water. They are an important tool to help reduce the spread of illness-causing microorganisms and are useful as an adjunct to hand-washing. In settings such as health care environments, alcohol-based hand sanitizers are the preferred and recommended method of hand hygiene when the hands are not visibly soiled.1 In addition, the use of alcohol-based hand sanitizers has become an international standard for proper hand hygiene and is strongly endorsed by the Centers for Disease Control (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), the Canadian Public Health Agency, the World Health Organization (WHO), and others.
The use of hand sanitizers is expanding worldwide, in part as a result of efforts by the WHO in its Patient Safety Initiative,2 which now covers more than 85% of the world’s population.3 In fact, in 2007, USA Today included one hand sanitizera in its list of 25 inventions that have changed modern life during the past 25 years, along with the cell phone, laptop computer and the iPodb.4
In the United States, hand sanitizers fall under the purview of the US Food and Drug Administration (FDA) and are regulated as drugs. Current regulations allow hand sanitizer manufacturers to make data-supported antibacterial- related claims such as “kills 99.99% of germs.” Additional claims include, “reduces bacteria that potentially can cause disease” and “decreases bacteria on the skin.”5
The vast majority of hand sanitizers contain short chain alcohols—i.e., ethanol, 2-propanol,1-propanol or combinations thereof—as the active ingredient. In the United States, most hand sanitizers are ethanol-based; however, alternate antimicrobials are found on the market. Following is an overview of the various actives used in hand sanitizers, including their benefits and limitations.