Hand Sanitizers: The good, The bad and the downright dangerous
Hand sanitizers with too little alcohol in them to be effective aren’t just a rip-off, they could be lethal if relied upon by medical professionals or members of the public to protect themselves and others against diseases like COVID-19.
The Centers for Disease Control and Prevention (CDC) recommends using hand sanitizers with at least 60% alcohol when you are not able to wash your hands. But with manufacturers struggling to meet the coronavirus-induced surge in demand, products with lower alcohol levels than this, some with none at all, have been flying off supermarket shelves and out of the warehouses of online retailers, often at exorbitantly high prices.
With millions of liters of these ineffective sanitizers already having made the way into the hands (literally) of unsuspecting buyers, the good news is that authorities in the United States, Canada and Europe are cracking down on offenders. Consumers are also hitting back.
GOJO Industries, the manufacturer of Purell, is facing a series of individual and class-action lawsuits over allegedly unsubstantiated claims about the effectiveness of its hand sanitizer.
One suit specifically identifies Purell’s marketing claim that it “kills 99.9% of illness-causing germs” as misleading and seeks damages for all consumers who “relied upon the product’s packaging and marketing materials” when making a purchasing decision.
The company has described the complaints as “without merit”, despite a January 17, 2020 letter from the U.S. Food and Drug Administration (FDA) warning that the language used on websites and social media accounts used to promote Purell was misleading.
Some of the hand sanitizers made by Purell and its rival Germ-X use benzalkonium chloride instead of alcohol as the active ingredient. The CDC warns that non-alcohol products like these may not work as well for many types of germs, merely reducing the growth of germs rather than killing them.
More recently, on May 19 it was revealed that the French fraud office had recalled Symex hand sanitizer gel after discovering that it does not contain enough ethanol to provide antiviral or antibacterial protection. This followed an investigation in April by a French media company which tested the gel and found it contained just 27% alcohol.
Alcohol in sanitizers: striking the right balance
While the CDC recommends hand sanitizers contain a minimum of 60% alcohol, there’s some debate over what the optimum amount is to protect users, not only against viruses like the one responsible for COVID-19, but also against bacterial-based diseases.
While some manufacturers continue to insist that levels of 60% are sufficient, there’s a growing consensus among experts that levels of between 70% and 85% strike the right balance between optimally effective and overkill.
According to an article on the National Center for Biotechnology Information website by researchers Nina A. Gold of Hackensack University Medical Center in New Jersey and Usha Avva of Joseph M. Sanzari Children’s Hospital, at the same university, most alcohol-based hand antiseptics contain isopropanol, ethanol, n-propanol, or a combination of two of these products.
“Ethanol, the most common alcohol ingredient, appears to be the most effective against viruses; whereas, the propanols have a better bactericidal activity than ethanol,” they said, adding that a combination of alcohols may have a “synergistic effect”.
The researchers also found that alcohol-based hand sanitizers are “tremendously effective” in preventing the spread of the seasonal flu, H1N1, URI, and other viral-based and bacterial-based diseases.
“Ethanol hand sanitizers were significantly more effective than hand washing with soap and water for removal of detectable rhinovirus, the most frequent cause of the common cold, from hands.”
A higher alcohol and lower moisture content makes it easier to use these sanitizers on paper, electronics, phones, elevator buttons etc. It also reduces the absorbance into porous materials like fabrics and allows for quicker, more effective destruction of pathogens.
Lower moisture content also allows the sanitizer to dry within the 20–30 second time frame recommended by the World Health Organization for optimal effectiveness, although other research found that using too much of any sanitizer lengthens the drying time and lowers its efficacy.
There is, however, such a thing as too much alcohol in a hand sanitizer, with more than 95% viewed as the maximum effective amount. That’s because some water is necessary to make sanitizers work properly.
Impurity alert
Dangerously low alcohol levels aren’t the only risks facing consumers. Some hand sanitizers have been found to contain potentially harmful levels of impurities.
On June 7, Science Times reported that Health Canada had issued a recall for five hand sanitizer brands because the alcohol in them is industrial grade. It warned in an advisory to the public that industrial-grade ethanol in the products contains impurities that are not found in the type of ethanol more commonly used in hand sanitizers and that frequent use of these products may result in dry skin, causing irritation or cracking.
“Since industrial-grade ethanol has not been approved for use in hand sanitizers in Canada, the Department has not reviewed it for safety or efficacy,” the advisory said.
The products listed in the recall are Eltraderm Hand Sanitizer, Contract Packaging Distributions Inc. hand sanitizer, Gel 700 Hand Sanitizer from Nature’s Own Cosmetic Company Inc., Sanilabs Hand Sanitizer, and Walker Emulsions Hand Sanitizer.
And manufacturers aren’t the only apparent culprits. Time.com reports that the owner of a 7-Eleven in River Vale, New Jersey, in the U.S., was arrested for allegedly making and selling a “spray sanitizer” after social media posts showed three 10-year-old boys and one 11-year-old boy had suffered apparent burns on their arms and legs after using the product.
The store owner allegedly mixed commercially available foaming sanitizer with water and packaged it for resale. A chemical reaction from the mixture caused the burns, according to Bergen County prosecutors.
So, what is the reason for the spike in the numbers of hand sanitizers containing potentially harmful levels of industrial grade ethanol?
A major contributing factor has been the financial hammer blow suffered by U.S. ethanol producers after states instituted stay-at-home orders in March in an effort to curb the spread of COVID-19. According to Reuters, by 30 April fuel ethanol production had fallen to a record low of 537,000 barrels per day as gasoline demand slumped. Fuel demand had dropped by roughly 30% worldwide.
In an attempt to stay afloat, many pivoted from producing alcohol for fuel to making it for hand sanitizer. But in so doing, some fell afoul of the FDA for products containing high levels of impurities.
The FDA on April 15 issued limits on certain chemicals permitted in alcohol-based hand sanitizer, updating temporary guidance it adopted the previous month as the health crisis deepened and more manufacturers registered to produce hand sanitizer.
Since then, according to the Reuters report, the FDA has notified several fuel ethanol companies that their product does not meet safety standards, forcing them to halt production and cancel supply agreements.
“In one case, the FDA said it had found significant levels of the carcinogen acetaldehyde in ethanol supplied by a company for use in hand sanitizer, according to a recent email exchange seen by Reuters,” the article said.
However, in a concession likely to bring some relief to ethanol companies, the FDA in early June announced it would relax regulations on impurities in alcohol-based hand sanitizer. Its commissioner Stephen M. Hahn said this was done to “help ensure widespread access to hand sanitizers during the COVID-19 public health emergency.”
The updated guidance allows hand sanitizer to include up to two parts per million of benzene.
Sanitizer buying tips
So, what should a consumer or commercial buyer of alcohol-based hand sanitizer do to ensure they’re getting an effective product?
First, check whether the product contains enough alcohol, at least 60%, but preferably higher — between 70% and 85%. Products described as “non-alcoholic” or “alcohol-free” are a no-no. If a brand doesn’t list its alcohol content, don’t buy it.
Commercial buyers should take this a step further and look beyond alcohol levels to ensure the purity of the product they’re purchasing. Reputable companies are now providing certificates of analysis on their products. They should at least meet, but preferably exceed, the FDA’s current, temporarily lower requirements.
Image Credit: @kellysikkema
