Hand sanitizers can't replace soap and water

Let's leave the hype behind and get sensible about hand sanitizers. There's a time and place for them but as backup only. In fact, even in response to the swine flu (H5N1) threat, the Public Health Agency of Canada's first piece of advice? "Wash your hands often and thoroughly in warm, soapy water."

In 2005, after conducting tests, a panel of experts and industry representatives gathered by the U.S. Food and Drug Administration found "no firm scientific evidence that the flood of antimicrobial products we observe has any discernible benefit over the use of regular soap and water."

Depends on the dirt
Several other studies found the longer it's been since you've washed your hands the less effective your hand sanitizer is going to be. Hand sanitizers won't work on really dirty hands. They work best on a relatively clean surface, like on the hands of doctors and nurses who wash frequently.

It also depends on what kind of germs hand gels are up against. They are not going to protect you in the kitchen because fatty and proteinaceous materials—the kind from meat, fish, eggs, milk, and legumes—are actually resistant to all alcohol-based sanitizers.

So when should you use hand sanitizers?
A study by the Centers for Disease Control and Prevention did find that hand sanitizers were effective in reducing gastrointestinal and other illnesses in households, schools and university dormitories, but only when used in moderation.

Another study, published last year in the journal Pediatrics, found that the combined use of surface disinfectants and hand sanitizers in elementary school classrooms reduced absenteeism due to gastrointestinal illness.

Watch the ingredients
But the CDC study also made an important proviso: the active ingredient ethyl alcohol, also known as ethanol, must have a concentration of 60 percent or higher to be effective. Otherwise, it's like washing your hands without soap. Those products with 40 percent or less alcohol were not effective in fighting any germs.

Very few brands live up to their reputations. Val Flechtner, biologist at John Carroll University conducted a test for WCPO-TV in Cincinnati, Ohio using the 12 leading brands. Only Purell and Germ-X (each with 62 percent ethyl alcohol) were able to reduce bacteria.

Dangerous for kids
The downside to the higher dosage is the danger of alcoholic poisoning to children. A couple of squirts are enough to overdose a child, particularly very young children who are constantly putting their fingers in their mouths. Soap and water, along with plenty of nagging, is still the best way.

Impossible goals
There are also some concerns that being overly clean can actually strip away the skin's natural oils, making us more prone to bacterial infection. "The goal is to annihilate all germs. But that isn't possible and it's not necessary or desirable. We rely on bacteria and viruses as part of our environment," said Kimberly Thompson, a professor at Harvard University and author of Overkill: Repairing the Damage from our Unhealthy Obsession with Germs, Antibiotics and Antibacterial.

Nothing can replace good old fashioned soap and water. Be sure to read our article: Mother Nature's best antibacterial: your hands!