With the rise of hospital and health care related infections, there has been a needed push to improve the frequency and effectiveness of hand washing by health care workers. This has spilled over into the general consumer market with a plethora of anti-bacterial soaps and hand cleaners now available. Enter 2020 with Covid and now everyone is more conscientious of hand hygiene. You might be surprised to learn that these anti-microbial soaps don’t actually work as well as you might think and worse yet are linked to health risks including cancer, developmental defects and hormone disruption.
List of Ingredients
Hand and skin disinfection products include soaps, gels, and foams containing alcohol (usually ethanol and/or isopropanol), triclosan, or other antiseptic ingredients like chlorhexidine, chloroxylenol (or PCMX), hexachlorophene, iodophor compounds, and quaternary ammonium compounds such as benzalkonium chloride.
Most of these chemicals “bio accumulate” which means they slowly build up in the tissues of the body, especially fat cells, where they remain as a constant reservoir. As an example of how common they are in our environment and how frequently we are exposed, triclosan is found in the urine of 75% of Americans, according to the Centers for Disease Control.
Of course, industry producers are quick to point out few studies that suggest the chemicals are safe, however, multiple research trials are piling up which show the contrary. And that doesn’t usually take into account the effects of bioaccumulation or synergy with other harmful chemicals. Are these common chemicals dangerous? Let’s examine just one of the most commonly found anti-microbial ingredients, triclosan.
Triclosan was developed as a surgical scrub for medical professionals and is also used in pesticides. It is found in about 140 consumer products including liquid soaps, hand sanitizers, dishwashing liquids, shaving gels and even socks, workout clothes, pillows and toys. In recent years, it has been added to a host of products to kill bacteria and fungus and prevent odors. It can be found in everything from kitchen cutting boards to shoes, often packaged with labels that tout “antibacterial” properties.
Numerous studies show that triclosan disrupts thyroid function and acts similar to the female estrogens and male androgens. Animal studies confirm liver cancer as a risk and show it affects breast cancer cells. It has been found to disrupt early growth and development, making it frightening to consider that one study found triclosan in the breast milk of 98% of the American mothers tested. Bacterial resistance is another problem resulting from the overuse of triclosan. 58% of rivers in America have been found to contain significant amounts of triclosan, which has been linked to toxic effects in various aquatic animals.
As a result of being in so many different types of products, triclosan is regulated by three different federal agencies: the FDA, the EPA and the Consumer Product Safety Commission. But the FDA, which oversees its use in personal-care products, has been working for nearly 40 years to establish the rules for the use of triclosan finally in 2017 banned it for use in over-the-counter products.
The rest of the mentioned chemicals have similar safety issues. The alcohols are clearly the safest, especially since they evaporate from the skin quickly, but even they are absorbed and measurable in the bloodstream. Ethanol is the same type of alcohol found in familiar alcoholic beverages, while isopropanol is found in rubbing alcohol. Our liver is well adapted to metabolize modest amounts of ethanol, thus, my research points to ethanol as the safest of the typical chemicals for use in hand cleansers.
What Works to Kill Germs
The best of the standard anti-microbial hand hygiene products contain alcohol, usually ethanol or isopropanol, with both broad spectrum and immediate effects. The germ-fighting power of triclosan and chlorhexidine is both lower and slower. There are a few exceptions to the rule, for example hand washing still works the best for specific bacteria such as Clostridium difficile.
The alcohols are typically found in hand rubs such as brand name Purell, while triclosan and chlorhexidine are mostly in anti-bacterial soaps and lotions, especially in health care settings. Unfortunately, in addition to ethanol, most hand rubs also have other ingredients that raise health risk concerns, such as fragrances and thickeners, so read the labels carefully.
Washing with plain soap is helpful at physically removing a large number of the bacteria and viruses from the skin and using anti-microbial soaps is slightly better. However, neither comes close to the effectiveness of alcohol based hand rubs.
Poor compliance with hand hygiene protocols is an ongoing issue in health care settings. Although most hospitals have made serious efforts at solving this problem we still have room for improvement. Health care workers complain that hand hygiene is difficult due to lack of time, inconvenience, understaffing, hand irritation and dryness, and skepticism over importance. A perceived low risk of cross contamination and the belief that gloves offer enough protection fool some, while others admit they just forget.
Just getting health care workers to use good hand hygiene protocols is half the battle. Several studies show that the alcohol based hand rubs are not only more effective but also way simpler and used more often than the soap and water approach. The result is better infection control, less costs and less time to implement.
In my house, and in my offices, we’ve found a safe and effective protocol for excellent hand hygiene. We use regular soap and water a few times per day, followed by alcohol rubs after every patient encounter. We carry alcohol hand rubs in the car for use when out and about. There is no need to use soap and water immediately after using alcohol rubs
There are numerous “all natural” hand cleansers that work well. Some contain essential oils, such as Thieves from Young Living, and it has been shown to be highly effective. Hand Sanz by All Terrain is one of the safest ethanol-based alcohol rubs I’ve found, as it does not contain other toxic chemical thickeners or fragrances.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.