We Must Stop Our Overuse Of Alcohol-Based Hand Sanitizer [Opinion]

We use hand sanitizer too often and could be damaging our health. As early as 2002, researchers have had suspicions that alcohol-based hand sanitizers might have negative consequences. People might not want to hear about it, but a decade and a half ago, research published in the Journal of Antimicrobial Chemotherapy claimed that alcohol-based hand sanitizers might induce biofilm that could contribute to the development of foreign body-related infections. Six years later, a study published in the American Journal of Infectious Control essentially mirrored the earlier finding and claimed that "biofilm production and, therefore, the pathogen potential of S. epidermidis can be induced by alcohol."

Many of us have suspected that hand sanitizers might allow only the worst microbes to remain and spread across our skin, but way back in 2008, American researchers discovered that the ingredients in our hand sanitizer bottles can actually induce the production of pathogenic biofilm. Induce it! These aren't the only studies that show this either. These are just two of many.

Biofilm is so much more dangerous than just lingering germs. Biofilm isn't just lingering germs, waiting until we find a sink to wash them away. It's like a practically impenetrable layer of germs. Many antibiotics can't even penetrate these biofilms. Yet, we regularly encourage each other and our children to use alcohol-based hand sanitizer habitually. We may be encouraging the creation of pathogenic biofilm on our own hands every time we use hand sanitizer. It's not just S. epidermidis either. Alcohol-based products were found to increase the formation of S. aureus as well, according to a study published in Infectious Diseases and Therapy.

"Infections associated with S. aureus in the US have a crude mortality rate of 25% along with hospitalizations resulting in approximately twice the length of stay, deaths and medical costs of typical hospitalizations," researchers wrote in a paper published in the journal Virulence. "S. aureus biofilms, once established, are recalcitrant to antimicrobial treatment and the host response, and therefore are the etiological agent of many recurrent infections."

It's shocking to me that hand sanitizers are so commonplace in our schools given the tremendous public health crisis caused by Staphylococci bacterial infections like MRSA and knowing that scientists are fully aware of the role that alcohol-based products can play in creating biofilm when used improperly. Not only is the research indicating that these products don't work as well as we have hoped, it also is indicating that alcohol-based products are causing worse problems, according to a 2012 article published in the journal FEMS Immunology and Medical Microbiology.

"Alcohol treatment also resulted in increased transcription of the biofilm-promoting genes icaA and icaD, as well as several antibiotic resistance genes. These results demonstrate that treatment of S. aureus preformed biofilms with alcohols enhances biofilm levels if maintained for extended periods. Thus, alcohols might be of limited usefulness for the eradication of preformed S. aureus biofilms."

Did you catch that? Alcohol has the potential to not only increase biofilm-promoting genes in bacteria but also encourage genes responsible for antibiotic resistance. The CDC has quite a bit to say about the impacts of antibiotic resistant bacteria.

"Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections."
The CDC lists MRSA as "Hazard Level: Serious," which is the second-highest level of severity. In the United States, there are over 11,000 deaths a year caused by MRSA. Granted, according to the CDC, some people are more at risk from infections than others. People on chemotherapy or arthritis medications, people on dialysis, people who undergo surgery, and people with weakened immune systems are all more prone to dying from bacterial infections, but that doesn't mean everyone else should feel like they are immune to bacterial infections. The CDC suggests the use of alcohol-based hand sanitizers only when access to handwashing sinks is not available.

In many classrooms across the nation, there will be a bottle of hand sanitizer sitting a foot away from a handwashing sink. The CDC does explain many situations when alcohol-based hand sanitizers might be needed, especially in a healthcare setting, but it does not excuse the seemingly overzealous reliance so many Americans have towards these little bottles of alcohol-based gels.

Staph bacteria is recognized as one of "the most frequent causes of biofilm-associated infections," according to a Current Topics in Microbiology and Immunology report, which added, "This exceptional status among biofilm-associated pathogens is due to the fact that staphylococci are frequent commensal bacteria on the human skin and mucous surfaces (and those of many other mammals)."

Biofilm of staph bacteria is a serious issue that is being extensively studied. While researchers figure out exactly what the deal is, can we all just take it easy on the alcohol-based hand sanitizers and utilize them the way the CDC suggests? The CDC says that washing our hands with plain soap and water is the most effective way to reduce the number of microbes on our hands and suggests using alcohol-based hand sanitizers that contain at least 60 percent alcohol only when soap and water are not available. If there is a sink nearby, we should use that instead of the easier alcohol-based sanitizer sitting next to it, because saving a minute isn't worth compounding upon a very serious health threat.

[Featured Image by Mayuree Moonhirun/Shutterstock]