Hand sanitizer is a liquid, gel or foam generally used to kill the vast majority of viruses/bacteria/microorganisms on the hands. In most settings, hand washing with soap and water is generally preferred. Hand sanitizer is less effective at killing certain kinds of germs, such as norovirus and Clostridium difficile, and unlike hand washing, it cannot physically remove harmful chemicals. People may incorrectly wipe off hand sanitizer before it has dried, and some are less effective because their alcohol concentrations are too low.
A typical pump bottle dispenser of hand sanitizer gel
|Other names||Hand sanitizer, hand antiseptic, hand disinfectant, hand rub, handrub|
Alcohol-based hand sanitizer that is at least 60% (v/v) alcohol in water (specifically, ethanol or isopropyl alcohol/isopropanol (rubbing alcohol)) is recommended by the United States Centers for Disease Control and Prevention (CDC), but only if soap and water are not available. The CDC recommends the following steps when using an alcohol-based hand sanitizer:
- Apply product to the palm of one hand.
- Rub hands together.
- Rub the product over all surfaces of hands and fingers until hands are dry.
- Do not go near flame or gas burner or any burning object during application of hand sanitizer.
In most healthcare settings, alcohol-based hand sanitizers are preferable to hand washing with soap and water, because it may be better tolerated and is more effective at reducing bacteria. Hand washing with soap and water, however, should be carried out if contamination can be seen, or following the use of the toilet. The general use of non-alcohol-based hand sanitizers is not recommended.
Alcohol-based versions typically contain some combination of isopropyl alcohol, ethanol (ethyl alcohol), or n-propanol, with versions containing 60% to 95% alcohol the most effective. Care should be taken as they are flammable. Alcohol-based hand sanitizer works against a wide variety of microorganisms but not spores. Compounds such as glycerol may be added to prevent drying of the skin. Some versions contain fragrances; however, these are discouraged due to the risk of allergic reactions. Non-alcohol based versions typically contain benzalkonium chloride or triclosan; but are less effective than alcohol-based ones.
Alcohol has been used as an antiseptic at least as early as 1363 with evidence to support its use becoming available in the late 1800s. Alcohol-based hand sanitizer has been commonly used in Europe since at least the 1980s. The alcohol-based version is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.
Alcohol-based hand sanitizers may not be effective if the hands are greasy or visibly soiled. In hospitals, the hands of healthcare workers are often contaminated with pathogens, but rarely soiled or greasy. In community settings, on the other hand, grease and soiling is common from activities such as handling food, playing sports, gardening, and being active outdoors. Similarly, contaminants like heavy metals and pesticides (generally found outdoors) cannot be removed by hand sanitizers. Hand sanitizers may also be swallowed by children, especially if brightly-coloured.
Some commercially available hand sanitizers (and online recipes for homemade rubs) have alcohol concentrations that are too low. This makes them less effective at killing germs. Poorer people in developed countries and people in developing countries may find it harder to get a hand sanitizer with an effective alcohol concentration. Fraudulent labelling of alcohol concentrations has been a problem in Guyana.
The current evidence for the effectiveness of school hand hygiene interventions is of poor quality.
Hand sanitizers were first introduced in 1966 in medical settings such as hospitals and healthcare facilities. The product was popularized in the early 1990s.
Alcohol-based hand sanitizer is more convenient compared to hand washing with soap and water in most situations in the healthcare setting. Among healthcare workers, it is generally more effective for hand antisepsis, and better tolerated than soap and water. Hand washing should still be carried out if contamination can be seen or following the use of the toilet.
Hand sanitizer that contains at least 60% alcohol or contains a "persistent antiseptic" should be used. Alcohol rubs kill many different kinds of bacteria, including antibiotic resistant bacteria and TB bacteria. They also kill many kinds of viruses, including the flu virus, the common cold virus, coronaviruses, and HIV.
90% alcohol rubs are more effective against viruses than most other forms of hand washing. Isopropyl alcohol will kill 99.99% or more of all non-spore forming bacteria in less than 30 seconds, both in the laboratory and on human skin.
In too low quantities (0.3 ml) or concentrations (below 60%), the alcohol in hand sanitizers may not have the 10–15 seconds exposure time required to denature proteins and lyse cells. In environments with high lipids or protein waste (such as food processing), the use of alcohol hand rubs alone may not be sufficient to ensure proper hand hygiene.
For health care settings, like hospitals and clinics, optimum alcohol concentration to kill bacteria is 70% to 95%. Products with alcohol concentrations as low as 40% are available in American stores, according to researchers at East Tennessee State University.
Alcohol rub sanitizers kill most bacteria, and fungi, and stop some viruses. Alcohol rub sanitizers containing at least 70% alcohol (mainly ethyl alcohol) kill 99.9% of the bacteria on hands 30 seconds after application and 99.99% to 99.999%[note 1] in one minute.
For health care, optimal disinfection requires attention to all exposed surfaces such as around the fingernails, between the fingers, on the back of the thumb, and around the wrist. Hand alcohol should be thoroughly rubbed into the hands and on the lower forearm for a duration of at least 30 seconds and then allowed to air dry.
There are certain situations during which hand washing with soap and water are preferred over hand sanitizer, these include: eliminating bacterial spores of Clostridioides difficile, parasites such as Cryptosporidium, and certain viruses like norovirus depending on the concentration of alcohol in the sanitizer (95% alcohol was seen to be most effective in eliminating most viruses). In addition, if hands are contaminated with fluids or other visible contaminates, hand washing is preferred as well as after using the toilet and if discomfort develops from the residue of alcohol sanitizer use. Furthermore, CDC states hand sanitizers are not effective in removing chemicals such as pesticides.
Alcohol gel can catch fire, producing a translucent blue flame. This is due to the flammable alcohol in the gel. Some hand sanitizer gels may not produce this effect due to a high concentration of water or moisturizing agents. There have been some rare instances where alcohol has been implicated in starting fires in the operating room, including a case where alcohol used as an antiseptic pooled under the surgical drapes in an operating room and caused a fire when a cautery instrument was used. Alcohol gel was not implicated.
To minimize the risk of fire, alcohol rub users are instructed to rub their hands until dry, which indicates that the flammable alcohol has evaporated. Igniting alcohol hand rub while using it is rare, but the need for this is underlined by one case of a health care worker using hand rub, removing a polyester isolation gown, and then touching a metal door while her hands were still wet; static electricity produced an audible spark and ignited the hand gel.:13 Fire departments suggest refills for the alcohol-based hand sanitizers can be stored with cleaning supplies away from heat sources or open flames.[full citation needed]
Research shows that alcohol hand sanitizers pose any risk by eliminating beneficial microorganisms that are naturally present on the skin. The body quickly replenishes the beneficial microbes on the hands, often moving them in from just up the arms where there are fewer harmful microorganisms.
However, alcohol may strip the skin of the outer layer of oil, which may have negative effects on barrier function of the skin. A study also shows that disinfecting hands with an antimicrobial detergent results in a greater barrier disruption of skin compared to alcohol solutions, suggesting an increased loss of skin lipids.
In the United States, the U.S. Food and Drug Administration (FDA) controls antimicrobial handsoaps and sanitizers as over-the-counter drugs (OTC) because they are intended for topical anti-microbial use to prevent disease in humans.
The FDA requires strict labeling which informs consumers on proper use of this OTC drug and dangers to avoid, including warning adults not to ingest, not to use in the eyes, to keep out of the reach of children, and to allow use by children only under adult supervision. According to the American Association of Poison Control Centers, there were nearly 12,000 cases of hand sanitizer ingestion in 2006. If ingested, alcohol-based hand sanitizers can cause alcohol poisoning in small children. However, the U.S. Centers for Disease Control recommends using hand sanitizer with children to promote good hygiene, under supervision, and furthermore recommends parents pack hand sanitizer for their children when traveling, to avoid their contracting disease from dirty hands.
People suffering from alcoholism may attempt to consume hand sanitizer in desperation when traditional alcoholic beverages are unavailable, or personal access to them is restricted by force or law. There have been reported incidents of people drinking the gel in prisons and hospitals to become intoxicated. As a result, access to sanitizing liquids and gels is controlled and restricted in some facilities. For example, over a period of several weeks during the COVID-19 pandemic in New Mexico, seven people in that U.S. state who were alcoholic were severely injured by drinking sanitizer: three died, three were in critical condition, and one was left permanently blind.
In 2021, a dozen children were hospitalized in the state of Maharashtra, India, after they were mistakenly orally administered hand sanitizer instead of a polio vaccine.
On 30 April 2015, the FDA announced that they were requesting more scientific data based on the safety of hand sanitizer. Emerging science suggests that for at least some health care antiseptic active ingredients, systemic exposure (full body exposure as shown by detection of antiseptic ingredients in the blood or urine) is higher than previously thought, and existing data raise potential concerns about the effects of repeated daily human exposure to some antiseptic active ingredients. This would include hand antiseptic products containing alcohol and triclosan.
Surgical hand disinfectionEdit
Hands must be disinfected before any surgical procedure by hand washing with mild soap and then hand-rubbing with a sanitizer. Surgical disinfection requires a larger dose of the hand-rub and a longer rubbing time than is ordinarily used. It is usually done in two applications according to specific hand-rubbing techniques, EN1499 (hygienic handwash), and EN 1500 (hygienic hand disinfection) to ensure that antiseptic is applied everywhere on the surface of the hand.
Some hand sanitizer products use agents other than alcohol to kill microorganisms, such as povidone-iodine, benzalkonium chloride or triclosan. The World Health Organization (WHO) and the CDC recommends "persistent" antiseptics for hand sanitizers. Persistent activity is defined as the prolonged or extended antimicrobial activity that prevents or inhibits the proliferation or survival of microorganisms after application of the product. This activity may be demonstrated by sampling a site several minutes or hours after application and demonstrating bacterial antimicrobial effectiveness when compared with a baseline level. This property also has been referred to as "residual activity." Both substantive and nonsubstantive active ingredients can show a persistent effect if they substantially lower the number of bacteria during the wash period.
Laboratory studies have shown lingering benzalkonium chloride may be associated with antibiotic resistance in MRSA. Tolerance to alcohol sanitizers may develop in fecal bacteria. Where alcohol sanitizers utilize 62%, or higher, alcohol by weight, only 0.1 to 0.13% of benzalkonium chloride by weight provides equivalent antimicrobial effectiveness.
Triclosan has been shown to accumulate in biosolids in the environment, one of the top seven organic contaminants in waste water according to the National Toxicology Program Triclosan leads to various problems with natural biological systems, and triclosan, when combined with chlorine e.g. from tap water, produces dioxins, a probable carcinogen in humans. However, 90–98% of triclosan in waste water biodegrades by both photolytic or natural biological processes or is removed due to sorption in waste water treatment plants. Numerous studies show that only very small traces are detectable in the effluent water that reaches rivers.
A series of studies show that photodegradation of triclosan produced 2,4-dichlorophenol and 2,8-dichlorodibenzo-p-dioxin (2,8-DCDD). The 2,4-dichlorophenol itself is known to be biodegradable as well as photodegradable.[full citation needed] For DCDD, one of the non-toxic compounds of the dioxin family, a conversion rate of 1% has been reported and estimated half-lives suggest that it is photolabile as well.[full citation needed] The formation-decay kinetics of DCDD are also reported by Sanchez-Prado et al. (2006) who claim "transformation of triclosan to toxic dioxins has never been shown and is highly unlikely."
Alcohol-free hand sanitizers may be effective immediately while on the skin, but the solutions themselves can become contaminated because alcohol is an in-solution preservative and without it, the alcohol-free solution itself is susceptible to contamination. However, even alcohol-containing hand sanitizers can become contaminated if the alcohol content is not properly controlled or the sanitizer is grossly contaminated with microorganisms during manufacture. In June 2009, alcohol-free Clarcon Antimicrobial Hand Sanitizer was pulled from the US market by the FDA, which found the product contained gross contamination of extremely high levels of various bacteria, including those which can "cause opportunistic infections of the skin and underlying tissues and could result in medical or surgical attention as well as permanent damage". Gross contamination of any hand sanitizer by bacteria during manufacture will result in the failure of the effectiveness of that sanitizer and possible infection of the treatment site with the contaminating organisms.
Alcohol-based hand rubs are extensively used in the hospital environment as an alternative to antiseptic soaps. Hand-rubs in the hospital environment have two applications: hygienic hand rubbing and surgical hand disinfection. Alcohol based hand rubs provide a better skin tolerance as compared to antiseptic soap. Hand rubs also prove to have more effective microbiological properties as compared to antiseptic soaps.
The same ingredients used in over-the-counter hand-rubs are also used in hospital hand-rubs: alcohols such as ethanol and isopropanol, sometimes combined with quaternary ammonium cations (quats) such as benzalkonium chloride. Quats are added at levels up to 200 parts per million to increase antimicrobial effectiveness. Although allergy to alcohol-only rubs is rare, fragrances, preservatives and quats can cause contact allergies. These other ingredients do not evaporate like alcohol and accumulate leaving a "sticky" residue until they are removed with soap and water.
The most common brands of alcohol hand rubs include Aniosgel, Avant, Sterillium, Desderman and Allsept S. All hospital hand rubs must conform to certain regulations like EN 12054 for hygienic treatment and surgical disinfection by hand-rubbing. Products with a claim of "99.99% reduction" or 4-log reduction are ineffective in hospital environment, since the reduction must be more than "99.99%".
The hand sanitizer dosing systems for hospitals are designed to deliver a measured amount of the product for staff. They are dosing pumps screwed onto a bottle or are specially designed dispensers with refill bottles. Dispensers for surgical hand disinfection are usually equipped with elbow controlled mechanism or infrared sensors to avoid any contact with the pump.
Consumer alcohol-based hand sanitizers, and health care "hand alcohol" or "alcohol hand antiseptic agents" exist in liquid, foam, and easy-flowing gel formulations. Products with 60% to 95% alcohol by volume are effective antiseptics. Lower or higher concentrations are less effective; most products contain between 60% and 80% alcohol.
- additional antiseptics such as chlorhexidine and quaternary ammonium derivatives,
- sporicides such as hydrogen peroxides that eliminate bacterial spores that may be present in ingredients,
- emollients and gelling agents to reduce skin dryness and irritation,
- a small amount of sterile or distilled water,
- sometimes foaming agents, colorants or fragrances.
The World Health Organization has published the following formulations to guide to the production of large quantities of hand sanitizer from chemicals available in developing countries, where commercial hand sanitizer may not be available:
|Ingredient||Volume required (10-L prep.)||Active ingredient % (v/v)|
|Ethanol 96%||8333 mL||80%|
|Glycerol 98%||145 mL||1.45%|
|Hydrogen peroxide 3%||417 mL||0.125%|
|Distilled water||added to 10000 mL||18.425%|
|Ingredient||Volume required (10-L prep.)||Active ingredient % (v/v)|
|Isopropyl alcohol 99.8%||7515 mL||75.15%|
|Glycerol 98%||145 mL||1.45%|
|Hydrogen peroxide 3%||417 mL||0.125%|
|Distilled water||added to 10000 mL||23.425%|
In 2010 the World Health Organization produced a guide for manufacturing hand sanitizer, which received renewed interest in 2020 because of shortages of hand sanitizer in the wake of the COVID-19 pandemic. Dozens of liquor and perfume manufacturers switched their manufacturing facilities from their normal product to hand sanitizer. In order to keep up with the demand, local distilleries started using their alcohol to make hand sanitizer. Distilleries producing hand sanitizer originally existed in a legal grey area in the United States, until the Alcohol and Tobacco Tax and Trade Bureau declared that distilleries could produce their sanitizer without authorization.
In the beginnings of the pandemic, because of hand sanitizer shortages due to panic buying, people resort of using 60% to 99% concentrations of isopropyl or ethyl alcohol for hand sanitization, typically mixing them with glycerol or soothing moisturizers or liquid contain aloe vera to counteract irritations with options of adding drops of lemon or lime juice or essential oils for scents, and thus making DIY hand sanitizers. However, there are cautions against making them, such as a wrong measurement or ingredient may resulting in an insufficient amount of alcohol to kill the coronavirus, thus rendering the mixture ineffective or even poisonous.
Additionally, some commercial products are dangerous, either due to poor oversight and process control, or fraudulent motive. In June 2020, the FDA issued an advisory against use of hand sanitizer products manufacture by Eskbiochem SA de CV in Mexico due to excessive levels of methanol – up to 81% in one product. Methanol can be absorbed through the skin, is toxic in modest amounts, and in substantial exposure can result in "nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death". Products suspected of manufacture by Eskbiochem SA with excessive methanol have been reported as far away as British Columbia, Canada.
- Medical research papers sometimes use "n-log" to mean a reduction of n on a (base 10) logarithmic scale graphing the number of bacteria, thus "5-log" means a reduction by a factor of 105, or 99.999%
- "Tentative Final Monograph for Health-Care Antiseptic Drug Products; Proposed Rule" (PDF). United States Federal Food and Drug Administration. March 2009. pp. 12613–12617. Archived (PDF) from the original on 10 March 2010.
- "Guide to Local Production: WHO-recommended Handrub Formulations" (PDF). WHO. April 2010. Retrieved 27 February 2020.
- "hand sanitizer - definition of hand sanitizer in English | Oxford Dictionaries". Oxford Dictionaries | English. Archived from the original on 18 September 2017. Retrieved 12 July 2017.
- Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force (October 2002). "Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America" (PDF). MMWR. Recommendations and Reports. 51 (RR-16): 1–45, quiz CE1–4. PMID 12418624.
- "Show Me the Science – When & How to Use Hand Sanitizer in Community Settings | Hand washing | CDC". cdc.gov. 3 March 2020. Retrieved 16 March 2020.
CDC recommends washing hands with soap and water whenever possible because hand washing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help... sanitizers do not eliminate all types of germs... Hand sanitizers may not be as effective when hands are visibly dirty or greasy... Hand sanitizers might not remove harmful chemicals
- de Witt Huberts, J; Greenland, K; Schmidt, WP; Curtis, V (1 July 2016). "Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review". American Journal of Infection Control. 44 (7): 764–71. doi:10.1016/j.ajic.2016.01.045. PMID 27061254.
- Meadows, E; Le Saux, N (1 November 2004). "A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children". BMC Public Health. 4: 50. doi:10.1186/1471-2458-4-50. PMC 534108. PMID 15518593.
- "Clean Hands Save Lives!". Centers for Disease Control and Prevention. 11 December 2013. Archived from the original on 18 August 2017.
- Bolon, MK (September 2016). "Hand Hygiene: An Update". Infectious Disease Clinics of North America. 30 (3): 591–607. doi:10.1016/j.idc.2016.04.007. PMID 27515139.
In 2002, the CDC released an updated hand hygiene guideline and, for the first time, endorsed the use of alcohol-based hand rubs for the majority of clinical interactions, provided that hands are not visibly soiled
- Hirose, R; Nakaya, T; Naito, Y; Daidoji, T; Bandou, R; Inoue, K; Dohi, O; Yoshida, N; Konishi, H; Itoh, Y (18 September 2019). "Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients". mSphere. 4 (5). doi:10.1128/mSphere.00474-19. PMC 6751490. PMID 31533996.
For many reasons, alcohol hand sanitizers are increasingly being used as disinfectants over hand washing with soap and water. Their ease of availability, no need for water or plumbing, and their proven effectiveness in reducing microbial load are just a few.
- World Health Organization (2015). The selection and use of essential medicines. Twentieth report of the WHO Expert Committee 2015 (including 19th WHO Model List of Essential Medicines and 5th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization. hdl:10665/189763. ISBN 9789240694941. ISSN 0512-3054. WHO technical report series; no. 994.
- "Guide to Local Production: WHO-recommended Handrub Formulations" (PDF). Retrieved 11 April 2020.
- Long, Bruce W.; Rollins, Jeannean Hall; Smith, Barbara J. (2015). Merrill's Atlas of Radiographic Positioning and Procedures (13 ed.). Elsevier Health Sciences. p. 16. ISBN 9780323319652. Archived from the original on 18 September 2017.
- Baki, Gabriella; Alexander, Kenneth S. (2015). Introduction to Cosmetic Formulation and Technology. John Wiley & Sons. p. 173. ISBN 9781118763780. Archived from the original on 18 September 2017.
- "Alcohol-free hand sanitizer prices are skyrocketing, but they don't actually work to prevent the coronavirus, Business Insider - Business Insider Singapore". www.businessinsider.sg. Retrieved 11 April 2020.
- Block, Seymour Stanton (2001). Disinfection, Sterilization, and Preservation. Soil Science. 124. Lippincott Williams & Wilkins. p. 14. Bibcode:1977SoilS.124..378B. doi:10.1097/00010694-197712000-00013. ISBN 9780683307405. Archived from the original on 18 September 2017.
- Miller, Chris H.; Palenik, Charles John (2016). Infection Control and Management of Hazardous Materials for the Dental Team (5 ed.). Elsevier Health Sciences. p. 269. ISBN 9780323476577. Archived from the original on 18 September 2017.
- World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- Reynolds, SA; Levy, F; Walker, ES (March 2006). "Hand sanitizer alert". Emerging Infectious Diseases. 12 (3): 527–9. doi:10.3201/eid1203.050955. PMC 3291447. PMID 16710985.
- Okafor, Winifred (31 March 2020). "COVID-19: Not all hand sanitizers can kill virus — Pharmacist". InsideMainland.
- "Purcill Hand Sanitizer being recalled for low alcohol content". News Source Guyana. 9 April 2020.
- Willmott, M; Nicholson, A; Busse, H; MacArthur, GJ; Brookes, S; Campbell, R (January 2016). "Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis". Archives of Disease in Childhood. 101 (1): 42–50. doi:10.1136/archdischild-2015-308875. PMC 4717429. PMID 26471110.
- "Origin of ordinary things: Hand sanitizer". The New Times | Rwanda. 17 March 2020. Retrieved 29 March 2020.
- CDC – Handwashing: Clean Hands Save Lives Archived 29 July 2017 at the Wayback Machine
- "Dirty Hands Spread Dangerous Diseases like H1N1 (aka swine flu)". San Jose Mercury News. 25 April 2009.
- Trampuz, Andrej; Widmer, Andreas F (2004). "Hand Hygiene: A Frequently Missed Lifesaving Opportunity During Patient Care". Mayo Clinic Proceedings. 79 (1): 109–16. doi:10.4065/79.1.109. PMC 7094481. PMID 14708954.
alcohol effectively kills all coronaviruses. The virucidal activity of alcohol against enveloped viruses (such as influenza virus or human immunodeficiency virus) is good, except for rabies virus.
- CDC (11 February 2020). "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. Retrieved 9 March 2020.
- Rotter, Manfred L. (1999). "Handwashing and hand disinfection". In Mayhall, C. Glen (ed.). Hospital Epidemiology and Infection Control (2nd ed.). ISBN 9780683306088.
- Hibbard, John S. (May–June 2005). "Analyses Comparing the Antimicrobial Activity and Safety of Current Antiseptic Agents". J. Infusion Nursing. 28 (3): 194–207. doi:10.1097/00129804-200505000-00008. PMID 15912075. S2CID 5555893.
- Kramer, Axel; Rudolph, Peter; Kampf, Gonter; Pittet, Didier (27 April 2002). "Limited efficacy of alcohol-based hand gels". Lancet. 359 (9316): 1489–1490. doi:10.1016/S0140-6736(02)08426-X. PMID 11988252. S2CID 30450670.
- Pietsch, Hanns (2001). "Hand Antiseptics: Rubs Versus Scrubs, Alcoholic Solutions Versus Alcoholic Gels". Journal of Hospital Infection. 48 (Supl A): S33–S36. doi:10.1016/S0195-6701(01)90010-6. PMID 11759022.
- Reynolds, Scott A.; Foster Levy; Elaine S. Walker (March 2006). "Hand Sanitizer Alert". Emerging Infectious Diseases. 12 (3): 527–9. doi:10.3201/eid1203.050955. PMC 3291447. PMID 16710985. Archived from the original on 2 February 2007. Retrieved 2 February 2007.
- Girou, Emmanuelle; Sabrina Layou; Patrick Legrand; Francoise Oppein; Christian Brun-Buisson (August 2002). "Efficacy of hand rubbing with alcohol-based solution versus standard handwashing with antiseptic soap: randomised clinical trial". British Medical Journal. 325 (362): 362. doi:10.1136/bmj.325.7360.362. PMC 117885. PMID 12183307. Archived from the original on 27 November 2009. Retrieved 16 October 2009.
- Pedersen, L.K.; E. Held; J.D. Johansen; T. Agner (2005). "Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection". British Journal of Dermatology. 153 (6): 1142–1146. doi:10.1111/j.1365-2133.2005.06875.x. PMID 16307649. S2CID 46265931. Archived from the original on 6 March 2016.
- Pedersen, Kynemund; Elisabeth Held; Jeanne Duus Johansen; Tove Agner (2005). "Short-term effects of alcohol-based disinfectant and detergent on skin irritation". Contact Dermatitis. 52 (2): 82–7. doi:10.1111/j.0105-1873.2005.00504.x. PMID 15725285. S2CID 24691060.
- Boyce, John M. (July 2000). "Using Alcohol for Hand Antisepsis: Dispelling Old Myths". Infection Control and Hospital Epidemiology. 21 (7): 438–41. doi:10.1086/501784. PMID 10926392.
- Boyce, John M.; Kelliher, Susan; Vallande, Nancy (July 2000). "Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel". Infection Control and Hospital Epidemiology. 21 (7): 442–8. doi:10.1086/501785. PMID 10926393.
- Gold, Nina A.; Avva, Usha (2018). "Alcohol Sanitizer". StatPearls. PMID 30020626.
- Seal, Kelsey; Cimon, Karen; Argáez, Charlene (9 March 2017). "Summary of Evidence". PubMed Health.
- "When & How to Wash Your Hands". cdc.gov. 4 October 2018.
- "Alcohol-Based Hand-Rubs and Fire Safety". Centers for Disease Control and Prevention. 15 September 2003. Archived from the original on 3 April 2007. Retrieved 26 April 2007.
- Ohio OAC 1301:7-7-3405.5
- Aiello, A. E.; Larson, E. L.; Levy, S. B.; et al. (2007). "Consumer antibacterial soaps: effective or just risky?" (PDF). Clin Infect Dis. 45: S137–47. doi:10.1086/519255. PMID 17683018.
- Löffler, Harald; Günter Kampf (2008). "Hand disinfection: How irritant are alcohols?". Journal of Hospital Infection. 70: 44–8. doi:10.1016/S0195-6701(08)60010-9. PMID 18994681.
- Pedersen, L.K.; E. Held; J.D. Johansen; T. Agner (2005). "Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection". British Journal of Dermatology. 153 (6): 1142–1146. doi:10.1111/j.1365-2133.2005.06875.x. PMID 16307649. S2CID 46265931.
- Wagner, Daniel S. (2000). "GENERAL GUIDE TO CHEMICAL CLEANING PRODUCT REGULATION" (PDF). International Sanitary Supply Association, Inc. Archived from the original (PDF) on 31 December 2009.
- Judith E. Foulke (May 1994). "Decoding the Cosmetic Label". FDA Consumer Magazine.
- "Paging Dr. Gupta, Hand sanitizer risks". CNN. 21 June 2007. Archived from the original on 25 April 2009.
- "Hand Sanitizers Could Be A Dangerous Poison To Unsupervised Children". NBC News Channel. Retrieved 15 July 2007.
- "International Travel with Infants and Young Children". Travelers' Health – Yellow Book. 8. March 2009.
- "Prisoner 'drunk on swine flu gel'". BBC news online. 24 September 2009.
- Don't Drink the Hand Sanitizer Archived 14 May 2017 at the Wayback Machine NY Times Retrieved March 2017
- Karimi, Faith (27 June 2020). "Three people died and one is permanently blind after drinking hand sanitizer in New Mexico". CNN. Retrieved 27 June 2020.
- Pratap, Rishabh M.; Guy, Jack (2 February 2021). "Indian children hospitalized after ingesting hand sanitizer instead of polio drops". CNN. Retrieved 2 February 2021.
- "FDA issues proposed rule to address data gaps for certain active ingredients in health care antiseptics". U.S. Food and Drug Administration. 30 April 2015. Archived from the original on 2 July 2015.
- Kampf G, Ostermeyer C (Apr 2003). "Inter-laboratory reproducibility of the hand disinfection reference procedure of EN 1500". J Hosp Infect. 53 (4): 304–6. doi:10.1053/jhin.2002.1357. PMID 12660128.
- "Do hand sanitizers really work?". University of Toronto News. Retrieved 29 March 2020.
- Akimitsu, N; Hamamoto, H; Inoue, RI; Shoji, M; Akamine, A; Takemori, KI; Hamasaki, N; Sekimizu, K (1999). "Increase in Resistance of Methicillin-Resistant Staphylococcus aureus to β-Lactams Caused by Mutations Conferring Resistance to Benzalkonium Chloride, a Disinfectant Widely Used in Hospitals". Antimicrobial Agents and Chemotherapy. 43 (12): 3042–3043. doi:10.1128/AAC.43.12.3042. PMC 89614. PMID 10651623.
- "Antibacterial Household Products: Cause for Concern". Centers for Disease Control and Prevention. Archived from the original on 16 August 2001. Retrieved 1 June 2001.
- Davis, Nicola (1 August 2018). "Bacteria becoming resistant to hospital disinfectants, warn scientists". The Guardian.
- Pidot, Sacha J.; Gao, Wei; Buultjens, Andrew H. (1 August 2018). "Increasing tolerance of hospital Enterococcus faecium to handwash alcohols". Science Translational Medicine. 10 (452): eaar6115. doi:10.1126/scitranslmed.aar6115. PMID 30068573.
- "Hand NTP Research Concept: Triclosan" (PDF). National Toxicology Project. Archived from the original (PDF) on 10 May 2009. Retrieved 20 November 2008.
- McMurry LM, Oethinger M, Levy SB (1998). "Triclosan targets lipid synthesis". Nature. 394 (6693): 531–2. Bibcode:1998Natur.394..531M. doi:10.1038/28970. PMID 9707111. S2CID 4365434.
- "Environmental Emergence of Triclosan" (PDF). Santa Clara Basin Watershed Management Initiative. Archived (PDF) from the original on 3 June 2008. Retrieved 1 January 2006.
- Heidler, Jochen; Halden, Rolf U. (March 2007). "Mass balance assessment of triclosan removal during conventional sewage treatment". Chemosphere. 66 (2): 362–9. Bibcode:2007Chmsp..66..362H. doi:10.1016/j.chemosphere.2006.04.066. PMID 16766013. Retrieved 25 January 2010.
- European Commission 2000
- Wisk, Joseph D.; Cooper, Keith R. (1990). "Comparison of the toxicity of several polychlorinated dibenzo-p-dioxins and 2,3,7,8-tetrachlorodibenzofuran in embryos of the Japanese medaka (Oryzias latipes)". Chemosphere. 20 (3–4): 361–377. Bibcode:1990Chmsp..20..361W. doi:10.1016/0045-6535(90)90067-4.
- Aranami et al. 2007
- Sanchez-Prado, Lucia; Llompart, Maria; Lores, Marta; García-Jares, Carmen; Bayona, Josep M.; Cela, Rafael (2006). "Monitoring the photochemical degradation of triclosan in wastewater by UV light and sunlight using solid-phase microextraction". Chemosphere. 65 (8): 1338–47. Bibcode:2006Chmsp..65.1338S. doi:10.1016/j.chemosphere.2006.04.025. PMID 16735047.
- "Consumers Warned Not to Use Clarcon Skin Products". U.S. Food and Drug Administration. 15 June 2009. Archived from the original on 14 June 2009. Retrieved 15 June 2009.
- de Groot AC (1987). "Contact allergy to cosmetics: causative ingredients". Contact Dermatitis. 17 (1): 26–34. doi:10.1111/j.1600-0536.1987.tb02640.x. PMID 3652687. S2CID 72677422.
- Bonnabry, Pascal; Voss, Andreas (2017). "Hand Hygiene Agents". In Pittet, Didier; Boyce, John M.; Allegranzi, Benedetta (eds.). Hand Hygiene: a Handbook for Medical Professionals. John Wiley & Sons. pp. 51 et seq. ISBN 9781118846865.
- "White House Works With Distillers to Increase Hand Sanitizer Production", Forbes, 18 March 2020
- Kaur, Harmeet. "Distilleries are making hand sanitizer with their in-house alcohol and giving it out for free to combat coronavirus". CNN. Retrieved 21 March 2020.
- Levenson, Michael (19 March 2020). "Distilleries Race to Make Hand Sanitizer Amid Coronavirus Pandemic". The New York Times. Retrieved 21 March 2020.
- Alcohol and Tobacco Tax and Trade Bureau. "Production of Hand Sanitizer by Distilled Spirits Permittees". The TTB Newsletter. US Department of the Treasury. Retrieved 21 March 2020.
- Lindberg, Sara. "How to Make Your Own Hand Sanitizer". Healthline. Healthline Media. Retrieved 30 June 2020.
- "71° Store shelves wiped clean? Here's how you can make homemade hand sanitizer". Fox 6 Now. Fox Television Stations, LLC. Retrieved 1 July 2020.
- Mitroff, Sarah. "No, you shouldn't make your own hand sanitizer". CNET. Retrieved 25 March 2020.
- "FDA advises consumers not to use hand sanitizer products manufactured by Eskbiochem". fda.gov. Food and Drug Administration. 19 June 2020. Retrieved 27 June 2020.
- "British Columbians warned over hand sanitizers containing potentially toxic ingredient". richmond-news.com. Richmond News. 27 June 2020. Retrieved 27 June 2020.
- "FDA updates on hand sanitizers consumers should not use". U.S. Food and Drug Administration (FDA). 10 August 2020. Retrieved 10 August 2020.
- "COVID-19". U.S. Food and Drug Administration (FDA). 5 August 2020. Retrieved 10 August 2020.
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- "Executive Summary: National Stakeholders Meeting on Alcohol-Based Hand-Rubs and Fire Safety in Health Care Facilities". American Hospital Association, Co-Hosted by the U.S. Centers for Disease Control & Prevention (CDC) and AHA. 22 July 2003. Archived from the original on 8 March 2008.