Not all hand sanitizers are created equal

Many nurses have raised concerns about the chemicals found in the products in their homes and the health care settings where they work. Hand sanitizers are one of those products. Eliminating nosocomial infections is paramount in the hospital setting, and nurses use hand sanitizers multiple times throughout the day, so it’s important to have a hand sanitizer that’s the safest possible. Eliminating fragrance and Triclosan is a great start. in 2013, WSNA conducted extensive research on hand sanitizers and as a result changed our giveaway hand sanitizer to a safer product that has no fragrance or Triclosan and does not pose a fire risk.

Smell is one of our incredible senses that alerts us to hazards like fires or gas leaks, and gets our mouths watering with smells of barbeque and sweet peach pie on a warm summer’s night. It evokes memories of our first school lunch, our first date and yes … our first job as nurses in a hospital. But not all smells are equal. Fragrance in hand sanitizers creates an unneeded risk for toxic chemical exposure. Fragrance is considered to be among the top five known allergens, according to the Campaign for Safe Cosmetics). Because fragrance is considered a trade secret, companies are not required to disclose their fragrance formulas. Often containing dozens or hundreds of chemicals, these chemicals—whether organic essential oils or manmade—can cause allergic reactions, are sensitizers, and can cause or exacerbate asthma. Consequently, a number of health care facilities across the nation have deemed their facilities “fragrance free” to reduce the potential of negative health outcomes.

Additionally, products with fragrance, including hand sanitizers, generally contain phthalates (either Di(2-ethylhexyl) phthalate (DEHP) or Diethyl phthalate (DEP)) which are endocrine disruptors, linked to asthma and may cause reproductive harm such as hypospadias—a birth defect involving an abnormally placed urethra in infant males.

Finally, there is some concern about alcohol based hand sanitizers causing fire. There have been cases where individuals have become burned by applying alcohol based hand sanitizers (ABHS), briskly rubbing their hands together and either touching electronic equipment or creating static electricity, resulting in combustion.

“Portland hospital fire investigated; hand sanitizer link suspected in girl's injuries. However, other similar incidents have happened. In 2002, doctors in Kentucky reported that a nurse's hand antiseptic ignited from a spark of static electricity; and in a 1998 Arizona case, a patient suffered serious injuries in an operating room fire involving an alcohol-based antiseptic.”
– Nick Budnick. (The Oregonian, Feb 18, 2013)

"A fire occurred when a nurse in a neonatal intensive care unit placed an alcohol-based sanitizer in her hands and then, while rubbing in the sanitizer, walked toward an oxygen/air proportioner to change a setting on the device. Her hand was still wet with the sanitizer when she reached for the device's control knob. She then felt a shock, heard a "whoosh" sound, and saw the knob immediately catch fire. Other clinicians disconnected the device, extinguished the flames, and cared for the infant nearby. The nurse's hand was burned, but no other injuries were reported.”
– (ECRI, 2006). Health Devices Alerts Action Item Accession Number: A7964 Fire Risk from Alcohol-Based Hand Sanitizers Worsens in Oxygen-Enriched Environments.

Though these fires and injuries are rare, they do occur. As a precautionary approach, WSNA’s giveaway hand sanitizer is now alcohol free.

It is important to follow your institution’s policies and procedures on hand washing and the use of hand sanitizers. Washing hands with warm water and soap, with 60 seconds of friction, is a great alternative to using hand sanitizers and does not expose you to the aerosolization of the hand sanitizer at face level where it increases the potential for exposure through inhalation. Become an active member of your health and safety team and review your institutions current purchasing protocols around hand sanitizers. Nurses have great power in their voice and the health care industry desperately needs our guidance.

For more information on hand sanitizers and hand washing, visit the website of the Environmental Working Group, and check out the Physicians for Social Responsibility's 2010 study “Hazardous Chemicals in Health Care: A Snapshot of Chemicals in Doctors and Nurses”.

For information about ordering WSNA hand sanitizers (in quantities of five bottles or more), contact Martin Hsiung.