December is Handwashing Awareness Month: Be Aware, Wash With Care

During the month of December, friends and families are close and the pathogens they carry come into close proximity with each other. For this reason, it is only fitting to spread awareness that December is National Handwashing Month. Although seemingly basic, handwashing can protect from a variety of illnesses and even decrease antibiotic resistance.¹

According to the Center for Disease Control (CDC), diseases such as diarrhea and respiratory infections in children can be decreased by 33% and 20%, respectively, just by handwashing with soap.¹ Washing your hands with soap and water appropriately can decrease antibiotic resistance by decreasing the need for antibiotics by extricating infectious bacteria altogether before the bacteria can cause illness. Additionally, fewer patients being prescribed antibiotics plays a large role in decreasing the risk of antibiotic resistance.²

The CDC states that handwashing with soap and water is the best method, in most situations, to rid your hands of infectious pathogens. When handwashing is available, the CDC recommends wetting your hands with clean, running water, applying and lathering soap, scrubbing the backs of your hands, between your fingers, and under your fingernails for at least 20 seconds, rinsing your hands under running water, and drying your hands with a clean towel or air-drying them.²

However, the CDC does recommend hand sanitizer when handwashing is not an option. To use hand sanitizer most effectively, apply the sanitizer and rub your hands together over your entire hand for about 20 seconds, or until your hands are dry.²

With the recent increase of handwashing and hand sanitizing during the COVID-19 pandemic, alcohol-based hand sanitizers have been few and far between on store shelves. The FDA recognized this public health issue and released temporary guidelines for manufacturers who were not currently drug manufacturers but wanted to help be a solution to the problem.

In mid-October 2021, the FDA made an announcement regarding their temporary policies and guidelines that were put into place in March of 2020 that allowed for the increase in manufacturers for alcohol-based hand sanitizer to meet the demand for hand sanitizing products during the pandemic. They announced that they are withdrawing their temporary alcohol-based hand sanitizing manufacturing guidelines due to the decreased demand and increased availability of hand sanitizing products.

The temporary guidelines will be revoked on December 31st, 2021, and companies using the temporary policies must stop the production of these products.³ Anyone wanting to continue to manufacturer hand sanitizers must abide by the tentative final monograph for over-the-counter topical antiseptics.³ They must also comply with the FDA’s “Current Good Manufacturing Practice (CGMP) Regulations.”^3,4 Additionally, companies that wishes to discontinue manufacturing alcohol-based hand sanitizing products can deregister using the Electronic Drug Registration and Listing Information.^3,5

Many health care providers jumped into action when there was a lack of hand sanitizing products on the market. The rise of homemade hand sanitizer compelled the FDA to release a “do-not-use” list as a guide for ingredients to avoid in hand sanitizing products, as well as brands of hand sanitizing products that have not been approved for various reasons (ie, microbial contamination).⁶

The 2 ingredients that raise the most concern are types of alcohol, methanol, and 1-propranolol. Patients should be educated against using these products if they are planning to make their own products or use someone else’s homemade hand sanitizer. Methyl alcohol, methanol, or wood alcohol is not acceptable to use in hand sanitizing products, as it can be toxic and life-threatening when easily ingested, dermally absorbed, or inhaled.⁶ Effects of methanol ingestion or absorption include nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the central nervous system, or death.^6,7

To put this data on methanol into perspective, 70% to 80% of methanol in the body is metabolized to formaldehyde.⁷ Despite the toxic effects to human bodies, it does not have the pathogen killing capacity of the other alcohols and is not an effective handwashing product. Carrying a large potential of toxicity when absorbed through the skin and being ineffective at killing pathogens, it is highly dangerous and ineffective to use methanol in hand sanitizing products.⁶

The other ingredient that is not suitable for hand sanitizing products is 1-propanol. This ingredient should not be mistaken for the commonly used 2-propanol (isopropyl alcohol). 1-propanol is toxic when ingested and can even lead to death. The FDA has expanded their hand sanitizer do-not-use list to include products that contain or may be contaminated with 1-propanol.⁶

This December, keep in mind the benefits of washing your hands with soap and water. Hand sanitizers can work great as well, but be sure to check the ingredient label twice. If you are considering continuing to manufacture alcohol-based hand sanitizing products, review the new guidelines and be prepared to make any necessary adjustments. Additionally, take some time to talk with your patients about methods for good hand hygiene and explain the benefits of being aware and washing with care.

REFERENCES

1. Show Me The Science - Why Wash Your Hands? [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2021Nov30]. Available from: https://www.cdc.gov/handwashing/why-handwashing.html
2. When and How to Wash Your Hands [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2021 [cited 2021Nov30]. Available from: https://www.cdc.gov/handwashing/when-how-handwashing.html
3. Commissioner of the FDA in Brief: FDA Withdrawing Temporary Guidances for Alcohol-Based Hand Sanitizers [Internet]. U.S. Food and Drug Administration. FDA; [cited 2021Nov30]. Available from: https://www.fda.gov/news-events/press-announcements/fda-brief-fda-withdrawing-temporary-guidances-alcohol-based-hand-sanitizers
4. Center for Drug Evaluation and Research. Current good manufacturing practice (CGMP) regulations [Internet]. U.S. Food and Drug Administration. FDA; [cited 2021Nov30]. Available from: https://www.fda.gov/drugs/pharmaceutical-quality-resources/current-good-manufacturing-practice-cgmp-regulations
5. Center for Drug Evaluation and Research. Drug registration and listing system (DRLS and eDRLS) [Internet]. U.S. Food and Drug Administration. FDA; [cited 2021Nov30]. Available from: https://www.fda.gov/drugs/guidance-compliance-regulatory-information/electronic-drug-registration-and-listing-system-edrls
6. Center for Drug Evaluation and Research. Drug registration and listing system (DRLS and eDRLS) [Internet]. U.S. Food and Drug Administration. FDA; [cited 2021Nov30]. Available from: https://www.fda.gov/drugs/guidance-compliance-regulatory-information/electronic-drug-registration-and-listing-system-edrls
7. Moon CS. Estimations of the lethal and exposure doses for representative methanol symptoms in humans. Ann Occup Environ Med. 2017 Oct 2;29:44. doi: 10.1186/s40557-017-0197-5. PMID: 29026612; PMCID: PMC5625597.