Alcohol-free sanitiser gets thumbs-up as poisonings mount
Alcohol-free hand sanitiser is just as effective against Covid19 as alcohol-based products, a US study has found.
The news comes hard on the heels of a warning from the Western Cape poison information helpline of a rise in calls about sanitiser ingestion, and as Stellenbosch University medical students sound the alarm about an exponential rise in hand eczema caused by sanitiser use.
Throughout the Covid-19 pandemic, the World Health Organisation (WHO) and Centers for Disease Control and Prevention in the US have recommended the use of sanitisers containing at least 60% alcohol.
But in the new study, researchers at Brigham Young University in Utah said they wanted to put this to the test because there is limited research on what really kills SARS-CoV-2, the virus that causes Covid-19.
They experimented with benzalkonium chloride, which is commonly used in alcoholfree sanitisers, and other quaternary ammonium compounds, or quats, which are among the most common disinfectants in the food industry.
In most of the tests, the compounds eliminated at least 99.9% of the virus within 15 seconds.
“Our results indicate alcoholfree hand sanitiser works just as well, so we could, maybe even should, be using it to control Covid-19,” said lead author Benjamin Ogilvie, whose study was published on Saturday in The Journal of Hospital Infection.
Ogilvie said alcohol-free sanitisers have advantages.
“Benzalkonium chloride can be used in much lower concentrations and does not cause the familiar ‘burn’ feeling you might know from using alcohol hand sanitiser,” he said.
“It can make life easier for people who have to sanitise hands a lot, like healthcare workers, and maybe even increase compliance with sanitising guidelines.”
A letter to the December edition of the SA Medical Journal from fifth-year Stellenbosch medical students Sergio Alves and Allison Arendse, and consultant dermatologist Suretha Kannenberg, said cases of eczema have multiplied rapidly as a result of sanitiser use, especially among health workers.
They reported the results of a study from Hubei Province in China, where Covid-19 was first reported, and said three-quarters of health workers had reported dermatitis symptoms.
“Issues with alcohol-based hand sanitisers include the use of non-standard formulas, meaning methanol is used instead of ethanol, types of alcohol used, such as isopropyl alcohol v. ethanol, and varying amounts of alcohol being used [60-80%],” said Alves and Arendse.
“Apart from the discomfort of dry, itchy skin, the breaks in the skin can serve as a point of entry for Covid-19. Additionally, alcohol rub dermatitis can become a debilitating and painful disease resulting in work absenteeism, which can severely impair the delivery of essential services.”
“Painful, dry skin could also inadvertently decrease hand hygiene compliance, which further increases the risk of disease transmission in these individuals.”
Alves and Arendse recommended the use of moisturiser immediately after sanitising to prevent alcohol rub dermatitis.
“Adequate skin care could increase hand hygiene compliance and should therefore be prioritised, especially among healthcare workers,” they said.
“Furthermore, preventive measures are critical to allay the next, albeit completely different, wave: that of allergic contact dermatitis, another unintended health consequence of Covid-19.”
Reports from around the world suggest a spike in posioning cases as a result of intentional or accidental consumption of alcohol-based hand sanitisers.
Poison Control in the US said sanitiser-related calls increased by 79% and the National Poisons Information Service in the UK has seen a 61% increase in such cases.
Writing in the SA Medical Journal, the team at Tygerberg and Red Cross hospitals in Cape Town that runs SA’s poisons information helpline said it had seen a similar phenomenon. But not every case was serious.
“Callers are given clear instructions on when to seek medical help and when staying at home is safe,” they said.
The poison team said the social isolation and financial stress caused by Covid-19 meant they expect more people who have ingested poisons to arrive in hospital emergency departments.
Ogilvie, from Brigham Young, said he hoped reintroducing alcohol-free sanitisers in response to his team’s advice would reduce the chances of people encountering potentially “sketchy” alcohol sanitisers that have cropped up in response to the demand.
“Hand sanitiser can play an especially important role in controlling Covid-19,” he said.
“This is information that could affect millions of people.”