When hand washing is not handy: Cautions for hand sanitizer use
Washing hands with soap and water for at least 20 seconds is the most effective strategy for removing the COVID-19 virus from hands. In some situations, hand sanitizers can be used as a substitute if soap and water are not immediately available. Hand sanitizers (sometimes called hand rubs) are gels, foams, aerosols or liquids that contain antimicrobial agents. The goal of hand sanitizer use is to decrease the number of microorganisms on hands when soap and water aren’t readily available. The majority of hand sanitizers are alcohol based and made from formulations of isopropyl alcohol, ethyl alcohol or n-propanol. Alcohol-based hand sanitizers are currently considered the most effective for sanitizing against viruses. Some of the other active ingredients approved by Health Canada include chloroxylenol, benzalkonium chloride, iodine, benzethonium chloride and chlorhexidine gluconate.
Shortages of hand sanitizers have led some to consider making their own using formulations found online. Health Canada has released a warning against making or purchasing homemade (DIY) products and recommends that Canadians who have these products stop using them.
Non-approved products and adverse effects from production or use
There are serious adverse outcomes that can occur from the production or use of homemade products. The alcohol-based ingredients needed to make hand sanitizers appropriate for SARS-CoV2 are flammable, can be toxic and must be handled with care in well-ventilated areas. With shortages of the basic ingredients needed to make hand sanitizer formulations, some people may consider using other ingredients such as regular or over-proof alcohol. These substitutions are not recommended because the concentrations may not be adequate to make solutions that can destroy the SARS-COV-2 virus.
Due to current challenges accessing hand sanitizers, people may be considering alternative products such as witch hazel, tea tree oil and vinegar as replacements. These ingredients do not meet Health Canada’s criteria for use as disinfectants and are not recommended as hand sanitizer solutions. Even at low concentrations, bleach is not recommended as a hand sanitizer ingredient as it is extremely corrosive and can damage skin, eyes and other tissues
Health Canada approved hand sanitizers
Health Canada recommends using hand sanitizers that have been approved for sale in Canada. A list of hand sanitizers that are authorized for sale in Canada is regularly updated. Prior to use, it is advisable to check if hand sanitizer is approved by Health Canada by checking the Drug Information Number (DIN) or Natural Product Number (NPN) on the label against the evolving list of approved products. Health Canada approved hand sanitizers should never be diluted with water or have other ingredients such as oils, creams or fragrances added as these additions will reduce the product’s effectiveness.
Safe storage of hand sanitizers is critical as reports of accidental ingestion are increasing. Products should remain in original containers and not be put in cups, beverage containers or left open. Hand sanitizers should be kept away from food and food preparation areas. Children, pets and individuals with dementia are particularly at risk from accidental exposure.
Increased access to hand sanitizers across Canada
In response to COVID-19, Health Canada has initiatives underway to increase access to hand sanitizers for the public as well as for healthcare and first responder settings. These include an interim quickened approval process for hand sanitizers for personal (domestic) use and the allowance of approved hand sanitizers for domestic use to be distributed to healthcare settings. Health Canada has also allowed Canadian distilleries and breweries to begin manufacturing hand sanitizers, increasing quantity and access.
Checklist for safe use of hand sanitizing products
Thorough hand washing is still the best means of preventing the transmission of COVID-19. If it is deemed necessary to use hand sanitizer, ensure that you are using approved products in the safest manner:
- Hand sanitizers can be poisonous if consumed. Keep away from food and food preparation areas.
- Never put hand sanitizer in cups, glasses or beverage containers as this can lead to accidental ingestion.
- Hand sanitizer can be irritating to eyes and lungs so use in a well-ventilated area. Be careful when applying in enclosed places such as cars.
- Keep hand sanitizer safely away from children, pets and people with dementia.
- Hand sanitizers can be flammable. Keep products away from open flames such as gas stoves, candles, cigarettes and lighters.
- Check the products you have at home against Health Canada’s list of interim and approved hand sanitizers.
- Never water down your hand sanitizer or add oils, fragrances or creams. This will make the product less effective.
- Household bleach, even diluted, should never be used directly on skin as it can be extremely corrosive.
Nicol A-M. When hand washing is not handy: Cautions for hand sanitizer use [blog]. Vancouver, BC: National Collaborating Centre for Environmental Health; 2020 Apr 27. Available from: https://ncceh.ca/content/blog/when-hand-washing-not-handy-cautions-hand-sanitizer-use.
For more information, see the following notices and updates from Health Canada.
- Hard surface disinfectants and hand sanitizers (COVID-19)
- Hard-surface disinfectants and hand sanitizer (COVID-19): disinfectants and hand sanitizers accepted under COVID-19 interim measure
- Technical grade ethanol for the manufacture of hand sanitizers during the COVID-19 pandemic: Risk assessment summary report