In America, the land of excess, it’s been a surprising feeling to have anything in short supply, nonetheless completely out.
When toilet paper was impossible to find, we discussed how to make homemade reusable toilet paper.
When meat was absent from many store shelves, we talked about strategies to stretch your meat supply.
I didn’t worry much about hand sanitizer at the time, because we were at home with every opportunity to wash hands with soap and water, but I knew there were also major sanitizer shortages.
The country has responded in a number of ways to increase supply, including transforming liquor distilleries into hand sanitizer factories and relaxing FDA standards for purity. Some helpful, some maybe not!
Now that school is starting, we all need to use more hand sanitizer than ever if we’re sending our kids to school.
In our state, hand sanitizer will be required upon every entry on a school bus, classroom, lunchroom, etc. All this sanitation is to keep us safe from viruses, but the biggest problem might NOT be shortages of hand sanitizer to purchase (not really a big deal anymore).
Let’s talk about three genuine hand sanitizer problems that we may encounter this fall as we head back to school (or stay home):
- What ingredients in hand sanitizer do we want to avoid for human health or environmental reasons?
- If we really want to kill/remove germs and avoid viruses, are alcohol-based hand sanitizers best?
- Is it possible to over-sanitize the world, and what would the consequences be?
Could Hand Sanitizer Include Toxic Chemicals?
It’s not always possible to wash with soap and water, and with school mandating hand sanitizer throughout the day, how do we choose the least harmful sanitizer possible?
It turns out there may be neurotoxins among the hand sanitizer ingredients, and the FDA has relaxed safety restrictions to allow for the most widespread production possible.
The general attitude about the relaxed guidelines seem to be something like: It might not be safe, but at least we’re checking all the boxes of perceived safety.
The toxic ingredient popping up in the mainstream news is methanol, found in dozens of hand sanitizers. And this is just what’s newly toxic…
Methanol is a byproduct of ethanol, a common hand sanitizer ingredient, but when the FDA relaxed its high standards on the purity of ethanol, this has been the result.
Dangers of Methanol in Hand Sanitizer
Methanol is dangerous both via inhalation or absorption through the skin, leading to nausea, headaches, blurred vision, blindness, seizures and permanent damage to the nervous system. There are no safe levels of methanol in sanitizer, says the FDA.
As far back as 2018, researchers sounded warnings about undeclared methanol occasionally being found in hand sanitizers. A particular threat is that therapy to reverse symptoms must be used, and often it’s unclear that this precise therapy is needed because practitioners aren’t looking for methanol toxicity when someone begins having visual decline.1
The FDA said it will not take action against anyone producing hand sanitizers as long as they follow the guidelines, which include precise ingredients that must be used, a requirement to use denatured alcohol (that makes it taste bitter), that formulas must not include ingredients that improve taste or smell (which could encourage ingestion), no gels, foams, or aerosol sprays, and a few more. (See the actual FDA policy here.)
The FDA’s guidance isn’t a legal document or a law; it’s a set of recommendations.
The concerning piece of the new policy, which is supposed to be temporary because of the coronavirus pandemic (which itself seems to be less temporary than we all thought in March), is the relaxed interim limits on impurities.
Although the FDA has stated there is no safe level of methanol in hand sanitizer, as just one example, their document allows for 630 ppm of methanol.
The list includes genotoxic, neurotoxic, and carcinogenic ingredients, which the FDA hopes will not harm humans at low concentrations for a short period of time.
And now our schools will be mandating hand sanitizer use HOW many times per day? “In moderation” may be out the window here, and I’m concerned. (That’s one reason I advocate for training on how to take a mask break safely!)
Here’s how this is playing out in reality:
In late June 2020, one Mexican manufacturer was pegged for methanol in their products, sold under 9 different brands and labels. The FDA released a recall list and recommended that consumers avoid buying these 9 products, and then more and more were added to the list as the weeks went on.
None listed methanol on the ingredients, but tests revealed very unsafe levels. Some were sold at behemoths like Sam’s Club, no not just minor niche products.2, 3
The FDA’s Recalled and “Dangerous” Hand Sanitizer List is Less Helpful Now
Then on July 31, the FDA began adding sanitizers with less than 60% alcohol to the list as well, which muddies the waters.
I’m far more concerned about my kids putting a toxic ingredient on their hands than simply something that won’t work as effectively as another product! Besides that, “methanol” isn’t going to show up on the ingredients, but I’m intelligent enough to read the alcohol percentage all by myself.
You can see the full list of recommended recalled sanitizers here from August 3, 2020, but it’s not all that helpful since the FDA didn’t create two separate lists, one for “toxic” and one for “less potent.” This list will surely be outdated by the time you’re reading the post.
This one is probably a more accurate list of only the methanol-containing sanitizers, but it’s likely that others should be avoided after the list became muddied. Here’s the history of the FDA’s releases.
Eventually, the call by these scientists for more testing and regulation will probably be heeded, but for now, I believe we need to trust our manufacturers to have our best interests in mind, and not profits and scalability, which is why I love working with brands with human faces.
The sanitizers I recommend below are all formulated by human beings with whom I’ve had actual conversations, and I know they take purity standards as first priority, not profit.
It’s not “new” news that hand sanitizers have toxins; only methanol is a new problem…along with other potential neurotoxins and carcinogens that haven’t hit the news yet.
Other Toxins Are Hiding in Sanitizer Ingredients
Ethyl alcohol is the active ingredient in most hand sanitizers. Ethyl alcohol is the same alcohol that is in wine, beer and liquor. It works the same as rubbing alcohol to kill germs.
Alcohol kills germs dead, like a hydrogen bomb (sort of).
Many hand sanitizers from years ago used to also include triclosan, which takes a full two minutes to be effective (when is the last time you saw anyone rubbing sanitizer OR washing hands for a full 2 minutes, EVEN in corona-times??). Besides the inefficacy of triclosan for human hand sanitation, it’s highly detrimental to both human and environmental health.
Triclosan works more like a disease, so some bacteria can mutate to learn to resist the way in which triclosan works. It’s also a pesticide and causes problems in the environment once it’s in the water supply.
Triclosan is now banned by the FDA in handsoap, thank goodness, but you’ll still see it here and there. I’ve written pretty extensively on triclosan before, so I’m not going to rehash it other than to say this: triclosan is nasty stuff. It is not natural. It is not safe.4
Beyond keeping an eagle eye out for the evil triclosan, even the dollar-store alcohol-based sanitizers have some variation in their “other” ingredients.
Alcohol is very drying on skin, which is why most sanitizing gels add moisturizer, and water. That’s about all you’re getting in the bottle, along with a few other random chemicals.
Most of them, albeit synthetic, are not exceedingly harmful. However, here are a few you should be on the lookout for:
- Triethanolamine (one of those “top 10” nasty chemicals I’ve mentioned before, from the book Living Green)
- Fragrance (pretty much means anything could be in there, from hormone disruptors like phthalates to pesticides) See my interview with toxin expert Lara Adler for more on phthalates.
- Parabens (these hormone disruptors are ubiquitous in personal products and one of the first red flags I look for when I scan ingredients; here’s why)
This is why I’ve asked our school if kids may bring their own sanitizer, and I’ll be instructing my kids to use it only when it makes sense.
For example, in high school, kids are to sanitize upon entering and leaving a classroom. If a student simply walks down the hall to his next class and doesn’t touch anything, I would recommend him to skip the “enter” sanitizing.
Of course, when I asked this question of the high school principal during an info meeting, he said he’d never heard that question before and would have to look into it! I get that sort of answer a lot…
We Choose Natural Hand Sanitizers Without Toxins
In this unstable environment when policies, regulations, and procedures are changing by the hour and yet schools are requiring sanitizer, I’m going to take matters into my own hands (even if I never get that question answered by the principals).
My kids will be bringing their own sanitizer!
We have these 5 in our house, and I feel confident that they’re better than the unknown out there:
Wellnesse Moisturizing Hand Sanitizer
I support Wellnesse for many reasons, including their commitment to purity in ingredients, transparency to the consumer, and environmental impact reduction.
The hand sanitizer is a squirt bottle made of glass, which is 5x as efficiently recyclable as plastic.
The ingredients are incredibly simple, up to FDA standards for the percentage of alcohol, and don’t dry out the hands.
Wellnesse includes soothing essential oils like eucalyptus that serve to heal the damage wrought on hands by the alcohol and also smell great. Tea tree and peppermint are also in the mix, both with antipathogenic properties to add a little punch to the alcohol and increase potency against germs.
The scent is nothing you would want to drink, just pleasant, don’t worry! My kids love it. Do educate yourself on essential oil safety for kids and babies, as some sources don’t recommend a few of these for young children, and some folks are more likely to be sensitive to these compared to other oils.
We use about 3 squirts for our kindergartner, 4 for the grade school kids, and 4-5 for adults and my humongous oldest child who somehow became a teenager before I realized it. 😉
Why do I trust this brand?
I know the founders well enough that we’ve visited one another’s homes, and our kids wrote a cookbook together. They do good work.
Any negatives to this one? It’s a bit expensive, and the essential oils won’t be a favorite scent for everyone. Some small children aren’t strong enough to work a squirt bottle tip, and glass may be a hazard in backpacks.
Earthley All-Purpose Spray (Natural Hand Sanitizer)
Earthley is a great option for those who want an alcohol-based sanitizer that complies with FDA standards for percentage, also has a high commitment to purity, but is a little better on the budget.
The 8-ounce Earthley bottle is only about $2/ounce, compared to Wellnesse at $5/ounce, but it is packaged in plastic.
Earthley chooses lavender and lemon as its anti-bacterial, soothing essential oils. I know a lot of folks have opinions about EOs, and some like to avoid lavender for one reason or another, while others might be sensitive to eucalyptus and peppermint, so it’s wonderful to have both of these disparate options.
You can use the all-purpose spray on surfaces as well, as an air freshener, and even as a light deodorant! Totally have done that while out and realized I’d been in quarantine too long and forgot the ol’ deo habit… 😉
Ingredients are organic and non-GMO, and yep, I personally know the founder of Earthley too, and our house is peppered in their products.
Any negatives to this one? As with Wellnesse, some young kids aren’t strong enough to work the squirt bottle top and some families prefer to avoid lavender.
Kabana C19 Antimicrobial Hand Sanitizer Gel
I love having options and variety, and I think it’s going to be a good thing that my kids rotate what they use each week to avoid our bodies becoming accustomed to the same thing all the time.
No research on that yet, just a mom hunch!
Kabana has been a trusted mineral sunscreen for our family for over a decade, and I’ve interviewed the founder, a Stanford-trained biochemist. When he said he formulated a new sanitizer in the need of COVID-19, I couldn’t wait to try it.
Erik Kreider designed it specifically to be neurotoxin-free with that commitment to purity that I respect so much.
Here’s what he says about the product:
Most hand sanitizers use cheap denatured alcohol which contains neurotoxic chemicals like methanol to make it poisonous and exempt from liquor taxation. We protect your health by using 200 proof ethanol because it’s food grade and safe for you to use as directed as often as you like.
This sanitizer is totally different than any other I’ve ever tried because it’s made with ethanol rather than ethyl alcohol. It smells strong like it’s powerful, that’s for sure!
Some of my kids thought it was a bit “too much,” but my daughter loves it best, and after the first test, they have all used it without complaint. They do think it feels weird, but once it’s all rubbed in, it just feels nice and smooth.
C19 comes in a squeeze tube and is a gel, different than the two options above, which are more of a watery liquid.
The gel takes a bit longer to rub in which is a GOOD thing, and the ingredient hydroxyethylcellulose is similar to aloe vera (but food grade) and leaves a silky feel to the hands once it dries. It only costs about $2.25/ounce if you buy 3 tubes.
Any negatives to this one? The smell might be a bit strong for some kids, and it’s easy to get too much upon squeezing the tube. Better too much than too little?
Cedarberry Gel Hand Sanitizer
Wildthings insect repellent from Cedarberry has LONG been our family’s favorite natural bug spray of over a dozen we reviewed, and just recently on a hiking trip to a major national park, my husband’s 4 friends continued to reach to reapply their DEET-based sprays while he waltzed around with just one application of Wildthings Extreme. It’s amazing!
Monica, the chief over there, has touched base with me with a hand-written note every summer, and this summer she shared a sample of the new hand sanitizer.
She let me know that bottling supplies held up production of the bug spray for a while, but now they have found an even better supplier for one of the ingredients and it’s more effective than ever!
Enough about bug spray…but this is why I puffy-heart-love knowing my suppliers, who do such an amazing and thorough job with their suppliers. Right?
Monica started producing hand sanitizer specifically for local healthcare providers and to include with food deliveries to people living on the streets on Washington, DC, and you can support that mission with every Cedarberry hand sanitizer purchase — two will go to local folks in need for every one you buy.
The scent is lavender essential oil, very simple and pleasant, and the formula includes aloe vera for moisturizing. The container is a simple plastic flip top, easy to transport without spillage. Cost is about $3/ounce.
Ingredients: 70% ethyl alcohol, aloe barbadensis leaf, dimethicone, water, and organic lavender essential oil
Any negatives to this one?
One ingredient, triisopropanolamine, is rated 3-6 at EWG (middle level of safety) and a possible allergen. EDIT: Monica informed me that already they have changed the source for the sanitizer base, no more triisopropanolamine and carbomer. So now the only tiny downside is that the packaging is plastic, and it would be probable/possible for kids to squirt out too much. However, for school days plastic is a better choice, since glass can too easily break.
Grove Collaborative Hydrating Gel Hand Sanitizer
This is the first brand I’m sharing where I don’t personally know the owner or formulator, but it’s one we’ve used for years and enjoyed, and the ingredients are well-sourced. Note that I don’t know how ingredient sourcing may have changed since the pandemic as I know Grove has struggled to keep this product in stock. It’s frugal though, and moisturizing with no known toxins, so I still want you to know about the option.
Grove is the best value at just over $1/ounce! (If you sign up for Rakuten and install the browser extension, you’ll save another $1 on your first order and get money back at many different online shops!)
The gel includes aloe vera and coconut oil for moisturizing and many certified organic ingredients. My kids love the orange citrus scent.
We have some large bottles with a pump, but I believe with the pandemic supply chain issues, Grove has a number of different packages now. If you have a pump from a previous purchase or other brand, you could easily refill for the best home bathroom option.
The travel size would be great for a backpack, and Grove offers a spray as well.
Any negatives to this one? Depending on the packaging, it may be more or less difficult to use and travel with. Again, I’m not 100% positive on the ethyl alcohol sourcing; they do not claim non-GMO.
Buy Grove Collaborative hand sanitizer here. (You’ll get a free cleaning set as well.)
Ultimately I’m incredibly pleased to hear that our schools are going to be providing more opportunities for students to wash their hands with soap and water as well! We have to be cognizant about reality vs. lab research:
How Effective is Hand Sanitizer at Killing Viruses, Anyway?
It may take up to 4 minutes of rubbing with ethanol-based hand sanitizers to fully inactivate viruses. Whoa! Handwashing only took about 30 seconds.5
Although alcohol-based sanitizers almost always have the phrase “Kills up to 99.9% of germs!” emblazoned on their labels, that’s in perfect laboratory testing.
Actual usage in real situations typically results in more like 40-60% of germs getting the death blow. Not quite as comforting, is it?6
In a 2014 peer-reviewed study found that adding hand sanitizer to regular hand hygiene didn’t really impact school absences or transmission of illness in schoolchildren.7
Scientists tested a number of viruses in 2015 in a study published in the Journal of Hospital Infection.8
Alcohol-based hand sanitizers were effective within 30 seconds on some viruses, including influenza A, but it took 3 minutes for other viruses. Washing with soap and water was completely effective against all viruses tested.
This 2010 study reflected similar results, that soap and water are far better against norovirus than sanitizers. Norovirus is an intestinal “stomach flu” not to be confused with a coronavirus, which is totally different…but let’s be as comprehensively “safe” as we can, don’t you think?9
Finally, a systematic review of 28 studies in the Journal of Food Protection also found that foodborne pathogens are more likely to be reduced by handwashing vs. hand sanitizers.10
Of particular note, the scientists emphasized that although bacteria is inactivated rather quickly with alcohol-based products, viruses put up a much more difficult fight. “The presence of food debris significantly affects the microbial inactivation rate of hand sanitizers,” which must be noted by schools putting in place regulations about hand sanitizer being used upon entering classrooms after lunch.
Since COVID-19 is a relatively new virus, we can’t really extrapolate what we’ve seen in other studies. But scientists can make their best hypotheses.
In a review published in the June 2020 edition of the American Journal of Infection Control, scientists studied known literature to try to deduce how various hand sanitizers should effect SARS-CoV-2. Discussion includes the difference between bacteria and viruses, the specific structure of the novel coronavirus, and various hand sanitizer ingredients.11
The authors believe that because the novel coronavirus is an enveloped virus, it should behave like other viruses of the same structure and thus be inactivated by ethanol-based sanitizers, both on hands and surfaces.
There’s not enough evidence to suggest whether foam or gel is more effective, but the review states:
“Soap and water is superior to sanitizer, and when hand washing is unavailable or inconvenient, a sufficient volume of sanitizer is important to ensure complete hand coverage.”
All that said, I feel a lot more comfortable assuming that soap and water are more likely to completely eradicate viruses over waterless hand sanitizer.
This is not to say that hand sanitizer is completely useless, however. Although hand washing is best, plenty of studies have shown a reduced rate of infection when hand sanitizer is used regularly vs. not.
A 2000 study showed a nearly 20% reduction in elementary school absences with regular hand sanitizer use,12 a 2005 study showed rather equivalent microbial counts on nurses’ hands using sanitizer vs. handwashing,13 and a 2002 study demonstrated a 30% reduction in infection rates in an extended care facility when alcohol sanitizer was used.14 Note that none of these studies separated viral and bacterial infections.
The bottom line is that soap and water are best – prioritize handwashing whenever you can and encourage your schools to do the same wherever possible!
RELATED: What do you touch hundreds of times a day? Sanitize Your Cell Phone!
Myths About Hand Sanitizer (Does it Cause Superbugs??)
We know that hand sanitizer isn’t perfect, isn’t as good as handwashing, but IS a good option when soap and water aren’t available. But what myths are out there about hand sanitizer?
Myth: Alcohol-based sanitizers create antibiotic-resistant superbugs.
Alcohols are just killers, not transmutagenic drugs.
They do not have anything to do with antibiotics.
Alcohol-based sanitizers have even killed multiple-drug-resistant pathogens.6
Read about the science behind “superbugs” in the box here, from a plant biologist.
I am always grateful for the community at Kitchen Stewardship – it’s like having the smartest natural moms in the world all living right next door. I’ve compiled the best natural remedies for 12 of the most commonly discussed ailments here at KS, and am making this resource available for free to all my readers!
Imagine this ebook as a virtual chat over the backyard fence with your own neighbor, a wise older mom who raised a bunch of kids with intention, trying to avoid unnecessary medication and being kind to the earth.
Myth: We didn’t need sanitizers for years, so why now?
In the past, people either had access to water to wash their hands, used wet wipes (with alcohol in them, I believe), or died more often from infectious diseases.
Take your pick.
Myth: Alcohol-based sanitizers get kids drunk.
Many are concerned that kids will be drinking hand sanitizer to get drunk.
This IS a real concern, not that kids will become inebriated, but that drinking hand sanitizer can make people very sick or even cause death.
The FDA requires producers of hand sanitizer to use denatured alcohol, which tastes terrible and could never be mistaken for the kind of alcohol one might drink on purpose.15
There are also restrictions on adding ingredients to sanitizer that might make them smell delicious or taste too palatable.
This doesn’t always work: calls to the National Poison Data System increased 79% in March 2020 compared to March of the previous year. Most of these are children under 5 drinking something they shouldn’t.16
How to Use Hand Sanitizer Properly
I see this done incorrectly all the time, even by health professionals.
If my kids are going to use sanitizer, just like I am telling them about masks, they’re going to use them properly so that it causes the least harm to ourselves and others.
To be effective, hand sanitizer needs “enough” in both quantity and time – a quick memory tool to teach your kids is:
The CDC recommends it this way:
- Put enough sanitizer on your hands to cover all surfaces.
- Rub your hands together until they feel dry (this should take around 20 seconds).
Do NOT rinse or wipe off the hand sanitizer before it’s dry; it may not work well against germs.17
I tell my kids, “It doesn’t count until it’s dry,” and continue to encourage my family to use multiple squirts of the natural sanitizers we prefer to use.
And of course, we actually wash our hands with soap and water whenever possible, especially when we have dirt or food debris on our hands.
Dry Hands? We Have a Solution for That, Too
If your hands are becoming dried out from repeated washing or sanitizing, you’ll want an effective, natural moisturizer on hand.
MadeOn hard lotion has been our favorite for years, and the beeswax really locks in the moisture to make your hands feel completely pampered. The bar isn’t a super quick application, however, and it might not be perfect to send with kids to school as it will be a bit slick on computer keys, etc.
I prefer to apply MadeOn at night so it can really heal my dry skin as I sleep, but I also have one in my purse for long car rides.
For a quick daily lotion, I recommend Earthley body butter. It’s in a tub for quick application, rubs in well and the vanilla bean smells heavenly!
The Bottom Line on Safe Sanitizers
To recap for my skimmers:
- The FDA relaxed some hand sanitizer guidelines, opening up the possibility that neurotoxic and/or carcinogenic ingredients or by-products will be temporarily ok in the name of killing germs.
- This has already resulted in dangerous methanol levels in dozens of sanitizers on the market.
- There have always been some toxic ingredients to avoid in hand sanitizer, like phthalates, parabens, and more.
- Alcohol-based hand sanitizers are effective at killing germs, including viruses, but often real-life is less effective than lab testing, usually only about 40-60% effective.
- Alcohol needs quite a long time to dry to be fully effective, so at the very least, teach your kids to use “a big PLOP, rub 20 before you STOP.”
- Study after study proves that hand washing is more effective at inactivating all kinds of pathogens over hand sanitizer, so seek a sink when you can.
- Myths: Hand sanitizers using alcohol don’t create bacterial resistance (“superbugs”) but kids definitely should NOT drink them.
- Opt for natural sanitizers like Wellnesse, Earthley, C19 from Kabana, Cedarberry and Grove.
And finally and most importantly, soap and water are still best!18, 19, 20
One Final Question…
With all this hand sanitizer everywhere and cleaning classrooms multiple times per day and fogging churches with germ killers containing who-knows-what ingredients…will we create environmental and immune system problems if we over sanitize the world?
I love that research continues to show the benefits and greater efficacy of old-fashioned soap, water, and rubbing, folks…
I recommend cleaning your home but not too clean, washing your hands but no antibacterial soap, and building your family’s immune system through sleep, positive thinking, whole foods, and these other immune building ideas my family relies on.
If you have any influence on the choices made by your churches and schools, it’s not crazy or overbearing to gently ask questions like, “Is there another EPA-approved disinfectant that would be equally as effective but easier on our bodies?” Here are a few bleach alternatives that are EPA approved!
We will get through this stronger than ever, I’m sure of it, but I’m going to be the one asking the questions that people haven’t thought of before, the ones that may become “lessons learned” by experience (and failure) in the next few years that maybe we can avoid with a little evidence-based questioning and critical thinking.
Here’s to cognizance!
- Chan, A., & Chan, T. (2018). Methanol as an Unlisted Ingredient in Supposedly Alcohol-Based Hand Rub Can Pose Serious Health Risk. International Journal of Environmental Research and Public Health, 15(7), 1440. https://doi.org/10.3390/ijerph15071440
- Dukes, J. (2020, June 24). UTC professor explains dangers of methanol in hand sanitizer after FDA warning. Retrieved from https://www.wrcbtv.com/story/42286781/utc-professor-explains-dangers-of-methanol-in-hand-sanitizer-after-fda-warning
- Aulds, A. (2020, June 24). 100-Plus Hand Sanitizers. Retrieved from https://www.webmd.com/lung/news/20200624/fda-warning-these-9-hand-sanitizers-may-be-toxic
- Fukushima, K. (2020, July 28). 5 Hidden Dangers of Hand Sanitizers. Retrieved from https://www.thestreet.com/markets/5-hidden-dangers-of-hand-sanitizers-12966410
- Hirose, R., Nakaya, T., Naito, Y., Daidoji, T., Bandou, R., Inoue, K., Dohi, O., Yoshida, N., Konishi, H. & Itoh, Y. (2019, Sept). Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients. mSphere, 4(5) e00474-19; DOI: 10.1128/mSphere.00474-19
- American Safety Council. (n.d.) Hand Sanitizer [Infographic]. Retrieved from https://blog.americansafetycouncil.com/files/2013/11/Hand-Sanitizer-Myths-and-Tips.jpg
- Priest, P., McKenzie, J., Audas, R., Poore, M., Brunton, C. & Reeves, L. (2014, August 12). Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial. PLOS Medicine, https://doi.org/10.1371/journal.pmed.1001700
- Tuladhar, E., Hazeleger, W.C., Koopmans, M., Zwietering, M.H., Duizer, E. & Beumer, R.R. Reducing viral contamination from finger pads: handwashing is more effective than alcohol-based hand disinfectants. (2015, July 5). Journal of Hostital Infection, 90(3), 226-234. https://doi.org/10.1016/j.jhin.2015.02.019
- Liu, P., Yuen, Y., Hsiao, H.M., Jaykus, L.A. & Moe, C. Effectiveness of Liquid Soap and Hand Sanitizer against Norwalk Virus on Contaminated Hands (2010, January). Applied and Environmental Microbiology 76(2) 394-399; DOI: 10.1128/AEM.01729-09
- Foddai, A. C., Grant, I. R., & Dean, M. (2016). Efficacy of Instant Hand Sanitizers against Foodborne Pathogens Compared with Hand Washing with Soap and Water in Food Preparation Settings: A Systematic Review. Journal of food protection, 79(6), 1040–1054. https://doi.org/10.4315/0362-028X.JFP-15-492
- Golin, A.P., Choi, D. & Ghahary, A. Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses. (2020, June 18). American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2020.06.182
- Hammond, B., Ali, Y., Fendler, E., Dolan, M., & Donovan, S. (2000). Effect of hand sanitizer use on elementary school absenteeism. American journal of infection control, 28(5), 340–346. https://doi.org/10.1067/mic.2000.107276
- Hammond, B., Ali, Y., Fendler, E., Dolan, M., & Donovan, S. (2000). Effect of hand sanitizer use on elementary school absenteeism. American journal of infection control, 28(5), 340–346. https://doi.org/10.1067/mic.2000.107276
- Fendler, E. J., Ali, Y., Hammond, B. S., Lyons, M. K., Kelley, M. B., & Vowell, N. A. (2002). The impact of alcohol hand sanitizer use on infection rates in an extended care facility. American journal of infection control, 30(4), 226–233. https://doi.org/10.1067/mic.2002.120129
- Santos, C., Kieszak, S., Wang, A., Law, R., Schier, J., & Wolkin, A. (2017). Reported Adverse Health Effects in Children from Ingestion of Alcohol-Based Hand Sanitizers – United States, 2011-2014. MMWR. Morbidity and mortality weekly report, 66(8), 223–226. https://doi.org/10.15585/mmwr.mm6608a5
- Felton, R. (2020, July 28). New Hand Sanitizers Packaged in Beverage Bottles Could Pose Health Risks. Retrieved from https://www.consumerreports.org/product-safety/new-hand-sanitizers-in-glass-or-plastic-beverage-bottles-could-pose-health-risks/
- Hicks, T. (2020, July 6). How to Tell If the Hand Sanitizer You’re Buying Is Safe and Actually Works. Retrieved from https://www.healthline.com/health-news/how-to-tell-if-the-hand-sanitizer-youre-buying-is-safe#How-to-use-properly
- Thordarson, P. (2020, April 8). The coronavirus is no match for plain, old soap — here’s the science behind it. Retrieved from https://www.marketwatch.com/story/deadly-viruses-are-no-match-for-plain-old-soap-heres-the-science-behind-it-2020-03-08?mod=article_inline
- Centers for Disease Control. (n.d.) Hand Sanitizer Use Out and About. Retrieved from https://www.cdc.gov/handwashing/hand-sanitizer-use.html
- McCarthy, M. (2019, September 18). Want to Fight Off the Flu? Soap and Water Is Better Than Hand Sanitizers. Retrieved from https://www.healthline.com/health-news/flu-soap-and-water-better-than-hand-sanitizers