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Antibacterial soap vs. hand sanitizer

I recently taped a note to the soap dispenser in the office kitchen to warn my colleagues that the soap contained the chemical triclosan, a troubling antibacterial agent.

But products with triclosan, which aren't any more effective than soap and water, aren't just a waste of money; the chemical is endocrine disruptor, generates chloroform under common conditions and is turning up in wastewater, breast milk and fish.

My helpful little note lasted about three minutes before someone ripped it down, but several people stopped by my desk asking how to find soap without triclosan. People were also confused about the difference between waterless hand sanitizer and anti-bacterial soap.

If you're confused as well, here’s a little primer to help you sort it all out.

Hand sanitizers
Alcohol-based hand sanitizers, found in schools, hospitals, day-care centers, health clubs and grocery stores, can be a great substitute for hand washing if soap and water aren't available, as long as they contain more than 60 percent ethyl alcohol or isopropanol or a combination of the two.

And though they can kill bacteria, they differ from products labeled "antibacterial," which require water.

Available in a squeeze bottle or pump, sanitizer gel is alcohol-based and doesn't need to be rinsed off. Just a dime-sized dollop to dry hands kills micro-organisms by stripping away the outer layer of the oil on the skin.

After you've used it, the bacteria don't regrow as fast, which keeps "residual micro-flora that reside in deeper layers of skin from coming to the surface," according to theColorado State University Cooperative Extension.

But hand sanitizers still don't remove dirt; you need soap, water and friction for that. The setting and what's already on your hands also is important, because soil, food and other substances make the gels less effective.

Health-care workers, for example, can use waterless hand sanitizers in place of soap and water because the employees routinely clean their hands several times an hour, and sanitizers encourage compliance, according to the U.S. Centers for Disease Control and Prevention.

But the Illinois Department of Public Health says food-service workers should not use them exclusively, especially those handling ready-to-eat food or whose hands are wet or contaminated with fatty materials. Illinois day-care centers and homes, meanwhile, cannot use waterless hand sanitizers as an alternative to soap and running water.

Like any product not meant to be ingested, eating the stuff can be dangerous.

Earlier this year, the New England Journal of Medicine reported two cases of people -- a prison inmate and an alcoholic -- getting intoxicated after eating hand sanitizer. Watch your teenager.

Then there was the story of the 8-year-old girl who licked 10 to 20 globs of hand sanitizer while at a supervised play center at a suburban Chicago health club, an idea that originally came from a classmate at school. She ended up in intensive care for two days.

It's also not recommended for infants, but if you have a teether who has sucked on your hand-sanitized hands, don't panic. "The alcohol part evaporates in just seconds as it air dries ... so your hands may still feel it but there is no alcohol touching your child's lips," said nurse epidemiologist Ed Goodwin at Rush University Medical Center.

One other caution for smokers: It's flammable. Don't light a match if your hands are still wet with hand sanitizer.

If you’re looking for a natural hand sanitizer, with no alcohol or harsh chemicals, try Clean Well which uses a patented formulation of plant oils called Ingenium.

Antibacterial soap
Antibacterial soap, which contains the chemicals triclosan or triclocarban, must be used with water and is marketed as having the ability to kill bacteria. But it's no more effective than non-antibacterial soap and doesn't prevent colds or flu, which are caused by viruses, not bacteria.

Unless you're in a hospital environment, using products with triclosan, a biocide that can destroy biological structures at random, is overkill, like using a jackhammer to kill an ant.

Moreover, triclosan, which mimics the thyroid hormone and is bioaccumulating in the environment, is present in 60 percent of U.S. waterways investigated.

Unfortunately, it's nearly impossible to find liquid soap without triclosan. It's also added to toothpaste, deodorant, dog shampoo, cutting boards, clothing, toys and other antibacterial products. The best way around this is to "just rub your hands with plain water," said Sylvia Garcia-Houchins, manager of infection control at the University of Chicago. The key is the scrubbing action.

Or try soaps from Dr. Bronner’s or The Common Sense Farm.

Soap and water
Soap and water is the gold standard, especially if your hands are visibly soiled or you've just changed a diaper and have fecal matter on them.

A common mistake is applying the soap to dry hands. Instead, first, wet your hands. Then use the soap, scrubbing the fronts and backs of the hands and between the fingers for about 10 to 15 seconds. (Hand sanitizers are just the opposite; make sure your hands are dry.)

Soap doesn't necessarily kill germs; it makes your hands slippery so the germs slide down the drain, Garcia-Houchins said.