Hand Hygiene, Truths, Myths and Misinformation

June 26, 2006 |

There are many misconceptions about hand hygiene on the Internet. Hopefully, this information will help clear up some of those misconceptions.Washing your hands with soap and water will kill germs.

Truth or misinformation?


1. Plain soaps have minimal if any antimicrobial activity.
2. In several studies, hand washing with plain soap failed to remove bad microorganisms (pathogens) from the hands of hospital personnel.
3. Hand washing with plain soap can result in an increase in bacterial counts on the skin.
4. Occasionally, contaminated plain soaps have colonized hands with Gram-negative bacteria.

Reference: http: www.learnwell.org//handhygiene.htm

Killing germs on your hands decreases your immunity.

Truth or Myth?


1. The skin on your body is covered with microorganisms.
2. Our environment is contaminated with microorganisms.
3. You cannot kill all of the microorganisms on your hands.
4. Your large intestine contains large numbers of microorganisms.
5. All of the sources listed above stimulate your immune response.
6. Health Care Workers CDC guidelines call for alcohol rubs to be used 60 or more times a day between patients and after touching contaminated surfaces.
7. Killing germs on your hands will not decrease your immunity but it will help prevent infections.

Reference: http: www.learnwell.org/handhygiene.htm

Hand sanitizers do not kill germs.

Truth or misinformation?


1. Hand sanitizers containing a minimum of 60 to 95% alcohol are very efficient germ killers.
2. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE) tuberculosis, virus, including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, hepatitis, and fungus.
3. Alcohol rub sanitizers kill 3.5 log(10) (99.9%) of the bacteria on hands 30 seconds after application and 4 to 5 log(10) (99.99 to 99.999%) of the bacteria on hands 1 minute after application.
4. Alcohol rub sanitizers can prevent the transfer of health-care associated pathogens (Gram negative bacteria) better than soap and water.
5. Alcohol rub sanitizers are not appropriate for use when your hands are visibly dirty or contaminated with blood. Use soap and water.

Reference: www.learnwell.org/handhygiene.htm

Don’t kill the good germs. They protect our hands from the bad germs.

Truth or Myth?


1. Good germs are microorganisms normally found on human skin and bad germs are pathogenic (disease producing) microorganisms.
2. The numbers of good germs and bad germs on the hands are variable from one person to the next but remains relatively constant for each individual.
3. Good germs cannot protect you against bad germs. Anyone can become contaminated with bad germs (pathogens).
4. Bad germs (pathogens) do not always cause infections and good germs in the wrong place can cause infections.

References www.learnwell.org/handhygiene.htm Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91(suppl 3B):72S-75S. Richet P, Hubert B, Nitemberg G, et al. Prospective multi-center study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol 1990;28:2520-2525.

Alcohol dries your hands.

Truth or misinformation?


1. Frequent use of alcohol-based formulations for hand antisepsis can cause dry skin unless emollients and/or skin moisturizers are added to the formula.
2. The drying effect of alcohol can be reduced or eliminated by adding glycerin and/or other emollients to the formula.
3. In several prospective clinical trials, alcohol based hand sanitizers containing emollients caused substantially less skin irritation and dryness than soaps or antimicrobial detergents.
4. Allergic contact dermatitis or contact urticaria syndrome or hypersensitivity to alcohol or additives present in alcohol hand rubs rarely occurs.

Reference: www.learnwell.org/handhygiene.htm

Alcohol rubs cause (bacterial) mutation and resistance.

Truth or Myth?


1. Dead microorganisms don’t mutate. Alcohol rubs (biocides) kill microorganisms.
2. Current scientific evidence has not shown a link exists between the use of topical antimicrobial formulations and antiseptic or antibiotic resistance.
3. Antiseptics (biocides) have multiple (thousands) of nonspecific killing sites on and in the microbial cell which cannot easily mutate.
4. Antibiotics and antibacterial soaps (triclosan) have one very specific killing site on and in the microbial cell which can easily mutate.
5. Antibiotic resistance has no affect on the effectiveness of (biocides) antiseptics.

References: Jones R.D. Bacterial resistance and topical antimicrobial wash products. Am. J. Infect. 1999 Aug: 27(4):351-63. Barry A.L., Fuchs, P.C., Brown, S.D. Lack of Effect of Antibiotic Resistance on Susceptibility of Microorganisms to Chlorhexidine gluconate and Povidone iodine. Eur. J. Clin. Microbiol. Inf. Dis. 1999, 18: 920-921.

Alcohol rubs and Germ Out® kill germs better than soap and water.

Truth or misinformation?


1. Use Germ Out® or alcohol rubs to kill germs on your hands.

2. Use soap and water on visibly dirty or soiled hands.

Reference: www.learnwell.org/handhygiene.htm

For more information on hand hygiene visit www.germout.com

81 Responses to Hand Hygiene, Truths, Myths and Misinformation

  1. somugroup1 January 8, 2014 at 11:09 pm #

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  2. Rubye October 23, 2013 at 11:11 pm #

    When I originally commented I clicked the “Notify me when new comments are added”
    checkbox and now each time a comment is added I get four emails with
    the same comment. Is there any way you can remove me from that service?
    Thanks a lot!

  3. John August 5, 2013 at 11:35 am #

    So why bother?????????????

    I mean I can see it if you work in a hospital after you handle patients, but for the regular civilian, what’s the point if we always have microorganisms.all over us?

    Killing germs on your hands decreases your immunity.

    Truth or Myth?


    1. The skin on your body is covered with microorganisms.
    2. Our environment is contaminated with microorganisms.
    3. You cannot kill all of the microorganisms on your hands.

    Read more at http://scienceblog.com/10882/hand-hygiene-truths-myths-and-misinformation/#mg42p0ExwHQ5gKa5.99

  4. The article features verified necessary to us. It’s very educational and you’re naturally extremely educated in this field. You have got popped my own sight to be able to varying thoughts about this kind of matter along with interesting and reliable content material.

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  7. Shiva M March 8, 2012 at 2:03 pm #

    Jerk off! Get real, not obnoxious! Blogs like this are for people really interested in learning something! Not some stupid A?@#$ reply which could really harm someone who might not be as intelligent as someone like “you” and I and may literally take this as something important and harm themselves.

  8. Jahn February 21, 2012 at 2:53 am #

    I can’t wait to see the videos of people actually doing these things haha

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  10. troy December 9, 2011 at 10:58 pm #

    Thanks JsHibbard for your patience and brilliant, yet simple to understand, replies to the paranoid alarmist germaphobic “anonymous” posts. I’d remain anonymous too if I were him/her.

    I love hand sanitizer!!!

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  12. Joe Mama October 11, 2011 at 12:09 pm #

    i like this one it actually sounds like a scientific fact

  13. E September 11, 2011 at 3:45 pm #

    Ok, I NEED to know: Can hand soap kill dogs if they eat/drink it? Please reply ASAP!

  14. Kelli February 16, 2011 at 11:51 am #

    I was about to say that myself, thanks for posting.

  15. William November 23, 2010 at 2:03 pm #

    “The use of hand sanitizers and antiseptics will have no effect on our immune systems or our response to germs.”

    Try to watch out for such uses of absolutes. You cannot be 100% certain of anything. I would expect that from someone in marketing not medicine.

    Language is important.

    Your intentions might be good trying to bring a better product into an environment where many companies have likely done the bare minimum in order to increase their profits, but in many places you come off as simply trying to sell a product which to me makes you seem biased and untrustworthy.

  16. Andi-Body Piercer November 17, 2010 at 6:45 pm #

    I was wondering about Hepatitis C. I know that it will kill Hepatitis but does this include Hepatitis C ? That includes MERSA/STAPH as well?

  17. Andi-Body Piercer November 17, 2010 at 6:40 pm #

    thanks for that information

  18. Anonymous November 17, 2010 at 6:25 pm #

    Haha lets get rid of the idiots LOL

  19. SilenceLog November 13, 2010 at 11:06 am #

    The cheapest most effective hand sanitizer is boiling water. Please submerge your hands in a large pot of boiling water up to the elbow and leave them there for 10 minutes. Repeat this process every hour on the hour, and your hands will remain relatively sterile. In a pinch, open flame can be used. Place whole forearm into open flame for 5 minutes. Rotate arms/hands to get as even coverage as possible in the flames. Remember, if the flesh begins to bubble and sizzle, that is good. You are killing pathogens! If you have access to enriched plutonium, there are alternate methods of sterilizing your skin, but that is another discussion for another time.

    Remember that pathogens readily populate your face as well, so be sure to regularly submerge your entire head in boiling water, or of course, an open flame, as described above.

  20. callmekat November 6, 2010 at 1:29 pm #

    Also if it can actually go bad, what ingredient in the product goes bad and unusable?

  21. callmekat November 6, 2010 at 1:28 pm #

    Is it harmful to use expired sanitizer? I know some products have an expiration date because they are required. But the product is still good after the expiration date. So is sanitizer the same?

  22. Charlie Mcmullin November 5, 2010 at 6:48 am #

    i think you should just give it puppy chow/food. give it lots of toys to chew on, soft treats work best…. and make sure all of your cords are put up on rapped up becasue it would not be good if they got those… i would also recomend a lot of newspaper.

  23. YOUSUCKNUGGETS November 4, 2010 at 11:46 am #


  24. Undercover November 4, 2010 at 11:45 am #


  25. Undercover November 4, 2010 at 11:43 am #

    You know what? I think that your the fake! First of all your researches are atleast 4 years outdated, and your supposedly “informational” sites well I tried to see if it was the truth, and the sites didn’t even exist. I think you ARE A FAKE and nobody should listen to this guide. GOOD LUCK GETTING AIDS AND ALL THE OTHER DISEASES!

  26. Val October 16, 2010 at 9:50 pm #

    In your home, there’s no reason to use soaps that kill germs. The surfactants, not disinfectants, are what pick up bacteria and dirt. The simplest soaps will do the job. It’s purely mechanical action from the soap bubbles. For hospital personnel and doctors it’s a different matter.

  27. Nick McGivney September 3, 2010 at 4:09 am #

    Whatever about the truth and misinformation, you do yourselves no favours in the way you lay out your information, particularly at the start.

    What you want me to understand as fact, you present as a list of four things that are misinformation. On the other hand when you write ‘Washing your hands with soap and water will kill germs’ it is a statement of fact, which is the opposite of what you intended.

    That’s all.

  28. Hand Sanitizer August 26, 2010 at 1:27 pm #

    3. Alcohol rub sanitizers kill 3.5 log(10) (99.9%) of the bacteria on hands 30 seconds after application and 4 to 5 log(10) (99.99 to 99.999%) of the bacteria on hands 1 minute after application.
    4. Alcohol rub sanitizers can prevent the transfer of health-care associated pathogens (Gram negative bacteria) better than soap and water.

    They are getting even better.

  29. anonymous11 August 18, 2010 at 3:24 am #

    Dr J Hibbard,
    i was wondering how can you be sure that an antiseptic has killed all the bacteria? This is for a science prac, and after thorough searching, can’t find something to answer this question.

  30. Troll July 27, 2010 at 2:41 pm #

    thats “you’re”

  31. J Rook July 22, 2010 at 7:39 pm #

    Truth – References from 1999 completely ignore the significant advances in non-alcohol based hand and skin sanitizers. Products like MicroArmor are as effective as alcohol across a broader spectrum of viruses, bacteria and fungi. They are significantly safer and improve the condition of the skin as opposed to drying it out. Non-compliance with use of alcohol based hand sanitizers is a significant problem and specifically associated with the negative effect they have on hands due to long term use. School systems are moving away from alcohol based sanitizers as fast as possible due to safety issues – flammable and ingestion.

  32. Air Hygiene June 22, 2010 at 7:50 am #

    it’s common sense that the more you use anti bacterials an sanitizers that you lower your immunity.

  33. Sam June 15, 2010 at 9:05 am #

    BTWH1N1 Vaccine was a waste of tax payers money & people’s time!So you want to avoid the flu?? Wash your Hands!

  34. Anonymous June 12, 2010 at 1:00 pm #

    You obviously dont work in healthcare!

  35. Anonymous June 8, 2010 at 2:51 am #

    Are their any bacteria that are resistant to hand sanatizer?

  36. JSHibbard February 15, 2010 at 10:11 am #

    As I have explained before it is impossible to sterilize our skin or our environment. It cannot be done while a person is alive. Hand sanitizers and antiseptics are used to reduce the numbers of bad and good germs. Reducing the number allows our immune systems to fight infection without confronting overwhelming numbers of bad germs. Your example of Aztec and American indians is a good one. The American Indians had no previous exposure to Small Pox virus. Therefore, when they were exposed to the virus for the first time they were very susceptible. The had no immunity because they had no previous exposure. Many American Indians died until they developed an immunity to small pox. The recent H1N1 pandemic is another example of a susceptible population. Children and young adults had no immunity to H1N1. Older adults had a partial immunity due to their exposure to the Asian flu and Hong Kong flu. The secret to the use of hand sanitizers is to reduce the numbers of bad germs to the point where they will not overwhelm the host and cause infection and disease but they will illicit an immune response and immunity to the bad germ. Hand sanitizers cannot and will never sterilize the skin. The use of hand sanitizers and antiseptics will have no effect on our immune systems or our response to germs. There are too many germs present in our environment and on our skin. The only thing we can do is to lower the numbers we are exposed to so our immune system can cope with the assault of germs and is not overwhelmed. We have been using soap and water to wash our hands and bodies for centuries. While soap and water will not kill germs as well as hand sanitizers and antiseptics they will kill a few germs. The use of soap and water has not changed our immunity or immune response but it has increased our sanitation and hygiene and reduced the number of infections in the community and in the healthcare environment (i.e. hospital operating room). Hand sanitizers and antiseptics are much better germ killers and therefore will do a much better job of reducing infection and disease in the healthcare environment and the community.

  37. Anonymous 2 February 12, 2010 at 3:42 pm #

    I am sorry to see everyone ignoring the completely convincing argument that antiseptics do not result in resistant bacteria. This seems to have been thoroughly explained. I am more interested in the idea that our immune systems are built up by constant exposure to bacteria over the course of our lives and fighting off minor infections. If you completely sterilize your environment your whole life you run a much higher risk of a very serious infection that over runs your immune system when you are placed in an environment where that sterilization is not available. This is analogous to what happened to the aztecs and native americans when suddenly exposed to foreign contaminants that were not present in their environment previously. Sure, using hand sanitizer will not lower your immune system now, but its systematic use over a lifetime may have profound effects on your ability to resist serious infection later on.

  38. JSHibbard February 10, 2010 at 3:41 pm #

    Please read the reply comment above to “I would expect this from J S Hibbard”. You may change your mind about “my beloved Germ Out(R)” and Population Ecology. Also will you please site references for your statement that “the population that grows back will not be the same genetically”. There is no artificial selection with the use of antiseptics. Sanitizers are an equal kill product. They do not discriminate. The bacteria replacing the killed bacteria will be normal skin flora. The only danger is if your hands become contaminated by a disease producing pathogen. This why you use a sanitizer.

  39. JSHibbard February 10, 2010 at 3:25 pm #

    You did not read the reply very carefully. The numbers of bacteria do return after the use of a sanitizer or antiseptic. However, the number will not triple. The number will return to the number found on normal skin. The population will be essentially the same as the population before the use of sanitizer. The danger is that your hands may become contaminated with a pathogenic (disease producing) organism. This is the reason you should use a sanitizer. There is no artificial selection when you use a sanitizer. Despite our best efforts we cannot eliminate all microorganisms from our skin. The bacterial population that replaces the bacteria killed by the sanitizers will be the same as the population before the use of sanitizers. In addition, please keep your sarcastic comments to yourself and please read my comments to either you or one of your buddies concerning my role as CEO of Germ Out(R). You might find the explanation enlightening. Also please do not repeat the same comments three times. we saw the first one. Thank you.

  40. JSHibbard February 10, 2010 at 3:04 pm #

    I agree with everything you have said but I do not agree with your statement that “Benzalkonium chloride and Chlorhexidine gluconate irritate the skin during regular use”. Benzalkonium chloride was originally isolated from coconut oil in the 1930s. It has been used ever since with extremely low irritation rates. Irritation with regular use of benzalkonium chloride is rare, much less than irritation due to the single use of iodine containing products. I have been involved in clinical trials using chlorhexidine gluconate. We used chlorhexidine on over a thousand subjects and carefully monitored for irritation. We never saw any evidence of irritation. Please cite any references you may have that either benzalkonium chloride or chlorhexidine gluconate causes irritation after regular use.

  41. JSHibbard February 10, 2010 at 2:06 pm #

    It is better that I did not stay anonymous. I have been involved in the clinical trials for antiseptics since 1998. I have worked for and with several companies developing antiseptics for preparation for the skin before surgery and injection. The clinical trials were all conducted by independent laboratories under the supervision of the FDA and under strict FDA rules and regulations. The FDA audits all of the study results and the trials. In addition all the clinical study methods, results and conclusions were published in peer reviewed scientific journals. I can assure you with 100 percent certainty the results of the trials were very “relevant”. Two of the antiseptics I worked with, ChloraPrep and Chlorascrub are now being used by hospitals all over the world to prep the skin before injection and surgery. I believe that proves “relevancy”. My work on antiseptics carried me into the field of hand sanitizers. I do not believe the use of one antiseptic at minimal concentration like Purell and Germ X, is adequate for use as a hand sanitizer. Therefore I developed a new second generation hand sanitizer that contains two antiseptics, like ChloraPrep and Chlorascrub,. It is called Germ Out(R). Germ Out(R) contains 70 % isopropyl alcohol and 0.02% benzalkonium chloride. If the alcohol doesn’t kill the germ the benzalkonium chloride will. My agenda is clear. I want to replace all barely adequate hand sanitizers like all the alcohol gel with a far superior hand sanitizer like Germ Out(R). I am trying to protect people from pathogenic microorganisms. One other thing you need to know. Purell was developed by GOJO industries. GOJO is a soap company. If they manufactured a a really good hand sanitizer would this take sales away from their soap sales?

  42. JSHibbard February 10, 2010 at 1:40 pm #

    i believe the comment was referring to a persons immune system not to the resistance of bacteria. Bacteria do not have an “immune” system like humans however they can become resistant to an antimicrobial. Antibiotics and triclosan (in antibacterial soap) kill bacteria by altering one very specific site in the bacterial cell wall. As opposed to antibiotics and triclosan, antiseptics and alcohol hand sanitizers kill bacteria by altering thousands of nonspecific sites on the bacterial cell wall and cell membrane. It is relatively easy for bacteria to become resistant to an antibiotic by altering one specific site but it is not easy for bacteria to alter thousands of non specific sites. This is the reason bacteria can become resistant to antibiotics relatively easily but do not become resistant to alcohol containing antiseptics and hand sanitizers. In addition if the antiseptic or hand sanitizer contains a second antiseptic like chlorhexidine gluconate or benzalkonium chloride, either the alcohol or the second antiseptic or both will kill the bacteria.

  43. Anonymous January 7, 2010 at 12:25 pm #

    Of course you will not see increased numbers of bacteria. So you’re not all wrong. However, the population that grows back will not be same genetically. The genetic make up will be a product of the artificial selection pressures introduced by your beloved germ-out. So Mr. CEO of Germ-Out manufacturer, tell me this, do they not teach Populations Ecology at Kansas? Or do you choose to ignore it?

  44. Anonymous January 7, 2010 at 12:24 pm #

    Of course you will not see increased numbers of bacteria. So you’re not all wrong. However, the population that grows back will not be same genetically. The genetic make up will be a product of the artificial selection pressures introduced by your beloved germ-out. So Mr. CEO of Germ-Out manufacturer, tell me this, do they not teach Populations Ecology at Kansas? Or do you choose to ignore it?

  45. Anonymous January 7, 2010 at 12:23 pm #

    Of course you will not see increased numbers of bacteria. So you’re not all wrong. However, the population that grows back will not be same genetically. The genetic make up will be a product of the artificial selection pressures introduced by your beloved germ-out. So Mr. CEO of Germ-Out manufacturer, tell me this, do they not teach Populations Ecology at Kansas? Or do you choose to ignore it?

  46. Anonymous January 7, 2010 at 12:16 pm #

    I would expect this from John S. Hibbard. Your agenda is obvious. A simple google search shows that you are the CEO of an internet company that sells hand sanitizer. Therefore your “clinical trials” are no more relevant than those of the current kings of clinical research fraud Pfizer. Maybe you should have stayed anonymous…

  47. JSHibbard December 26, 2009 at 10:53 am #

    You are correct. The percent must be listed by law on the label. The concentration of ethyl alcohol in Germ X and Purell is 62% v/v. This is the minimal amount of ethyl alcohol needed to be effective. In order to be called a “hand sanitizer” an antiseptic must pass In Vitro testing. There is very good correlation between In Vitro laboratory testing and In Vivo testing in humans. Germ X and Purell are effective but hand sanitizers containing 70 % w/w isopropyl alcohol plus another antiseptic (benzalkonium chloride) are more effective and they have residual or persistent activity.

  48. JSHibbard December 26, 2009 at 10:34 am #

    No the big picture was not missed. The reason O.01% of the germs were missed is because they are “hidden” in the creases and crevices of the skin. Therefore they were not killed. It is impossible to kill all of the germs on the skin of a living person. Human hands or skin will never be sterile. All accessible germs will be killed by an antiseptic particularly if two antiseptics with different mechanisms of action are used. If one antiseptic doesn’t kill the germ the other one will. You are mixing antibiotics with antiseptics. Antibiotic resistance is well known. Resistance to antiseptics, because of their mechanisms of action, are rare (if they occur at all) or non existent. After the numbers of germs on the hands are reduced by an antiseptic exactly the same germs grow back on the hands. There is no difference between the germs before and after antiseptic use. That is why it is important to use an antiseptic with residual or persistent activity on your hands. At least you will be protected from the germs on your hands for 4 or more hours.
    When we say viruses are killed we were using “lay” not scientific terminology. What we really mean is “inactivated”. You are corrected. Viruses are not “really” killed they are “inactivated” which means their structure is altered so they cannot infect a cell and reproduce. Thank you for your input. You bring up many interesting and important points.

  49. Anonymous December 23, 2009 at 7:59 am #

    yes it will because the bacteria will come ammune to the hand sanitizer and it will no longer kill them

  50. Anonymous December 23, 2009 at 7:57 am #

    your and idiot

  51. Anonymous November 15, 2009 at 3:30 pm #

    This is very good to know! I never thought about that. What do you think about the pump bottles? Would they have the same rate of evaporation?

  52. Anonymous October 15, 2009 at 10:39 am #

    Hand sanitizer is made of people!

  53. JSHibbard October 3, 2009 at 12:12 pm #

    Yes, you are correct. Alcohol evaporates. Alcohol on your hands will evaporate in approximately 30 seconds. Alcohol in a hand sanitizer will also evaporate in an open container. It is very important to keep an alcohol containing hand sanitizer in a closed container. If the container is closed, the alcohol in the hand sanitizer will very quickly reach an equilibrium with the alcohol in the air in the bottle an no more alcohol will evaporate into the air in the bottle. It is possible that a very large bottle opened to many times might result in the alcohol concentration dropping below the effective level (62%). However, it is not probable. A hand sanitizer containing 70% alcohol is better than a sanitizer containing 62% alcohol. With 70% alcohol you can loose 10% of the alcohol to evaporation and it will still be effective. With 62% alcohol you cannot loose any alcohol to evaporation and still be effective. It also helps if your hand sanitizer contains a second germ killer like Chlorhexidine gluconate or Benzalkonium chloride. If the alcohol evaporates below the critical level (62%) the second germ killer will still kill germs.

  54. Anonymous October 8, 2009 at 12:12 pm #

    ……keep this one thing in mind when checking the %’s……the % must legally be listed by using either (v/v) for by volume, or (w/w) by weight, and if they aren’t the chances are the product doesn’t have enough active ingredients to be effective, and is riding the coat tails of some In Vitro tests, not bothering to test the finished product for efficacy.

    So flip over that bottle of GermEx or Purell Gel, and check it out……it will claim 62% ethyl, but wont tell you how much by either volume or weight…… So don’t waste your money guys.

  55. Anonymous October 8, 2009 at 1:02 pm #

    Considering Alcohol has no surface tension, the chance of it being caused by friction is unlikely. In fact it becomes a benefit when using an alcohol solution (not a gel, foam or lotion). Alcohol having no surface tension spreads across the skin, under the nails, and penetrates, while sterilizing everything in it’s path. If the solution also has a bonded conditioning emollient, then this is pulled with it helping to restore damaged tissues as well. There are only a couple products on the market that do this that we are aware of.

    This white “lumping” could also be explained by the Bio-residue build up left behind from the continued use of gels, foams or lotion products. It’s very common in the health care industry to see this, and many nurses and doctors we run into list this as a top complaint.

    We’ve also seen a high frequency of contact dermatitis (skin irritation) for the same reasons, especially in those products containing Benzalkonium Chloride or Chlorhexidine Gluconate. Both of which are known to irritate the skin during regular use.

    Hope this helps

  56. Anonymous September 29, 2009 at 12:32 pm #

    Alcohol evaporates at room temperature. Hand sanitizer is effective because the alcohol kills the germs, but the alcohol evaporates over time, with exposure to air. Have there been tests to determine evaporation rates? What about those huge bottles, is there any alcohol left to kill the germs after half the bottle has been used (so the empty portion of the bottle is filled with oxygen and evaporated alcohol)?

  57. JSHibbard September 18, 2009 at 4:03 pm #

    The Food and Drug administration regulates the concentration of alcohol in gel sanitizers. Alcohol is an active ingredient in gel sanitizers. The manufacture must follow very strict FDA guidelines called current Good Manufacturing Practices (cGMPs) when they make their product. The active ingredient must be within 10 percent of the concentration stated on the label 62% plus or minus 6.2%. In addition, the Standard Operating Procedures (SOPs) used during the manufacture are very carefully controlled by guidelines set up by the FDA. During manufacture the product often goes through several stages of testing for the concentration of alcohol. The short answer is the concentration is regulated by the FDA and is carefully controlled.

  58. Anonymous September 17, 2009 at 8:46 pm #

    C-Diff is NOT found in everyones digestive tract, it is not normal body floura. C-Diff is carried by some poeple and yes they may not know it until they take too many antibiotics and it is able to reproduce rapidly but there are many people who do not carry this and it certainly is not NORMAL to have it.
    Cathy RN

  59. JSHibbard May 17, 2009 at 3:34 pm #

    It probably is not dead skin flaking and lumping up on your hands. I also seriously doubt it is due to friction and alcohol. Alcohol is less irritating than soap and does not dry out your hands as much as soap if it contains a moisturizer. Also please read my previous response to this lady.

  60. JSHibbard May 17, 2009 at 3:25 pm #

    The examples you have given are true. In “certain” cases normal flora (good) germs do compete for resources and help resist colonization by pathogens (bad germs). If it were not for normal flora, humans would potentially not have a chance against bad germs. We would all be dead. There is also some cross immunization between good and bad germs. Your example of Lactobacillus and yeast is also correct but how do we get rid of the yeast infection? We treat with an antifungal agent.

    However, the statement that good bacteria do not protect humans from bad is not “patently” untrue. If it were “patently” untrue then communicable infectious disease would not exist. The facts are humans are susceptible to infectious diseases despite all the good germs in the world. Humans are constantly fighting a battle against infectious diseases. We need all the help we can get. Preventing infectious disease plays a big part in this battle. One way to prevent infectious disease is to kill the microorganism causing the disease before it infects a person or is transmitted to another person. Hand antiseptics and sanitizers kill germs on your hands and reduce the number germs on the hands to decrease the probability of infecting yourself or transmitting the bad germ to some one else.

  61. JSHibbard May 17, 2009 at 2:55 pm #

    If you kill 99.99% not 99.9%, of the germs on your hands, the other 0.01% are not killed and they remain on your hands. The probability that you kill just as many bad germs as good germs is the same. Eventually, the germs, good and bad will start to (multiply) grow back and eventually reach the same concentration as before antiseptic use. This cycle can be repeated over and over. This is why you must kill the bad and good germs over and over. Hand antiseptics and sanitizers do not distinguish between good germs and bad germs. If your hands become contaminated by bad germs, you want to kill as many bad germs as possible as quickly as possible to keep you from becoming infected with a disease producing germ.

    Your analogy with dogs is not applicable to this discussion. It is not possible for an antiseptic to distinguish between good germs and bad germs. Antiseptics kill all germs. Therefore, we cannot select for bad or good germs using an antiseptic or sanitizer.

    We do not want to kill all germs with antiseptics nor can we kill all germs with antiseptics. There are many very good germs in and on our bodies as well as in our environment. An example of a good germ is yeast. Yeast ferment sugar to alcohol which we drink and also use in antiseptics to kill bad germs. The bottom line on antiseptic use is we want to keep our hands as free from germs as possible. If we reduce the numbers germs on our hands, then we reduce the chances that we will become infected with a disease producing germ. It is a numbers game.

    Not all humans carry C. difficile in their digestive tract. C. difficile is found in some hospitals as endospores. Bacterial endospores are very resistant to many chemical disinfectants including antiseptics. Endospores are also very resistant to heat and drying. Therefore, endospores contaminate many hospital environments. They are also not easily grown or detected. Patients in the hospital for systemic infections are often treated very aggressively with oral antibiotics. Unfortunately, the oral antibiotics kill the good and bad germs in the digestive system. If and endospore of C. difficile is ingested and starts to grow, it can produce a toxin (poison) which kills the cells of the digestive tract causing a sometimes fatal disease called pseudomembraneous colitis. Pseudomembraneous colitis can be treated if the disease has not progressed to far. Your point is well taken. Perhaps oral antibiotics should be taken off the market and all serious systemic infections should be treated with intravenous antibiotics.

    Good germs will not protect you from bad germs. Individuals who have never used antiseptics or sanitizers will still become infected with many different disease producing microorganisms. These microorganisms cause infectious disease like typhoid fever, gastrointestinal flu, the common cold, and H1N1 (swine) flu, just to name a few. If we reduce the number of germs, we are exposed to on our hands our chances of becoming infected are reduced. That is the purpose of hand antiseptics and santizers.

  62. Anonymous April 23, 2009 at 10:39 pm #

    It is patently untrue that good bacteria don’t protect against bad bacteria. In fact it is well known that certain normal flora compete for resources with invading bacteria and help establish environmental conditions that resist colonization by pathogens. They may also cross-react immunologically with certain pathogens and therefore immunize the host against them. Vaginal lactobacilli appear to protect against yeast infection since their removal with antibiotics increases the risk of yeast infection. There are many other examples.

  63. JSHibbard April 15, 2009 at 12:02 pm #

    My best guess is that you switched hand lotions in the last two weeks. The alcohol and/or the gel is reacting with your hand lotion. Either switch your hand lotion or switch to a LIQUID hand sanitizer (with no gel) like Germ Out(R). Your husband did not have the same reaction because he was not using hand lotion. This is my best guess.

  64. JSHibbard April 15, 2009 at 11:57 am #

    Please keep all responses based on scientific investigations and references. Thank you very much.

  65. JSHibbard April 15, 2009 at 11:51 am #

    Alcohol rub hand sanitizers will kill Clostridium difficile vegetative cells (the bacteria). However, hand sanitizers will not kill the endospores (the resistant spores) of C. difficile. Soap and water will also not kill the endospores of C. difficile. Steam heat under pressure (autoclaving) and a germicides are two examples of ways to kill the endospores of C. difficile.

  66. JSHibbard April 15, 2009 at 11:41 am #

    No, use of hand sanitizer will not weaken your immune system. Follow the directions on the label of hand sanitizers and you will not weaken your immune system. Also, please refer to the second myth in the above discussions on hand hygiene. I am not sure what you mean by “over use”. If you use hand sanitizers like you use washing with soap and water there is no chance of weakening the immune system. Remember, if your hands are visibly dirty or soiled wash them with soap and water, dry them, and apply hand sanitizer. If your hands are not visibly dirty or soiled, use a hand sanitizer.

  67. Anonymous July 16, 2009 at 7:46 pm #

    Who regulates the concentration of alcohol in gel hand sanitizers? Is the final concentration listed on the label taking into consideration possible dilution from additives such as moisturizers and fragrances? Lastly, are hand sanitizers containing moisturizers and fragrances less effective at killing microbes when compared to those lacking added moisturizers or fragrances?

  68. Anonymous May 7, 2009 at 11:18 am #

    If you use something that kills 99.9% of germs on your skin or any other surface, what exactly do you think happens to the 0.01% that’s left? They reproduce to fill the space left by the other dead germs. Also, they feed on the dead germs so they grow even faster. Now when you consider that the 0.01% not killed by your antimicrobial soap or hand sanitizer is the one that has already mutated to be antibiotic resistant, it doesn’t take long to figure out that the surface will soon by populated by this type of micro-organism. Are you sure this is the surface you think is safe for your kids to eat on, or in the instance of shopping carts and babies, are you sure you want your baby teething on this surface?

    My analogy is one that will probably irritate animal lovers, but here it is. We all know that dogs can be very dangerous when they attack humans. Suppose we decided that we would kill all the dogs we could find in order to protect ourselves. Suppose that our method of doing this only managed to kill breeds of dogs that are generally less aggressive, and the ones who are more aggressive survived and multiplied to fill the ecological niche filled by dogs. Soon all the dogs on the planet would be more dangerous to humans than ever.

    If these solutions killed 100% of germs, it wouldn’t be such a big issue. But they don’t. We have no way to eradicate micro-organisms on this planet, so we’d darn well better not encourage it’s population to be ones we can’t kill when an infection with them occurs.

    Also, regarding the question about C. difficile, this is an organism we all have in our digestive tract and it usually only causes problems when a person takes a broad-spectrum antibiotic in order to kill some nasty infection they have. C. difficile is resistant to these antibiotics so it grows out of control and makes people very sick. So your answer about good germs not protecting us from bad germs is also patently false.

  69. Anonymous December 11, 2009 at 3:56 pm #

    Good and bad germs have nothing to do with the original post.

    What they were trying to point out is that our germophobic society is slowly creating resistant germs. It may not affect us in our lifetime, but it is going to catch up down the road.

    So that 0.01% of germs that are NOT killed with hand-sanitizers.
    1) They probably were not killed.
    2) Because they were not killed, they were the stronger and more aggressive germs (ie dog example)
    3) Because they are stronger/more resistant/aggressive, they are going to be harder to kill. Period.
    4) Because they are a germ, they are going to multiply.
    5) Now you are left with MORE of the hard-to-kill germs.

    And that has absolutely nothing to do with whether it is a “good” germ or a “bad” germ.

    And regarding the original article: You stated that viruses can be KILLED. That’s a pretty dumb statement when viruses are not alive in the first place. You can’t kill something that is not living. Geez… that’s basic science!!

  70. JSHibbard December 11, 2009 at 2:29 pm #

    Hey Cathy, I agree C. difficile is not normal flora. Not all C. difficile are toxin producers either. I apologize for giving the impression that “all people” carry C. difficile. That is not true. However, C.difficile is anaerobic and very difficult for micro labs to grow. Therefore, we probably should assume everyone is a carrier to error on the safe side.

  71. JSHibbard December 11, 2009 at 1:50 pm #

    The pump bottles are OK as long as they have a valve in the pump which prevents exposure to room air. Liquid and gel pump bottles with valves to prevent exposure to room air are acceptable and have the same rate of evaporation as a bottle with an air tight lid.

  72. JSHibbard December 11, 2009 at 1:59 pm #

    Alcohol sprayed on the hands as a liquid or gel and then rubbed into your hands and fingers evaporates and quits killing germs in approximately 30 seconds. The alcohol containing liquid or gel in a pump bottle is drawn off the bottom of the bottle so the alcohol concentration remains the same until the bottle is empty. Tests with a hand antiseptic sanitizer called “Germ Out” demonstrated the alcohol content in the bottle was stable for over five years.

  73. Anonymous July 6, 2009 at 9:20 pm #

    If there is bad bacteria and good bacteria then why don’t we just leave it. If the world is as you say a constant battle between good and evil, good and bad, then obviously there is a winner or just even, and the best thing to do would be to leave it, unless you think that you’ve ran your hand through poo been crawling through a subway and running your hands along the train platform!

  74. Anonymous January 15, 2009 at 6:06 pm #

    Will over use of hand sanitizer weaken your imune system?

  75. Anonymous December 28, 2008 at 11:51 pm #

    That happens to be dead skin flaking and lumping up on your hands do to friction and alcohol…

  76. Anonymous December 9, 2008 at 2:57 pm #

    ok who ever is “anonymous on fri, 2007-11-09 14:33″
    i mean HONESTLY since when did alchohol based hand sanitizer cause bacteria to tripple? once you get out of your own little world of make believe havvoc, let me know.

  77. Anonymous December 9, 2008 at 2:51 pm #

    hey hey hey

  78. Anonymous December 28, 2008 at 11:45 pm #

    They say hand sanitizers kill 99.99% of Germs and Viruses, However does it kill C-Diff (colostridium difficile)? E-mail me Butterfly_Crazy_2008@juno.com

  79. Anonymous September 17, 2008 at 4:22 pm #

    When I use a hand sanitizer, (ANY), I get little white gritt looking things all over my hands even between my fingers. I have to either have napkins to wipe afterwards or go wash my hands to remove them. I showed a doctor asking if this was a bacteria since I’m using an antibacterial and he replied saying no, I don’t know what that is. Do you have any ideas? VERY odd to me as this has never happened before the last couple of weeks. It almost couldn’t be good germs because it doesn’t happen to my husband. It’s also not the specific sanitizer because I’ve bought several different brands all having 62% alcohol.

  80. Anonymous February 16, 2008 at 3:27 pm #

    Dear Anonymous:

    We have been conducting clinical trials on alcohol based sanitizers and antiseptics for preoperative skin preparation for over 10 years on hundreds of volunteer subjects. We have never seen an increase in the number of bacteria after using alcohol based sanitizers or antiseptics. Quite the contrary, we always see a significant decrease in the numbers of bacteria on the skin. After several hours the number will return to normal unless an additional antiseptic like chlorhexiidne gluconate or benzalkonium chloride is used together with alcohol. If you have data to support you claim that the number of bacteria triple after alcohol use, please send it to me. I would like to see it. You will find my e-mail listed below. Thank you for your consideration.

    John S. Hibbard, Ph.D.
    (not anonymous)

  81. Anonymous November 9, 2007 at 1:33 pm #

    One day, we will realize that inventing hand sanitizer was a horrible idea.

    Hand sanitizer will kill bacteria. But because of the alcohol based formula, will cause the bacteria to triple its growth. One day, people will see what a mistake hand sanitizer is. The results should take place in about 5 years.

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