Lentis/Popular Hygiene: Perceptions and Practices

Background

Hand sanitizer

Hand sanitizer is a product that emerged in the second half of 20th century. An alternative to washing hands, this waterless formula has been endorsed by the Center for Disease Control as a successful method to clean hands. They recommend an alcohol concentration of at least 60%, but products contain anywhere from 0% (alcohol free) to 95% alcohol. A dime sized amount is sufficient to clean hands if rubbed in thoroughly. Though waterless antibacterial gel has existed since the 1940s, the first consumer product was not introduced until 1988 by Purell. A full time line can be found at the GOJO website. The product was initially marketed to hospitals for emergencies and food service industries to improve the hygiene of procedures. However, in the past decade hand sanitizer has spread to the general public as well. It is found in government buildings, schools, and universities across the country and has become a permanent and accepted fixture of our daily life.

Supporters

Hand sanitizer being used in the Navy (before lunch)

Hand sanitizer supporters claim numerous benefits of the product. It is used by nurses and doctors in hospitals, students and teachers at school, and business people at work. Other individuals also carry the product in bags or on key chains for fast and convenient use on the go. These people either directly endorse the product through advertisements, images, and testimonials, or indirectly simply by using hand sanitizer. Some of the benefits referenced by hand sanitizers supporters are:

1. Hand sanitizer is fast - Hand sanitizer needs to be rubbed in for 20 seconds or less, compared to the recommended 60 seconds needed for effective hand washing. This is particularly important for people that are required to wash their hands frequently, like nurses. In order to prevent cross-contamination, hospital employees must clean their hands every time they move between patients. If a nurse is required to clean his/her hands 7 times per hour during an 8 hours shift, it would take him/her 56 minutes to wash their hands, compared to only 18 minutes to use hand sanitizer. The medical profession has particularly highlighted this advantage of hand sanitizer because time is so valuable in a hospital. Evidence of this can be seen in the gelFAST Wearable Hand Sanitizer product, which can be worn on the belt for easy, quick access. Ads for gelFAST employ the slogan "Need it, Do it, Done", emphasizing how quickly the product can be used.
2. Hand sanitizer effectively kills germs - A review of 26 separate studies on the effectiveness of hand sanitizer concluded favorably, stating that it "support[s] the use of alcohol-based rubs for routine hand hygiene" and that hand sanitizers "remove microorganisms including bacteria, viruses, fungi and multiple drug resistance microorganisms from hands of personnel more effectively than hand washing with non-medicated soap or other antiseptic agents and water." The effectiveness of hand sanitizer is frequently used as a selling point, with most products claiming to kill 99.9% of bacteria. This advertisement for Purell shows an illustration of germs cowering in fear from Purell hand sanitizer. Other advertisements also suggest using hand sanitizer will keep you both germ and disease free. This advertisement claims it will kills germs that cause disease and foster a "healthy environment." Some doctors and nurses have supported the use of hand sanitizer as an effective way to promote hygiene in hospitals, as explained in this article.
3. Hand sanitizer is convenient - Hand sanitizer can be used anywhere, anytime, and is thus more convenient than traditional soap and water. Germ-X advertises that it can provide "quality antibacterial protection at home, work, school, or "on-the-go"." As one consumer writes on the Purell website, "You do not need soap and water to use PURELL®; it goes anywhere: fits into your purse and leaves your hands felling clean and refreshed." Hand sanitizer is marketed in small, easy to carry bottles and even in key chains. As one review by "Purell Lover" states on the Amazon site for Purell key chains, "I've owned a Jelly Wrap Purell keychain for around 2 years now. I can't tell you how handy this is especially with young children!" Hand sanitizer's convenience and portability is key in its success, as it fills a need of consumers to be able to clean their hands on the go. This is something hand washing can never provide, giving hand sanitizer a distinct market.

Since its move from hospitals and food services into schools, the navy, workplaces, bags, and purses, hand sanitizer has garnered numerous supporters. In a society where we fear germs and sickness, many have turned to hand sanitizer to keep their hands clean. One website even suggests selling hand sanitizers for school fundraisers, as "putting hand sanitizer everywhere all the time, year round benefits everyone." Other companies have begun to make hand sanitizer fashionable, using designers to make the products stylish. For example, Ed Hardy has created a line of sanitizing products, pictured on the Ed Hardy website. Products like the Kootie Killer use scents and fun colors to market hand sanitizers specifically to kids. These products illustrate how deeply hand sanitizer has enmeshed itself in society and become a marketable product. Clearly, hand sanitizer has gained a following in society. It fulfills society's desire to have clean hands quickly and conveniently.

Detractors

While there are many supporters of hand sanitizer use, there are also many people who are against its use or, more specifically, its overuse. Because it is so widely accepted in society, many people are unaware of the risks that arise from the improper use of hand sanitizers. Those who are opposed to the use of hand sanitizer express their dissent through written articles, interviews, and warning labels. The main risks of hand sanitizer use are outlined below.

1. Hand sanitizer may lead to superbugs - Most brands of hand sanitizer claim to kill 99.99% of bacteria on the hands. The 0.01% of bacteria that survive are resistant to the alcohol in the hand sanitizer. These bacteria may then more effectively evade antibiotics and lead to a rise in not only illnesses, but more severe and more difficult to cure cases. The Mayo Clinic advises limited use of antibacterial products in the home because its use in the home "may make [them] less effective in hospitals." Constantly killing the nonresistant bacteria on the hands allows the resistant bacteria to multiply more rapidly than it could under normal conditions.
2. Hand sanitizer does not remove dirt from hands - Hand sanitizer is intended to be an on-the-go supplement to traditional hand washing. However, people often use hand sanitizer as a replacement for hand washing, even when a sink and soap are readily available. One website states that "using hand sanitizer every once in a while as a backup is OK. But it's no replacement for good old fashioned soap and water." The Food and Drug Administration (FDA) also states that hand sanitizers should only be used "after proper washing of hands" to minimize the amount of microbes transferred when handling produce implying that hand sanitizer on its own is not suitably sufficient. Traditional hand washing, if done correctly, removes dirt and other contaminants from hands. Hand sanitizers may be as effective at killing bacteria, but it does not remove any other grime from the hands.
3. Hand sanitizer is not safe for children - Alcohol-based hand sanitizers have warning labels that state that the product should be kept out of reach of children. In order to be considered effective, hand sanitizers must contain at least 60% ethanol. This is the same alcohol present in wine, beer, and liquor. Typical liquors contain 40% ethanol. Children are allowed unsupervised use of hand sanitizers in most schools, and the high alcohol content could cause serious health problems for them if even a small amount were ingested. Some groups advise parents to avoid scented sanitizers because they are more tempting to children to taste. Also, alcohol-based hand sanitizer is highly flammable and should be used under careful adult supervision.

Because hand sanitizer is so popular in society, many of the dangers and warnings associated with it are often ignored. Many people believe that hand sanitizer is the best way to stay healthy because it kills such a high proportion of the bacteria on hands. However, researchers note that hand sanitizers kill 99.99% of bacteria in laboratory conditions. In real world applications, studies show that they only killed about 46-60% of bacteria on hands. While hand sanitizer can been an excellent supplement to traditional hand washing, its users should take care to understand exactly what the product does and why it can be harmful if used incorrectly.

Social Implications

The convenience of hand sanitizer has made it an item commonly found in purses, key chains, hospitals, and near entrances of classrooms and dining halls across the country. This technology increases cleanliness practices and in turn improves preventative health measures. In addition, its appeal is strongly correlated to social awareness and concern of possible epidemics. For example, as seen in the graph below, the Nielsen Company indicates that the demand for hand sanitizer increased during flu seasons and was substantially amplified in 2009 due to the spread of the H1N1 flu virus.

This trend suggests that though the properties and effectiveness of hand sanitizer are still areas of debate amongst the scientific community, the success of the product depends on the consumer perception of increased health risk. Hand sanitizer sellers successfully play on the implicit fear of germs and sickness. With a rise in perceived risk of illness or the presence of more germs, people compensate by purchasing easy-to-use hygiene goods, including hand sanitizer.

Multiple brands of hand sanitizer have been marketed (e.g. Purell, Germ-X) in the past decades. The success of the product is not solely due to the chemical components, but also the marketing strategies. It utilizes the same advertising strategies of hand washing, namely that it kells germs and can prevent disease and even save lives. With these tactics, hand sanitizer is viewed as a replacement for soap and water and is seen as easier to use than the hassle of hand washing. Most of the dispensing technology ejects the recommended dose to minimize possible over-consumption. The creation of pocket-sized, automatic dispensing, and wall mounting containers aid in the attractiveness of the product. Because it appeals to a diverse population of individual buyers and large industries it can proliferate across markets and be found in many sizes in an array of locations.

References