What should be the active ingredient content of hand sanitizer for hospital use?

Hand Sanitizer Content for Hospital Use

Alcohol-based hand sanitizers for hospital use should contain 60-95% alcohol (ethanol or isopropanol) as the active ingredient, with ethanol being more effective than isopropanol against viruses. 1

Optimal Alcohol Concentration

• Alcohol solutions containing 60%-95% alcohol are most effective for hand sanitization in healthcare settings, with higher concentrations being less potent because proteins are not denatured easily in the absence of water 1
• Ethanol 60%-95% is classified as a Category I agent (generally safe and effective) by the FDA for use in antiseptic handwash products 1
• Isopropanol 70%-91.3% is widely used, with 60% isopropanol adopted in Europe as the reference standard for alcohol-based hand rubs 1

Antimicrobial Efficacy

• Alcohols have excellent germicidal activity against gram-positive and gram-negative bacteria, multidrug-resistant pathogens (MRSA and VRE), Mycobacterium tuberculosis, and various fungi 1
• Ethanol has greater activity against viruses than isopropanol, which is crucial in healthcare settings 1
• For nonenveloped viruses (like rotavirus, adenovirus, and rhinovirus), a 60% ethanol formulation can reduce infectivity titers by >3 logs 1
• For hepatitis A and enteroviruses (e.g., poliovirus), 70%-80% alcohol concentration is required for reliable inactivation 1

Formulation Considerations

• Adding 1%-3% glycerol or other skin-conditioning agents can reduce the drying effect of alcohol on skin, improving compliance 1
• Alcohol-based rinses or gels containing emollients cause substantially less skin irritation and dryness than soaps or antimicrobial detergents 1
• The volume of product applied is critical - insufficient volume results in inadequate antimicrobial activity 1
• For optimal efficacy, hands should not feel dry after rubbing for 10-15 seconds; if they do, insufficient product was likely applied 1

Special Formulations

• Adding chlorhexidine, quaternary ammonium compounds, or triclosan to alcohol-based solutions can result in persistent antimicrobial activity 1
• Ethanol plus chlorhexidine gluconate formulations provide significantly lower bacterial counts both immediately after use and after spending time in ICU common areas compared to ethanol-only products 2
• Low viscosity rinses, gels, and foams are all available for hospital use, with some evidence suggesting rinses may reduce bacterial counts more effectively than gels 1

Safety Considerations

• Alcohol-based hand sanitizers are flammable (flash points 21°C to 24°C) and should be stored away from high temperatures or flames 1
• Alcohol is not appropriate when hands are visibly dirty or contaminated with proteinaceous materials 1
• Non-alcohol alternatives like benzalkonium chloride are significantly less effective against noroviruses compared to alcohol-based products (0.3 log reduction vs. 1.7-3.3 log reduction for ethanol) 3
• Ingestion of alcohol-based hand sanitizers can cause toxicity, particularly if they contain methanol (which is not an acceptable ingredient) 4

Application Recommendations

• For routine hand hygiene in healthcare settings, alcohol-based hand sanitizers should be applied to all surfaces of the hands and rubbed until completely dry 1
• The CDC recommends that alcohol-based hand sanitizers should be rubbed over all surfaces of the fingers, hands, and wrists until the sanitizer has dried (approximately 30 seconds) 1
• Alcohol can prevent the transfer of healthcare-associated pathogens more effectively than handwashing with plain soap and water when hands are heavily contaminated 1

Common Pitfalls to Avoid

• Using insufficient volume of product - this significantly reduces antimicrobial efficacy 1, 5
• Applying alcohol-based sanitizer to wet hands - this dilutes the concentration and reduces effectiveness 1
• Using alcohol-impregnated towelettes, which contain limited amounts of alcohol and have effectiveness comparable only to soap and water 1
• Selecting products with strong fragrances that may be poorly tolerated by healthcare workers with respiratory allergies 1

In conclusion, hospital hand sanitizers should contain 60-95% alcohol (preferably ethanol) as the active ingredient, with the addition of emollients to reduce skin irritation. For maximum efficacy against the broadest range of pathogens, ethanol at 70-80% concentration provides optimal protection in the healthcare environment.