When determining which hand sanitisers to purchase for your practice, it is important to consider environmentally conscious options without skimping on quality. Here, Emma Culjat-Vukman highlights what to look for in a hand sanitiser.
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The first consideration when choosing a hand sanitiser is likely to be whether it will contain alcohol. An alcohol-based formulation provides an effective antibacterial agent, but it can leave skin feeling very dry so staff may have a preference for alcohol-free sanitisers. Unfortunately, however, many of the alcohol-free sanitisers can harm the environment.
One of the most common active ingredients in alcohol-free formulations is benzalkonium chloride.1 It has been shown to be an effective steriliser, and showed better results than an 70 per cent ethanol alternative in a study by Bondurant and others in 2019.2 Benzalkonium chloride is commonly used in pharmaceutical products and antibacterial soaps, as well as in the food industry.3 However, there is increasing evidence that benzalkonium chloride contributes to antibiotic resistance,3,4,5 and is now linked with concerns of environmental damage as traces of this compound have been found in various water systems – both natural sources and drinking water.6 Although it might successfully disinfect our hands, its use may contribute to a larger public health issue.
Likewise, triclosan and triclocarban are antibacterial agents sometimes found in alcohol-free (and some alcohol-based) sanitisers. Both were banned in the USA by the Food and Drug Administration (FDA) in 2017, due to evidence that they act as endocrine disrupters7 and cause toxicity to marine life; however, there is no equivalent ban in the UK.8,9
Many companies have opted to remove triclosan and triclocarban entirely due to consumer pressure, but they can still be found in certain formulations of hand sanitisers and antibacterial hand soaps.
Based on a 2008 recommendation from the FDA, 60 to 95 per cent alcohol is the best range for germicidal efficiency. Some more recent studies suggest a narrower range of 85 to 95 per cent is more effective.10 It is also important to clearly display the recommended contact time at sanitiser stations. This is the period of time which hands should be rubbed together to optimise sanitiser efficacy, and is usually listed on the bottle or the manufacturer's website. Contact times tend to range from 20 to 30 seconds.
Types of alcohol
Most alcohol-based disinfectants contain either a propanol (for example, isopropanol), ethanol, or both combined.1 According to research, ethanol is mostly effective against viruses, whereas propanol has higher bactericidal efficacy.1 It is quite possible that using a sanitiser with both alcohols could provide some synergistic benefits to the user.
Most alcohol-based hand sanitisers contain ingredients to prevent dryness as well as ingredients to help rehydrate the skin. Ensuring ingredients such as glycerol and aloe vera are present in sanitisers would therefore be very beneficial to practice staff.11
To reduce the environmental impact of packaging, reuse small sanitiser containers throughout the practice and buy the largest refills possible. It is important to disinfect these small bottles as often as possible to help limit the spread of bacteria and viruses.
Likewise, buy bottles that are recyclable in your area. Clear plastic is usually widely recyclable, but white and coloured plastics may not be; also keep in mind that sometimes the bottles are recyclable but the caps and pumps are not. This can often be unavoidable depending on your region, and if so, be sure to separate the recyclable and non-recyclable components, ensuring that all components are fully rinsed beforehand.
It is also important to keep in mind that bottles from medical purchasing companies might be required to be disposed of through a biohazard disposal company if there is still liquid inside.
It can be difficult to prioritise environmental impact in the veterinary field, but every small step we take as a profession can make a huge difference – purchasing environmentally friendly alternatives for commonly used practice products is a good place to start.
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