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Tuesday, February 9, 2010

Not Your Mother’s Hand Sanitizer: A New Trend in the Jan San Market

Not Your Mother’s Hand Sanitizer: A New Trend in the Jan San Market
For years, the health care industry, along with government, municipal, and corporate professionals have been indoctrinated with the notion that alcohol gels and rubs are the “recommended” hand sanitizing alternative when washing with soap and water is not readily convenient.

And, as anyone in the “Jan San” industry will appreciate, the 2009 Swine Flu “pandemic” inspired not only an unprecedented focus on hand hygiene, but a massive spike in hand sanitizer product sales. According to a recent Nielsen Co. report, retail market sales of hand sanitizer for the 52 week period ending in October 2009 generated as much as $180 million; a staggering 70% increase from the prior year. While Neilsen does not include sales figures from institutional markets, the reader will appreciate that sales from the institutional sector is equivalent to, if not greater than consumer-market figures.

That said, this revitalized focus on hand hygiene and the related surge in hand sanitizer product sales included a game-changing headline; non-alcohol hand sanitizer manufacturers reported as much as ten-fold sales increases from 2008.
Up until recently, alcohol-free alternatives have been considered a nascent and “still emerging” product category, and thanks to the US Centers For Disease Control long-standing (but recently modified) position that benefited a select number of companies known for their alcohol-based sanitizers, the non-alcohol sector has, until recently, represented no more than 1%-2% of the overall market.

But, the combination of a continuous stream of academic and research studies pointing to the “downside” of alcohol-based hand sanitizers, coupled with heightened awareness on equally-effective, yet safer, environmentally friendlier, and arguably, more cost-efficient hand sanitizer products has resulted in a major shift away from flammable, alcohol-based products, and towards alcohol-free products, most of which utilize the organic compound benzalkonium chloride (a/k/a BAC, a/k/a BZK) as the active ingredient.

A quaternary ammonium, BAC, and its cousins, are long-recognized to be effective antibacterial and antiseptic agents proven to be upwards of 99.99% effective against a broad spectrum of pathogens, including enveloped and non-enveloped viruses. Unlike alcohol, these products do not cause the skin to become dry/irritated, they are not flammable, and they provided extended persistency.

While the hospital industry has remained reticent at best to adopt these not terribly new formulations, procurements of non-alcohol sanitizers on behalf of government, municipal, military, correctional, corporate, senior care and educational venues has, according to many, taken distributors by surprise. In turn, they’ve been inspired to reach out with both hands to well-equipped manufacturers of alcohol-free products and dispensing systems.

According to the Chief Medical Officer for Kalamazoo County Michigan, “.. I don't know why we always seem to stress alcohol -based hand sanitizes. It may be to keep public education easier/ less complicated. I personally don't like them because I have eczema and it really dries and inflames my skin (increasing my risk for infection!)...”

This new movement comes despite the fact that for years, the US Centers For Disease Control (CDC) has provided nominal guidance on alcohol-free hand sanitizer alternatives. And, while CDC did update its position on alcohol-free alternatives in a August 2009 memo directed to K-12 educational systems [“..for those that prohibit alcohol-based sanitizers, non-alcohol products can be useful..”], CDC’s long-standing, and seemingly exclusive endorsement of alcohol-based hand sanitizer has been heavily discounted, if not completely disregarded by a continually growing audience representing a broad spectrum of facilities and procurement officers; all of whom have either restricted or out-right banned alcohol hand sanitizer products from their venues. Case in point: in January 2009, the U.S. Naval Submarine Command officially prohibited alcohol sanitizers on board the fleet of submarines.

With hands in their faces, these decision makers have inspected the irritated skin caused by repeated application of alcohol sanitizers, and they’ve researched the connection between dry/irritated hands and increased risk of exposure to easily-transmitted pathogens. When reviewing the [ironic] cautionary statements provided by makers of alcohol-based products that include “recommend washing hands before applying”, coupled with their acknowledging flash-point liability, and the increasing news media reports connecting alcohol-based products to unintended ingestion and alcohol-poisoning, as well as intended product “re-purposing” by those with substance abuse issues, the decisions to switch to non-alcohol products have been easily supported. One need only search with key phrase “alcohol hand sanitizer” to appreciate the preponderance of after-affect application and product misuse.

Consequently, these facility managers have migrated to well-documented and well-researched non-alcohol hand sanitizer products, as these products have proven to be (i) equally if not more effective insofar as killing pesky pathogens when compared to alcohol-based products,(ii) safer to the skin (iii) non-flammable (iv) non-destructive to material such as industrial floor wax, paint, clothing, (v), more persistent, and (vi), 2x-3x more cost efficient, as non-alcohol, foam-formatted products require less frequent application, and the foam format is widely-accepted to be more efficient when compared to gel and/or lotion-based products. With more than two dozen products in the market, leading brand names within the space include among others, “Hy5”, “Soapopular”, DEB SBS’s “InstantFoam” , “SafeHands”, and “HandClens” made by Woodward Labs.

Before reviewing the product and price comparisons of any particular alcohol-free brands vs. alcohol-based alternatives, it is critically important to put the topic of hand sanitizers into proper perspective.

We’re not talking about chemotherapy or a vaccination to ward off Ebola; we’re talking skin safe, facility-safe hand hygiene products that can successfully protect adults and children against easily transmitted pathogens when washing with soap and water is not readily convenient.

At this point, the under-informed reader might be swayed to embrace the arguments in favor of non-alcohol formulas, and otherwise “sold” on the above value propositions. The more informed are inclined to ask “And what are the negative ‘features’ of benzalkonium chloride?” Or, the very informed reader might be familiar with a memorandum submitted in 2003 by GOJO Industries, Inc., the manufacturer of Purell hand sanitizers, to the Federal Drug Administration (FDA), in which GOJO solicited the FDA to prohibit the registration of benzalkonium chloride-based hand sanitizer products. This request, which was denied by FDA, suggested, but failed to demonstrate, that BAC-based products were “ineffective and potentially dangerous.”

1. Even if BAC is a common active ingredient in cleaning formulas used for hot tubs and swimming pools, this writer does not recommend continuously swimming in high concentrations of benzalkonium chloride. Certain studies have found that while BAC is one of the safest organic compounds, excessive inhalation can have a negative effective on those suffering from asthma. Merely proving the common wisdom that too much of anything is not good. Including tap water.

2. While BAC has been the active ingredient in contact lens solutions, enough studies have found that excessive application within eye drops can have negative effects on the cornea. This writer wears eye glasses, and wouldn’t think of applying a hand sanitizer product to the eyes, and most responsible manufacturers of BAC-based hand sanitizer products caution against product coming into contact with eyes. If inadvertently applied to the eyes, manufacturers’ labels recommend washing the eyes with water. One need not be a trained health care professional to opine on the impact of applying an alcohol gel to the eyes.

3. Select independent lab studies have found that certain pathogens develop a resistance to benzalkonium chloride when applied in high doses and with excessive frequency. Again, and however much those studies might be taken out of context when factoring in the concentration levels used in those studies, it merely confirms that “too much of anything is no good”. For any nurse that has an extended history of applying alcohol gel or rub to their hands, take a look at your hands while you’re reading this article.

4. Product executives at Johnson and Johnson Inc., undeniably a prominent and highly-respected health care product company, and the marketing licensee for the Purell brand, continue to affirm the position taken by its licensor GOJO Industries with regard to their opinion i.e. purported “dangers” of benzalkonium chloride-based sanitizers. Yet, when J&J executives overseeing the Purell brand were recently reminded that a separate division of J&J markets “BandAid” brand Foaming Antiseptic, a foam-formatted product that not only uses .13 concentration of benzalkonium chloride as its active ingredient, but is otherwise identical in composition to many alcohol-free hand sanitizer products, the same executives indicated they “can’t speak for other divisions of the corporation or other products marketed under the corporate umbrella.”

In summary, this writer maintains the view that washing with soap and water remains the most effective hand hygiene protocol, yet when soap and water is not readily available, one need not be an epidemiologist to recognize that certain non-alcohol hand sanitizer formulas are more pragmatic than alcohol.

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