Do You Know What’s In Your Sanitizer?
Hand sanitizer may seem like a fairly innocuous substance. It kills germs but doesn’t harm people, right? Unfortunately, it’s not so simple. In recent months, the FDA has reported “adverse events, including blindness, cardiac effects, effects on the central nervous system, and hospitalizations and death” as a result of methanol-contaminated hand sanitizers which were labeled as containing ethyl alcohol (ethanol).
As of August 1, the FDA has identified over 135 brands of supposedly ethanol-based sanitizers that are contaminated with anywhere from 1% to 80% methanol – a toxic chemical that destroys the optic nerves if 1/3 ounce is swallowed and has a lethal dose of 1 ounce. This national tragedy, a result of poor regulatory oversight, confusing technicalities in industry guidelines, and an uncontrolled rush to manufacture and import any quality of sanitizer at any cost, has made it abundantly clear that not all sanitizers are equal and that we need to start paying attention to the listed and unlisted ingredients in hand sanitizer.
There are 2 types of FDA-approved hand sanitizers:
1. NON-ALCOHOL-BASED SANITIZERS
Only one active ingredient is currently approved for use in non-alcohol-based sanitizers in the US: benzalkonium chloride. It is used in antibacterial sprays (Lysol, Dettol), algaecides (used to clean pools), spermicides, and at very low concentrations (0.01% or less) it has been a standard preservative in eye drops, though this use is decreasing due to toxicity concerns. It is used at 0.13% concentration in sanitizer.
In 2011, a study of benzalkonium chloride sanitizer in schools was halted due to concerns about contact dermatitis and genotoxic effects (damage to a cell's genetic information, potentially leading to cancer). The study found no safe non-alcohol-based sanitizer suitable for school use.
Benzalkonium chloride is widely documented as a skin irritant and as a suspected respiratory toxicant, immunotoxicant, gastrointestinal toxicant and neurotoxicant. NIOSH states that regarding short-term exposure, it is “corrosive to the eyes, the skin and the respiratory tract. Corrosive on ingestion. If a solution is swallowed, aspiration into the lungs may result in chemical pneumonitis”; that the long-term exposure effects are not known; and that regarding chemical dangers, it “decomposes on heating producing toxic and corrosive fumes including ammonia, chlorine and nitrogen oxides.”
Poisoning deaths have been documented (Japanese nurse investigated over 20 killings at end of shifts to avoid ‘nuisance’ of telling families of deaths – The Telegraph, July 10, 2018). The FDA lists it as a Category III active ingredient, meaning that "available data are insufficient to classify as safe and effective, and further testing is required”. A related compound, benzethonium chloride, was previously approved for hand sanitizer use but was banned in 2019 by the FDA, which stated that it is “not generally recognised as safe and effective.”
2. ALCOHOL-BASED SANITIZERS
Two types of alcohol are approved for use in sanitizer:
- ETHYL ALCOHOL (ETHANOL)
Ethanol is produced by fermentation – it is the standard “drinking alcohol”, present in alcoholic beverages. Alcohol poisoning from ethanol is common and is sometimes fatal. It is typically the result of drinking too many alcoholic beverages, but alcohol poisoning also occurs when people, including infants, drink hand sanitizer. Aside from the inherent toxicity of ethanol, ethanol-based sanitizers carry two major areas of risk:
1. Contamination from toxic methanol, identified in over 135 sanitizer brands.
2. Ethanol “denaturants”: mandatory chemical additives for all non-beverage ethanol-based products (antifreeze, ethanol-based sanitizer, etc.), added to discourage people, including alcoholics and infants, from drinking them. FDA guidelines do not require ethanol denaturants to be included in ingredient lists! The FDA currently recommends a combination of two denaturants:
Denatonium benzoate: the most bitter-tasting chemical known to exist. The health effects are unknown, as it has rarely been studied, though in one case, a 33-year-old man developed asthma and urticaria from exposure to denatonium benzoate in an alcohol-based sanitizer.
Tert-butyl alcohol: this chemical is known to be irritating to the skin and eyes. The World Health Organization states that its vapors cause “dizziness, drowsiness, nausea, headache, vomiting.” NIOSH states that it “may affect the central nervous system… Repeated or prolonged contact with skin may cause dermatitis.”
Even if ethanol could be used in pure form, it would not be the safest option, due to its toxicity in the rare occasions of ingestion. But the potential for methanol contamination and the certainty of the presence of denaturant chemicals make this a truly frightening option in today’s environment of loose oversight, poor quality control, and optional listing of ingredients.
- ISOPROPYL ALCOHOL
Isopropyl alcohol is significantly less toxic than ethanol. Unlike ethanol poisonings, isopropyl alcohol poisonings almost never result in death (1 death out of 18,051 isopropyl alcohol poisonings in one year was reported to the National Poison Data System). If ingested, it acts as a sedative. On the skin, it is gentler and less dehydrating than ethanol.
Importantly, the isopropyl alcohol manufacturing process does not generate methanol as a byproduct, whereas methanol is a byproduct in ethanol distillation. This is one significant reason that many ethanol-based sanitizers are at risk for methanol contamination.
As it is used in its pure form, without addition of any mystery chemicals, isopropyl alcohol is clearly the safe option for sanitizer today.