Hand wash vs hand sanitiser: the top 3 questions around hand hygiene 2022

The coronavirus pandemic has undoubtedly highlighted the importance of maintaining good hand hygiene and the active role that IPC (infection prevention and control) has in keeping us safe. Hand hygiene has since become an important part of our daily lives and continues to be an explicit concern for healthcare experts. This season of flu and coronavirus has reinforced the importance of maintaining good hand hygiene, however, so many of us are wanting an answer to that age-old question: which is better, handwashing or hand sanitising?

What is the main difference between handwashing and hand sanitising?

It should first be noted that both handwashing and hand sanitising are effective methods of maintaining good hygiene. The caveat, of course, is knowing when it is most effective to use which. Let us first highlight the main difference between handwashing and sanitising. 

The practice of hand sanitising has become increasingly common with each passing year. While the pandemic certainly opened up marketing opportunities for a variety of industries to pounce at the chance to push sales, there are two key aspects of hand sanitising that have found a wide appeal in today's society - its availability and versatility. No longer is there an essential need to find a restroom or facility that dispenses sanitising gel while traversing the outside world, rather, sanitising gel today comes in all shapes and sizes, featuring all sorts of child-friendly colours, shapes and unfortunately sometimes even a few questionable scents. Despite this, the availability (to carry a suspected small solution to a world problem) places sanitising amongst one of the best ways to maintain a good level of hand hygiene while on the move - as long as the gel itself is fit for purpose. According to the CDC (Centers for Disease Control and Prevention) "cleaning hands at key times with soap and water or hand sanitiser that contains at least 60% alcohol is one of the most important steps you can take to avoid getting sick and spreading germs to those around you”. It remains true, however, that sanitising gel is not as effective at removing germs and bacteria as handwashing. A 60% alcohol based gel can very quickly kill and reduce the number of harmful germs and bacteria, but will not be as efficient at removing certain infections and bacteria such as Norovirus, Cryptosporidium, and Clostridioides difficile.  

In light of this, handwashing stands out as perhaps the more ‘conventional’ method of maintaining one’s hygiene, steering away from a modern habit of being on the move, and offers a more ‘traditional’ feel. From a young age, we have all been taught to sing the ABC’s or count down from at least 20 when lathering our hands in soapy water to ensure an efficient scrub is accomplished, but how many of us know the science behind that perfect amount of time? Indeed, this is the main reason and the differentiating factor that handwashing offers over hand sanitising. The scientific explanation behind this is as follows: soap molecules are amphipathic, meaning they have both polar and non-polar properties. This enables soap to dissolve most types of germs including the harmful germs that are most commonly bacteria and viruses. When soap and water are used to produce a lather, this forms pockets called micelles that then trap and remove germs, harmful chemicals, and dirt from your hands. Finally, the running water helps remove all the, now trapped, germs and leaves your hands clean. All this put simply - handwashing provides a more inclusive form of protection against harmful infections and bacteria. 

The UCLA Health (University of California, Los Angeles), in association with the CDC, highlight why all three elements of handwashing are key:

  • Friction while washing your hands helps remove any debri 
  • Soap aids in emulsifying dirt, chemicals and microbes
  • Running water finally removes all dirt, debris and microbes.

What soap should I be using?

When using hand sanitising soap make sure that the sanitiser contains at least 60% alcohol. When using hand soaps the question has recently become more complex, however, the answer remains very simple. Essentially, with the introduction of antibacterial soaps, there has been quite a controversy around ‘the best’ and ‘most protective’ soap. The reality, however, is that ordinary soap is more than proficient in removing harmful bacteria and viruses from your hands.

Antibacterial soap (sometimes called antimicrobial or antiseptic soaps) contain certain chemicals that are not found in plain soaps. These added chemicals are intended to help reduce or prevent bacterial infections, however, there is widespread concern as to whether or not these added chemicals can provide a better form or protection than ordinary soap and whether or not some of the added chemicals could inadvertently turn out to be more harmful.

The FDA (Food and Drug Administration), concerned about the claims and lack of evidence supporting them, issued a directive in 2013 requiring antibacterial soap manufacturers to provide clinical evidence that their products were superior to non-antibacterial soaps. There has since been no evidence provided. Instead, the concern surrounding antibacterial soaps encouraged an experiment in animal studies exploring the effects of Triclosan (one such chemical that is found in many liquid antibacterial soaps). The results have shown that Triclosan can alter the way in which some hormones work in the body, raising further concern to the potential effects of use in humans. However, we do not yet know how Triclosan affects humans and more research is needed. 

A main concern of late is if an ongoing use of antibacterial products could lead to a strain of bacteria that is antimicrobial resistant - developing a resistance to the very treatments that are used to control them. The use of chemicals such as Triclosan, Triclocarban and other antibacterial agents, that are not fully neutralising - meaning that some germs are able to escape - have caused the FDA to encourage further studies into antibacterial soaps before the public start hailing them as the gold standard. Currently more research needs to be undertaken and there is still a debate amongst medical experts as to whether or not the continual use of antibacterial products could enable bacterial strains to become resistant to antibiotics and proliferate. 

In conclusion, however, there is no need to replace your ordinary soaps with antibacterial soaps. Harmful germs and Infections such as Norovirus and Clostridium difficile can be removed with standard soap. 

How should you wash your hands properly? 

According to the CDC, proper hand hygiene is vital to lowering infectious disease transmissions. Washing your hands properly will remove harmful viruses and bacteria that could otherwise spread illnesses such as food poisoning, flu, or diarrhoea. In fact, research has shown that handwashing lowers the rates of certain respiratory and gastrointestinal infections up to 23 and 48 percent, respectively. 

Following the advice of the NHS, here are 7 key steps to follow in order to ensure you are washing your hands properly. The recommended washing time is at least 20 seconds - though no step should be rushed and 20 seconds is a guideline minimum. 

  1. Wet your hands - wet your hands and apply enough liquid soap to create a good lather. The temperature of the water should be between 35°C and 45°C
  2. Rub your palms together - Rub your hands palm to palm in circular motions. Rotate both clockwise and anticlockwise
  3. Rub the back of your hands - with your fingers linked through the other hand, use your right palm to rub the back of your left hand. Swap and repeat. 
  4. Interlink your fingers - link your fingers together, facing each other, into clasped hands. Then rub your palms and fingers together.
  5. Cup your fingers - Cup your fingers together, with your right hand over and your left hand under. With your fingers interlocked, rub the backs of them against your palms. Then swap and repeat. 
  6. Clean your thumbs - enclose your right hand around your left thumb and rub as you rotate the thumb. Swap and repeat.
  7. Rub palms with your fingers - Rub your fingers over your left palm in a circular motion. Swap and repeat. 

Once you have finished following these 7 steps, you should then thoroughly rinse with warm running water and dry with a clean, disposable paper towel. A disposable paper towel is the best way to dry your hands and you should avoid using reusable towels as they can harbour dangerous levels of bacteria that can transfer back onto your hands. 

A brief summary 

In the wake of the COVID-19 pandemic, both handwashing and hand sanitising have been highlighted as key practices in order to maintain a healthy lifestyle. Using a hand sanitiser with at least 60% alcohol can be an effective method to kill any harmful bacteria, however, washing your hands with ordinary soap and running water should be the preferred method for hand hygiene. 

There are 7 key steps that should be followed when washing your hands to ensure a proper clean with the use of a disposable towel being the preferred method of drying your hands (best to avoid any reusable towel or material that could be harbouring harmful bacteria). 

Good hand hygiene is a lifestyle and a choice that benefits everyone. By reducing the risk of infection, the practice of washing your hands helps minimise the spread of potentially harmful illnesses to family, friends and work colleagues. The pandemic has been a catalyst in exposing the importance of hand hygiene, however, these practices are not exclusive in helping combat the spread of illnesses during a particular bacterial/viral breakout. Good hand hygiene is a time-tested intervention that should be practised consistently - especially after the pandemic