Not Your Mother’s Hand Sanitizer: A New Trend in the Jan San MarketFor years, the health care industry, along with government, municipal, and corporate professionals have beenindoctrinated with the notion that alcohol gels and rubs are the “recommended” hand sanitizing alternative whenwashing with soap and water is not readily convenient. And, as anyone in the “Jan San” industry will appreciate, the2009 Swine Flu “pandemic” inspired not only an unprecedented focus on hand hygiene, but a massive spike in handsanitizer 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 theinstitutional 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 agame-changing headline;

non-alcohol

hand sanitizer manufacturers reported as much as

ten-fold

sales increases from2008.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 aselect 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 benzalkoniumchloride (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, and proven to be upwards of 99.99% effective against abroad spectrum of pathogens, including enveloped and non-enveloped viruses. Unlike alcohol, these products do notcause the skin to become dry/irritated, they are not flammable, and they provided extended persistency.Several studies have demonstrated the pathogen-killing effectiveness of benzalkonium chloride products

increase

swith repeated application, while the effectiveness of alcohol

decreases

with repeated application. This would beobvious to most when considering that alcohol destroys the protective oils imbedded within the skin, as well asprotective skin cells.While the hospital industry has remained reticent at best to adopt these not terribly new formulations, procurementsof non-alcohol sanitizers on behalf of government, municipal, military, correctional, corporate, senior care andeducational venues has, according to many, taken distributors by surprise. In turn, they’ve been inspired to reach outwith both hands to well-equipped manufacturers of alcohol-free products and dispensing systems.According to the Dr. Richard Tooker, Chief Medical Officer for Kalamazoo County Michigan, “.. I don't know whywe always seem to stress alcohol -based hand sanitizes. It may be to keep public education easier/ less complicated. Ipersonally don't like them because I have eczema and it really dries and inflames my skin (increasing my risk forinfection!)...”This new movement comes despite the fact that for years the US Centers For Disease Control (CDC) has providednominal guidance on alcohol-free hand sanitizer alternatives. And, while CDC

did

update its position on alcohol-freealternatives in a August 2009 memo directed to K-12 educational systems [“..for those that prohibit alcohol-basedsanitizers, 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 growingaudience representing a broad spectrum of facilities and procurement officers; all of whom have either restricted orout-right banned alcohol hand sanitizer products from their venues. Case in point: in January 2009, the U.S. NavalSubmarine 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 exposureto 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 andalcohol-poisoning, as well as intended product “re-purposing” by those with substance abuse issues, the decisions toswitch to non-alcohol products have been easily supported. One need only search YouTube.com 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 handsanitizer products, as these products have proven to be (i) equally if not more effective insofar as killing peskypathogens when compared to alcohol-based products,(ii) safer to the skin (iii) non-flammable (iv) non-destructive tomaterial 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 bemore 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”, “InstantFoam” , “GentleCare”,“SafeHands”, and “HandClenz”.Before reviewing the comparisons of any particular alcohol-free brands to alcohol-based alternatives, it is criticallyimportant 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 whenwashing 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 thenegative ‘features’ of benzalkonium chloride?” Or, the

very

informed reader might be familiar with a memorandumsubmitted in 2003 by GOJO Industries, Inc., the manufacturer of Purell hand sanitizers, to the Federal DrugAdministration (FDA), in which GOJO solicited the FDA to prohibit the registration of benzalkonium chloride-basedhand sanitizer products. This request, which was denied by FDA, suggested, but failed to demonstrate, that BAC-based products were “ineffective and potentially dangerous.”1.

Product executives at Johnson and Johnson Inc., undeniably a prominent and highly-respected health careproduct company, and the marketing licensee for the Purell brand, continue to affirm the position taken by itslicensor 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 aseparate division of J&J markets “BandAid” brand Foaming Antiseptic, a foam-formatted product whoseactive ingredient is a .13 concentration of benzalkonium chloride, and is otherwise identical in compositionto many alcohol-free hand sanitizer products, the same executives indicated they “can’t speak for otherdivisions of the corporation or other products marketed under the corporate umbrella.”2.

Even if BAC is a common active ingredient in cleaning formulas used for hot tubs and swimming pools, thiswriter does not recommend continuously swimming in high concentrations of benzalkonium chloride.