Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences?

Abstract

In order to reduce the transmission of pathogens, and COVID-19, WHO and NHS England recommend hand washing (HW) and/or the use of hand sanitizer (HS). The planetary health consequences of these different methods of hand hygiene have not been quantified. A comparative life cycle assessment (LCA) was carried out to compare the environmental impact of the UK population practising increased levels of hand hygiene during the COVID-19 pandemic for 1 year. Washing hands with soap and water was compared to using hand sanitizer (both ethanol and isopropanol based sanitizers were studied). The isopropanol-based HS had the lowest environmental impact in 14 out of the 16 impact categories used in this study. For climate change, hand hygiene using isopropanol HS produced the equivalent of 1060 million kg CO2, compared to 1460 million for ethanol HS, 2300 million for bar soap HW, and 4240 million for liquid soap HW. For both the ethanol and isopropanol HS, the active ingredient was the greatest overall contributing factor to the environmental impact (83.24% and 68.68% respectively). For HW with liquid soap and bar soap, there were additional contributing factors other than the soap itself: for example tap water use (28.12% and 48.68% respectively) and the laundering of a hand towel to dry the hands (10.17% and 17.92% respectively). All forms of hand hygiene have an environmental cost, and this needs to be weighed up against the health benefits of preventing disease transmission. When comparing hand sanitizers to handwashing with soap and water, this study found that using isopropanol based hand sanitizer is better for planetary health. However, no method of hand hygiene was ideal; isopropanol had a greater fossil fuel resource use than ethanol based hand sanitizer. More research is needed to find hand hygiene sources which do not diminish planetary health, and environmental impact is a consideration for public health campaigns around hand hygiene.

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“… 151 Method of hand hygiene should also be considered, a study on surgical scrubbing in the UK found using alcohol-based hand gel could save approximately 930 000 L of water per year for an average UK hospital. 152 Recently, Duane et al 153 conducted a hand hygiene life cycle analysis and concluded that alcohol-based hand gel was more environmentally sustainable than handwashing with soap. However, it should be noted that this study compared the hand hygiene methods at population level use rather than within a hospital setting in which the alcohol gel might not be suitable for clinical use.…”

Environmentally Sustainable Endoscopy Practices

“…In endoscopy, full hand disinfection is not required and use of alcohol rubs instead of hand washing may be done when hands are not visibly soiled or in contact with potential spore-forming pathogens. 27,28 Both alcohol-based gels and petrochemical soaps are not environmentally safe as they contaminate water sources. 29 Use of natural and environment friendly products may be the way forward.…”

Impacts of hand sanitizer on human health and environment: a review

“…In comparison to soap, sanitizers are not effective against all types of germs (ex-against non virus agents and Clostridium difficile) and in case of dirty and greasy hands (Vermeil et al, 2019). A comparative life cycle assessment (LCA) of hand washing with soap (soap+water) and hand sanitizer (both ethanol and isopropanol based sanitizers) was carried out in UK to compare the environmental impact of increased levels of hand hygiene during the COVID-19 pandemic (Duane et al, 2022). The isopropanolbased hand sanitizer had the lowest environmental impact in 14 out of the 16 impact categories used in this study.…”

“…When comparing hand sanitizers to hand washing with soap and water, this study found that using isopropanol based hand sanitizer is better for planetary health. However, no method of hand hygiene was ideal; isopropanol had a greater fossil fuel resource use than ethanol based hand sanitizer (Ghafoor et al, 2021;Duane et al, 2022).…”