What are the advantages of a benzalkonium chloride over alcohol-based hand sanitisers?

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Sychem Protect vs. Alcoholic Hand Sanitisers 

Benzalkonium chloride-based hand sanitisers have several distinct advantages over alcohol-based hand sanitisers. While both product forms are FDA Monograph for leave-on products, fast-acting and allow for use without water or towels, benzalkonium chloride-based products are non-flammable, non-damaging to the skin, are persistent, and will not stain clothing or flooring.

Safety

Sychem benzalkonium chloride-based instant hand sanitiser is non-flammable. An internet search for alcohol-based hand sanitisers and fire will produce multiple hits. Flash fires associated with use of alcohol-based hand hygiene products can have potentially severe consequences for healthcare workers and their patients. A published example reported an incidence of flash fire associated with the use of an alcohol-based hand antiseptic agent. The fire occurred when a spark of static electricity ignited the alcohol-based hand gel on the hand of a health care worker who had just removed a 100% polyester gown.

The healthcare worker put the pre-measured amount of alcohol-based hand gel in the palm of her hand from a wall-mounted dispenser. She then removed the 100% polyester gown, placed it on a metal surface, and began rubbing the gel onto both hands. While her hands were damp, she pulled open a metal sliding door, heard an audible static spark, saw a flash of light, and experienced spontaneous flames on the palm of one hand. After the incident, the palm showed redness but no blisters. Flames singed the hair on her arm.

Skin Irritation

Alcohol-based hand sanitisers are effective for occasional use, but long-term, frequent use of the alcohol products can cause skin irritation. Alcohol solubilizes and strips away sebum and lipids that guard against bacterial infections of the skin. Extensive use of alcohol-based hand sanitisers actually increases the skin’s susceptibility to infection by transient disease-causing bacteria. This situation can increase the chances of spreading disease-causing microorganisms among patients.

Effectiveness & Residual Activity

Alcohol-based hand sanitizers stop working the instant they dry. The leading manufacturer of alcohol-based hand sanitisers claims that their product kills 99.99% of most common germs that may cause disease in as little as 15 seconds. Alcohol-based hand sanitisers dry in 8-10 seconds, and fall below the efficacious concentration of alcohol in seconds. It has been reported that alcohol-based hand sanitizers offer no residual protection, and that if your hands feel dry after rubbing them together for 15 seconds, an insufficient volume of alcohol gel was likely applied [1]. 

Sychem benzalkonium chloride-based hand sanitiser dries fast, but 10-15 seconds slower than alcohol-based hand sanitisers allowing more than the minimum contact time for complete efficacious coverage, including under fingernails. Additionally, benzalkonium chloride-based hand sanitizers deliver 2 to 4 hours of residual protection.

Published studies report that benzalkonium chloride-based hand sanitisers demonstrated greater sustained antibacterial activity than gelled alcohol-based hand sanitisers that actually became less effective with repeated use and made the skin dirtier, not cleaner due to removal of protective natural skin oils and entrapment of dead skin cells by the polymer thickeners used in the gelled alcohol-based products.

In the referenced study to simulate repeated usage, alcohol-based and alcohol-free benzalkonium chloride-based hand sanitisers were compared. In the study, subject’s hands were repeatedly inoculated with bacteria followed by application of hand sanitiser, then evaluated for antimicrobial effectiveness. The antimicrobial efficacy of the alcohol-based hand sanitizer showed a markedly decreased antimicrobial efficacy with subsequent contamination and decontamination cycles, whereas the alcohol-free benzalkonium chloride-based hand sanitiser showed a steady increase in antibacterial efficacy.

In addition to these objective results, subjects were asked to subjectively evaluate the condition of their hands after the completion of the test protocol. 47% of the subjects who had completed the test protocol with the alcohol-based hand sanitiser reported palmar pain or discomfort, and tended to indicate some discomfort in palmar surfaces for one to several days after the test. In contrast, none of the subjects that used the alcohol-free benzalkonium chloride-based formula reported any pain or discomfort of their hands after completing the test protocol.

In Summary 

• Benzalkonium chloride-based hand sanitisers had a greater sustained antibacterial activity than
alcohol-based hand sanitisers.
• Alcohol-based hand sanitisers became less effective with repeated use and irritated the hands of
subjects.
• Benzalkonium chloride-based hand sanitisers became more effective without irritation after
repeated use.

[1] Marples, RR, & Towers, AG (1979). A laboratory model for the investigation of contact transfer of microorganisms.
The Journal of Hygiene, 82(2), 237-248.
[2] Dyer, DL, Gerenraich, KB, & Wadhams, PS (1998). Testing a new, alcohol-free sanitizer to combat infection.
Association of Operating Room Nurses Journal, 68(2), 239-251.

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