Soap vs. sanitizer: The truth about hand hygiene

The COVID-19 pandemic drastically shifted the way we approach hand hygiene. What was once a basic, everyday habit became an essential practice in protecting our health. For many it’s now second nature to wash our hands frequently – but do we truly understand the importance of doing it correctly?

To usher in World Hand Hygiene Day (May 5), we’ll explore the importance of hand washing, share best practices, debunk five common myths, present five facts, and compare the efficacy of hand washing vs. hand sanitizers.

Health benefits of hand washing

Hand washing plays a crucial role in preventing the spread of germs, viruses, and bacteria. From doorknobs to elevator buttons, we touch countless surfaces every day. Some of these surfaces may carry harmful microorganisms that can cause illness when we touch our face, eat, or come into close contact with others.

According to Dr. James Hellinger, MD, Mass General Brigham, surface contact microorganisms factor significantly into stringent hospital hand-washing requirements.

“Think about all the surfaces you touch throughout the day at home, shopping, at the office, or visiting friends and family,” Hellinger said. “And think about shared surfaces, spots that you and many others touch throughout the day – especially in the colder months with so many respiratory illnesses – such as elevator buttons, doorknobs, shared screens, work computers, or phones, to name a few. Surface contact is the primary means of infectious transmission for any common germs, especially bacteria, gastrointestinal, and respiratory viruses.”

Thoroughly washing our hands with soap and water significantly reduces the risk of spreading or contracting infectious diseases, from the common cold to illnesses that can start mild and worsen, like the flu and COVID-19, and causes of gastroenteritis, like norovirus. For some, even the common cold, COVID, or the flu can develop into bad pneumonia or gastrointestinal infections and become quite serious.

Best practices for hand washing

The CDC recommends the following steps for effective hand washing and removing dirt, grease, and the majority of harmful germs:

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
3. Scrub for at least 20 seconds.
4. Rinse thoroughly under clean, running water.
5. Dry your hands using a clean towel or air dryer.

Five myths about hand washing

Despite the wealth of information available, there are still many misconceptions about hand washing.

1. Myth: Hot water is necessary to kill germs.
   • Fact: Temperature isn’t as important as friction and soap. Water that’s too hot can actually damage your skin, so aim for comfortable, clean water at any temperature.¹
2. Myth: Hand washing doesn’t matter if you don’t have visible dirt on your hands.
   • Fact: Even if your hands appear clean, they can still carry invisible germs and bacteria. It’s essential to wash your hands regularly, especially after touching public surfaces.²
3. Myth: Hand sanitizers are a complete substitute for hand washing.
   • Fact: While hand sanitizers are convenient, they can’t remove dirt, grease, or some types of germs as effectively as soap and water.¹
4. Myth: Antibacterial soap is much more effective than regular soap.
   • Fact: Regular soap works just as well in removing germs. Antibacterial soaps are not necessary for everyday hand washing and can contribute to the development of resistant bacteria over time.³
5. Myth: Wearing gloves removes the need for handwashing.
   • Fact: Wearing gloves does not remove the need for handwashing as gloves can have unseen defects or can be torn during use, providing a point of contact for skin.⁴ The longer you wear gloves, the more likely they are to become contaminated, increasing the risk of transferring germs to yourself or to others, especially by touching your face.

Five facts about hand washing

1. Hand washing can prevent 1 in 3 cases of diarrhea and 1 in 5 respiratory infections like the common cold and flu.¹
2. Germs can spread quickly. A person with unwashed hands can unknowingly transfer bacteria to surfaces, food, or others. Washing your hands stops this cycle.¹
3. Hand washing reduces the spread of antibiotic-resistant bacteria. By washing hands properly, you prevent the spread of drug-resistant bacteria that could lead to serious infections.¹
4. Effective hand washing improves children’s health. Studies show that regular hand washing can reduce respiratory illness and the spread of gastrointestinal diseases in children, leading to fewer sick days.⁵
5. Hand washing is essential in healthcare settings. Healthcare workers washing their hands properly can prevent the transmission of hospital-acquired infections, which are a significant cause of patient illness and that can spread at work to other patients or at home to friends and family.⁶

 Hand wash vs. hand sanitizer: Which is better?

While hand sanitizers are a convenient option, they don't provide the same level of protection as hand washing. Here’s why:

1. Effectiveness: Hand washing with soap and water is more effective at removing dirt, grease, and a broader range of pathogens. Soap molecules break down oils and lift away dirt and germs, whereas hand sanitizers primarily kill bacteria but may not remove all dirt.⁷
2. Usage: Hand sanitizers are best used when soap and water aren’t available, such as during travel or when you’re out and about. For optimal cleanliness, however, washing your hands with soap and water is always preferable.⁸
3. Alcohol content: Hand sanitizers need to contain at least 60% alcohol to be effective. If your sanitizer doesn't have enough alcohol, it may not be able to kill all germs.⁸

“While hand washing is preferred, hand sanitizers are by far the best alternative for convenience, if you anticipate exposures in public places, and highly effective for nearly all infections,” Hellinger said. “However, there are gastrointestinal infections that can spread by surface contact and are better eliminated by hand washing. One is the norovirus bug that is common and spreadable in community settings. The others include c. difficile, a bacteria spread by a spore that can affect those in healthcare settings, and the cryptosporidium parasite, which is more common with rural outbreaks.”  

By following best practices, we can protect ourselves, our families, and our communities from preventable illnesses. For more tips on hand hygiene, click here. To learn more about our hospitals’ hand hygiene quality and safety measures, click here.

1 CDC, Handwashing Facts, https://www.cdc.gov/clean-hands/data-research/facts-stats/index.html

2 New Mexico State University, Day 2: Germs are Invisible, https://handwashing.nmsu.edu/documents/day-2-germs-are-invisible-invisible-things.pdf

3 FDA, Topical Antiseptic Products: Hand Sanitizers and Antibacterial Soaps, https://www.fda.gov/drugs/information-drug-class/topical-antiseptic-products-hand-sanitizers-and-antibacterial-soaps#:~:text=For%20consumer%20antiseptic%20washes%2C%20millions,rule%20on%20consumer%20antiseptic%20washes.

4 Meritech, 5 Handwashing Myths, https://www.meritech.com/blog/5-handwashing-myths

5 National Library of Medicine, Impact of hand hygiene intervention on hand washing ability of school-aged children, https://pmc.ncbi.nlm.nih.gov/articles/PMC8138401/#:~:text=Research%20shows%20that%20youngsters%20who,According%20to%20Joshi%20et%20al.

6 CDC, About Hand Hygiene for Patients in Healthcare Settings, https://www.cdc.gov/clean-hands/about/hand-hygiene-for-healthcare.html

7 CDC, Hand Sanitizer Facts, https://www.cdc.gov/clean-hands/data-research/facts-stats/hand-sanitizer-facts.html

8 CDC, Hand Sanitizer Guidelines and Recommendations, https://www.cdc.gov/clean-hands/about/hand-sanitizer.html#:~:text=Washing%20hands%20with%20soap%20and,by%20checking%20the%20product%20label.