The COVID-19 pandemic has forced us to leave our norms into an uncharted course of life. Let’s just get it straight, while all of us do practice personal hand hygiene,not all of us are into it; “Water is enough”, “No dirt not very dirty leh”. However, ever since the global emergency, the Ministry of Health and healthcare professionals have been advocating proper hand hygiene techniques.

In addition to that, the use of hand sanitizers were also encouraged. All of a sudden, racks of sanitizers were emptied overnight. Hypermarkets ran out of hand soaps, even anti-bacterial wet wipes were not spared.

Appropriate Hand Hygiene

As per WHO’s recommendations, the best and most effective way to maintain proper hand hygiene is hand-washing with water and soap. To ensure that most germs and bacteria are killed in the process, it takes as long as to sing the ‘Happy Birthday’ song twice[i](or any of your preferred 20-second tunes).

If you are feeling fancy, visit this link to create your own Hand-washing lyric poster! Here’s one made using my favourite song:

Hand Sanitizers – Making Hand Hygiene Possible, Anywhere & Anytime

Let’s face it, not all of us have access to soap and water at all times. Fortunately, there is an alternative when soap and water are not readily available – hand sanitizers. These are recommended when hands are not visibly soiled and greased[ii][iii]while handling daily activities. Hand sanitizers come in all sorts of formulations and variations, for instance:

Click here for more information regarding the most suitable hand sanitizers.

When Demand ↑ & Supply ↓

As per discussion, the entire globe is scouting for these bottles of hand sanitizers due to their convenience. They come in all shapes and sizes and most of them fit snugly into your bags and pockets. Hence when its overpowering demand reaches a point where suppliers are unable to meet them, humans are creative in finding methods to manufacture their very own.

WHO had released a Guide to Local Production: WHO-recommended Handrub Formulations and some of our local hospitals are manufacturing hand rubs based on the guide.

The four main ingredients to produce hand sanitizers are:

• Ethanol 96% or Isopropyl alcohol 99.8%
• Glycerol
• Hydrogen Peroxide
• Distilled water

Read: Guide to Local Production: WHO-recommended Handrub Formulations

Then we have the issue of infodemic where all sorts of information are introduced onto social media platforms without credible sources (Pretty sure most of us may have seen the alcohol + aloe vera gel formulation to make hand rubs). Unreliable sources of bits and pieces of information can be misleading and mishaps could happen.

Getting your sources checked!

Malaysians are resourceful people and hence, the DIY hand rubs. Alcohol, be it ethanol or isopropyl alcohol in the said concentrations can be purchased easily in the market but what is more alarming would be the additives used to produce these alcohols.

Denatured ethanol, which is the main ingredient in alcohol-based rubs, is ethanol rendered poisonous to be ingested internally to humans. The process of denaturation requires denaturants such as methanol, pyridine or other additives. Methanol is a commonly used denaturant as its boiling point is similar to ethanol. A concentration of at least 5% v/v is used to produce denatured ethanol[iv].

Why is methanol a concern in hand sanitizers?

Firstly, let us take a look at some of the properties[v] of methanol in the tabulated data below.

As we can see, methanol is a toxic molecule. The distressing situation with DIY hand sanitizers is that chemical distributors do not declare the amount of methanol being used while denaturing ethanol. This is the reason why the source of the raw materials must be checked thoroughly to ensure the product meets the satisfactory requirements of guidelines. On the other hand, the public is advised to look out for the ‘NOT’ notification number which certifies that the product has been registered with the NPRA (National Pharmaceutical Regulatory Agency) under cosmetics products.

A notification number is unique for each product in the following format:  NOTyymmxxxxxK (y: year, m: month, x: serial number)[vi]. The public may head on to this link (make sure to select the “Cosmetic” category) to ensure that the hand sanitizers purchased are registered with NPRA.

The sudden surge of sanitizer production to meet public demands has made it difficult to ensure stringent regulations. Essentially, ensuring sufficient medication supply is our main priority during this pandemic. However, this is no excuse to turn a blind eye on unregulated home-made hand sanitizers. As pharmacists, it is our duty to ensure that only safe products are in the market. 

Seek help if needed at the nearest Emergency & Trauma Department if one experiences the aforementioned toxic effects post accidental absorption of hand rubs.

Dermal and inhalation methanol toxicity rarely occurs hence hand sanitizers are a safe option for hand hygiene where handwashing is impossible.

The safest way to keep our hands clean in a pandemic like this? #WashYourHands with soap and water! Remember to sing ‘Happy Birthday’ twice!

The opinions expressed in the article are the writer’s own and do not reflect the view of MPS YPC.

References:

[i] Clean hands protect against infection, WHO

[ii] When and How to Wash Your Hands, CDC

[iii] Hand Hygiene: Why, How & When?, WHO

[iv] What are the differences between denatured and non-denatured ethanol

[v] Compound Summary: Methanol, PubChem, National Library of Medicine, National Center for Biotechnology Information

[vi] Cosmetic Notification, National Pharmaceutical Regulatory Agency (NPRA)