Has the increased use of hand sanitizers during the pandemic impacted antimicrobial resistance?

Posted on March 10, 2021   by Sunil Pandey

During the SARS-CoV-2 pandemic, the importance of hand hygiene has been heavily promoted as vital in controlling the spread of the virus. In this blog, Sunil Pandey, PhD student in microbiology and infectious disease at George Mason University, USA, discusses the indirect effect antimicrobial cleaning products have on other infectious diseases.

iStock/Ake Dynamic

When the COVID-19 pandemic hit, scientists, governments and national and international agencies urged the public to practice proper hand hygiene, including the use of alcohol-based hand sanitizers. The increased emphasis on hygiene caused a surge in demand for hand sanitizers and cleaning products. Unfortunately, recommendations around these products did not discuss their responsible use or the impact these products have on bacteria. As a result, the coronavirus pandemic seems to have enhanced the threat of antimicrobial resistance (AMR). Many hospitals are even treating COVID-19 patients with antibiotics to reduce secondary bacterial infections. Increased use of antibiotics can cause resistant bacteria to become more common.  

Antimicrobials, such as antibiotics and antiviral, antiprotozoal, and antifungal medicines are used frequently in healthcare as treatment for numerous diseases. These medicines help us fight against infection - especially if our immune system is weak or compromised. Micro-organisms can mutate after they are exposed to antimicrobial compounds and the misuse of antibiotics is causing antimicrobial resistance to increase in several bacteria. During the COVID-19 pandemic, healthcare institutions and members of the public are heavily using different hand sanitizers to minimize the risk of exposure to SARS-CoV-2.  

Questions arise as to whether use of hand sanitizers reduce the risk of SARS-CoV-2 infection! Are we reading the label of those hand sanitizers before we use them? Are we following the recommendation to use the protocol given by the manufacturer? A Center for Disease Control (CDC) report showed that the US recorded 2.8 million antibiotic-resistant infections in 2018 alone, and over 35,000 people died because of resistance in the same year. According to the World Health Organization (WHO), AMR is one of the top 10 global public health threats.  

As drug resistance increases, antibiotics will become progressively less effective at treating infections. We urgently need new antimicrobials to treat resistant infections as options run out. If we do not change the way antibiotics and sanitizers are used now, new antibiotics that will come in the future will suffer the same fate.  

Hand sanitizer-associated resistance is another area of concern. Hand sanitizers may need to be used in combination with other procedures and should always be used appropriately. One way to prevent bacteria from becoming resistant is to make sure people clean their hands for a full 20-30 seconds.  

Bacteria can also develop resistance to certain cleaning chemicals if they are repeatedly exposed to a lower concentration or if use is infrequent. Diluting the chemical, or irregular use can provide a survival advantage to the most resistant strains, which ultimately leads to an increase in the overall resistance of the microbial population. Much research has already shown that hospital disinfectants are less effective against some strains of bacteria, and resistance is increasing every day. For example, research conducted by Pidot and colleagues in 2018 showed that the bacteria Enterococcus faecium – which is one of the leading causes of hospital-acquired infections –  is becoming more resistant to alcohol sanitizers.   

What we need to do is use hand sanitizers and cleaning products like prescription medication. Read the instructions provided sensibly, as any deviancy can render them ineffective. When there are no approved protocols, avoid diluting or combining products with other ones. Many people are making homemade sanitizers – we have to follow advice on  government sites, approved institutions and approved recipes and ingredients to make sure these are effective.   

So, when using sanitizers and chemical cleaners we need to think about how best to protect ourselves from COVID-19 and other diseases but also avoid creating an environment where even more antimicrobial-resistant micro-organisms can emerge. Antimicrobial resistance already causes over 700,000 deaths a year worldwide; it's so important we act with caution to prevent the further impact of the resistance.  

I am not saying we have to totally throw away the sanitizers, but I think it’s time to rethink the way we are using them.