Hand Sanitizer Ingredients To Watch Out For



After the COVID pandemic you may be tempted to arm yourself with lots of hand sanitizer to keep you and your family safe from any virus or unfriendly bacteria. We have been told to wash our hands over and over, to use hand sanitizer whenever we leave the house, and to clean surfaces and products we buy.

While this may be okay and necessary in certain circumstances, antimicrobial compounds don’t distinguish between beneficial and unfriendly bacteria, and their overuse may have unintended effects on our microbiome.

Keep reading to learn more about hand sanitizer ingredients to avoid.

Alcohol-based hand sanitizer

Hand sanitizers come in two main forms: alcohol-based and alcohol free. Alcohol-based hand sanitizer can contain more than one type of alcohol along with other additives [1]. The types of alcohol it may contain are isopropanol, ethanol, or n-propanol. 

While alcohol may cause an allergic reaction in some people [2], it is still a proven method for reducing the transmission of respiratory and gastrointestinal diseases [3] as well as coronaviruses [4].

These types of hand sanitizer can be tempting to young children as they usually come in colored bottles and have a candy or fruit scent. But a watchful eye is important. If a child ingests just a bit more than a taste of hand sanitizer, they can be at risk for alcohol poisoning. This can cause: 

  • Confusion
  • Vomiting
  • Drowsiness
  • In more severe cases, respiratory arrest and death [5], [6].

Up to July 2023, the America’s Poison Centers managed 9,394 cases of exposure to alcohol-based hand sanitizer in children under 12 years of age [6].

Alcohol free hand sanitizer

Because alcohol free hand sanitizer is meant to be used with water, there’s little risk of alcohol poisoning. But in some cases, the active ingredients are still fairly noxious. So, it helps to be familiar with some of their most common ingredients. These are:

  • Triclosan
  • Benzalkonium chloride (BAC)
  • Benzethonium chloride (BET)
  • Chloroxylenol (PCMX)

The first one, triclosan, was banned in consumer products by the FDA in 2016 because of research on its side effects [7]. And because of that, it is highly unlikely that you’ll find a product containing this chemical today in the US. But, if you have old cleaning products on your shelf or live in another country, look for triclosan in the ingredient list. If you find it, we suggest you throw that product away.

BAC, BET and PCMX are still widely used in hand sanitizers, even if these seem to be as equally dangerous as triclosan. Are you wondering why these chemicals were not banned from the US, like triclosan?

Well, they are still allowed to be used in hand sanitizers not because they are safer, but because manufacturers requested the FDA more time to conduct studies regarding their safety.

Now let’s look at each of these antimicrobial chemicals in more detail.


Triclosan is a chemical well known for its antimicrobial, antiviral, antifungal, and preservative properties [8]. Due to these properties, a few years ago it was widely used in a number of household items. For example, you could find triclosan in:

  • Lotions
  • Hand soap
  • Hand sanitizer
  • Eye and face makeup
  • Natural health products
  • Fragrance and deodorants
  • Toothpaste and mouthwash
  • Shampoo

These are some of the negative effects of triclosan on the microbiome:

  • It has a high probability of being passed from your skin and mouth into your breastmilk. This may reduce the levels of beneficial bacteria present in your baby’s gut [9].
  • Using triclosan toothpaste at two months postpartum was shown to increase the levels of Proteobacteria in both mom and baby [10]. High levels of Proteobacteria have been associated with type 2 diabetes, children’s obesity, and inflammatory bowel syndrome [11].
  • Postnatal daily use of all-purpose cleaners containing triclosan was reported to increase a child’s risk of being overweight or obese at both 1 and 3 years of age [12]. Scientists think that the inhalation of these chemicals may alter the balance of bacteria in the gut.
  • Triclosan may increase the risk of developing respiratory and food allergy in adults [13].

Benzalkonium chloride (BAC)

Alcohol free hand sanitizer often contains quaternary ammonium compounds that have been shown to be effective against COVID-19 [14].

One of these quaternary ammonium compounds is BAC, the chemical you’ll find in most antibacterial liquid hand soaps. But BAC is also used in other products like eye drops [15] and antibacterial cleaning wipes. It may also be a contaminant of commercial grapefruit seed extract [16], which is sometimes used in baby waterwipes.

The widespread use of BAC has made some bacteria counterattack it and become resistant to it. Some examples are methicillin-resistant Staphylococcus aureus (MRSA) and Listeria monocytogenes [17], [18].

To make things worse, at the same time these bacteria are becoming more resistant to BAC, they are also becoming more resistant to common antibiotics [17]–[19].

BAC was banned in Europe, where it can’t be used in hand and body wash antiseptics [20]. Not surprising, because animal and laboratory studies suggest that BAC may have several harmful effects in humans:

  • It may be neurotoxic, and its effects in animals are similar to those of triclosan [21].
  • It may disrupt the gut barrier and induce inflammation [22], [23].
  • It may decrease fertility [24].
  • It may cause skin irritation and sometimes evoke allergic reactions [25].

With the COVID pandemic, the use of quaternary ammonium compounds has increased heavily and one study reported a not so surprising fact in humans: Compared to before the pandemic, there was a 174% increase in the concentration of BAC residues in blood [26]. And the presence of these residues correlated with an increase in inflammatory markers [27].

Benzethonium chloride (BET)

BET can be found in antibacterial cleaning wipes; and like BAC, it may also be a contaminant of commercial grapefruit seed extract [28].

One animal study showed that exposure to low concentrations of BET disrupted the gut barrier, which could contribute to inflammatory bowel disease [23]. Another animal study found that BET was as toxic as triclosan [21].

Chloroxylenol (PCMX)

PCMX is another common antimicrobial used in alcohol free hand sanitizer. It is toxic for animals [21] and it may produce contact dermatitis [29].

Another concerning fact is that PCMX has been detected in urine after using it to wash hands [30]. 

However, PCMX could be the lesser evil. One animal study showed that exposure to low concentrations of PCMX were toxic for the gut but not as much as BET and BAC [23].

Our recommendation on hand sanitizers

There is no advantage to using alcohol free hand sanitizer or alcohol-based hand sanitizer over regular soap and water. The latter are equally effective at eliminating viruses and bacteria, and is in fact the method the FDA recommends for hand washing [31], [32].

So if you are at home, opt for soap and water and practice correct hand washing.

Doing so will protect your microbiome against potentially harmful effects. And it will also prevent release of toxic ingredients into the environment, which may cause damage to marine organisms [33], [34].

When on the go, small measures like asking your children to avoid touching objects at the store instead of drenching their hands in sanitizer can help keep them safe in more than one way. Make sure to keep alcohol-based hand sanitizers out of the reach of babies and toddlers. Check this FDA list of unsafe hand sanitizers to avoid.

And while it is still too early to determine the exact effects of over sanitization due to the COVID pandemic [35], we believe an appropriate measure to ease the disruption of our microbiome is to feed our friendly microbes with good, high-quality food. 

Protect your family’s microbes by including lots of veggies, fruits, healthy fats, and fermented foods in your diet.


[1] N. A. Gold, T. M. Mirza, and U. Avva, “Alcohol Sanitizer,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2021. Accessed: Dec. 20, 2021. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK513254/

[2] S. Ophaswongse and H. I. Maibach, “Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome. A review,” Contact Dermatitis, vol. 30, no. 1, pp. 1–6, Jan. 1994, doi: 10.1111/j.1600-0536.1994.tb00719.x.

[3] T. J. Sandora et al., “A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home,” Pediatrics, vol. 116, no. 3, pp. 587–594, Sep. 2005, doi: 10.1542/peds.2005-0199.

[4] A. P. Golin, D. Choi, and A. Ghahary, “Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses,” Am. J. Infect. Control, vol. 48, no. 9, pp. 1062–1067, Sep. 2020, doi: 10.1016/j.ajic.2020.06.182.

[5] “American Association of Poison Control Centers - Hand Sanitizer.” https://aapcc.org/track/hand-sanitizer (accessed Dec. 20, 2021).

[6] O. of the Commissioner, “COVID-19 Update: FDA Warns Consumers About Hand Sanitizer Packaged in Food and Drink Containers,” FDA, Feb. 09, 2020. https://www.fda.gov/news-events/press-announcements/covid-19-update-fda-warns-consumers-about-hand-sanitizer-packaged-food-and-drink-containers (accessed Dec. 20, 2021).

[7] Food and Drug Adminnistration, HHS, “Safety and Effectiveness of Consumer Antiseptics; Topical   Antimicrobial Drug Products for Over-the-Counter Human Use. Final rule,” Fed. Regist., vol. 81, no. 172, pp. 61106–61130, Sep. 2016.

[8] A. D. Russell, “Whither triclosan?,” J. Antimicrob. Chemother., vol. 53, no. 5, pp. 693–695, May 2004, doi: 10.1093/jac/dkh171.

[9] C. S. Bever et al., “Effects of triclosan in breast milk on the infant fecal microbiome,” Chemosphere, vol. 203, pp. 467–473, Jul. 2018, doi: 10.1016/j.chemosphere.2018.03.186.

[10] J. V. Ribado, C. Ley, T. D. Haggerty, E. Tkachenko, A. S. Bhatt, and J. Parsonnet, “Household triclosan and triclocarban effects on the infant and maternal microbiome,” EMBO Mol. Med., vol. 9, no. 12, pp. 1732–1741, Dec. 2017, doi: 10.15252/emmm.201707882.

[11] G. Rizzatti, L. R. Lopetuso, G. Gibiino, C. Binda, and A. Gasbarrini, “Proteobacteria: A Common Factor in Human Diseases,” BioMed Res. Int., vol. 2017, p. 9351507, 2017, doi: 10.1155/2017/9351507.

[12] M. H. Tun et al., “Postnatal exposure to household disinfectants, infant gut microbiota and subsequent risk of overweight in children,” CMAJ Can. Med. Assoc. J. J. Assoc. Medicale Can., vol. 190, no. 37, pp. E1097–E1107, Sep. 2018, doi: 10.1503/cmaj.170809.

[13] J. H. Savage, E. C. Matsui, R. A. Wood, and C. A. Keet, “Urinary levels of triclosan and parabens are associated with aeroallergen and food sensitization,” J. Allergy Clin. Immunol., vol. 130, no. 2, pp. 453-460.e7, Aug. 2012, doi: 10.1016/j.jaci.2012.05.006.

[14] B. H. Ogilvie, A. Solis-Leal, J. B. Lopez, B. D. Poole, R. A. Robison, and B. K. Berges, “Alcohol-free hand sanitizer and other quaternary ammonium disinfectants quickly and effectively inactivate SARS-CoV-2,” J. Hosp. Infect., vol. 108, pp. 142–145, Feb. 2021, doi: 10.1016/j.jhin.2020.11.023.

[15] S. P. Epstein, D. Chen, and P. A. Asbell, “Evaluation of biomarkers of inflammation in response to benzalkonium chloride on corneal and conjunctival epithelial cells,” J. Ocul. Pharmacol. Ther. Off. J. Assoc. Ocul. Pharmacol. Ther., vol. 25, no. 5, pp. 415–424, Oct. 2009, doi: 10.1089/jop.2008.0140.

[16] G. R. Takeoka, L. T. Dao, R. Y. Wong, and L. A. Harden, “Identification of benzalkonium chloride in commercial grapefruit seed extracts,” J. Agric. Food Chem., vol. 53, no. 19, pp. 7630–7636, Sep. 2005, doi: 10.1021/jf0514064.

[17] N. AKimitsu et al., “Increase in resistance of methicillin-resistant Staphylococcus aureus to beta-lactams caused by mutations conferring resistance to benzalkonium chloride, a disinfectant widely used in hospitals,” Antimicrob. Agents Chemother., vol. 43, no. 12, pp. 3042–3043, Dec. 1999, doi: 10.1128/AAC.43.12.3042.

[18] M. Rakic-Martinez, D. A. Drevets, V. Dutta, V. Katic, and S. Kathariou, “Listeria monocytogenes strains selected on ciprofloxacin or the disinfectant benzalkonium chloride exhibit reduced susceptibility to ciprofloxacin, gentamicin, benzalkonium chloride, and other toxic compounds,” Appl. Environ. Microbiol., vol. 77, no. 24, pp. 8714–8721, Dec. 2011, doi: 10.1128/AEM.05941-11.

[19] F. L. Short et al., “Benzalkonium chloride antagonises aminoglycoside antibiotics and promotes evolution of resistance,” EBioMedicine, vol. 73, p. 103653, Nov. 2021, doi: 10.1016/j.ebiom.2021.103653.

[20] Commission Implementing Decision (EU) 2016/1950 of 4 November 2016 on the non-approval of certain biocidal active substances pursuant to Regulation (EU) No 528/2012 of the European Parliament and of the Council (Text with EEA relevance ), vol. 300. 2016. Accessed: Dec. 20, 2021. [Online]. Available: http://data.europa.eu/eli/dec_impl/2016/1950/oj/eng

[21] V. S. Sreevidya, K. A. Lenz, K. R. Svoboda, and H. Ma, “Benzalkonium chloride, benzethonium chloride, and chloroxylenol - Three replacement antimicrobials are more toxic than triclosan and triclocarban in two model organisms,” Environ. Pollut. Barking Essex 1987, vol. 235, pp. 814–824, Apr. 2018, doi: 10.1016/j.envpol.2017.12.108.

[22] S. Michée, F. Brignole-Baudouin, L. Riancho, W. Rostene, C. Baudouin, and A. Labbé, “Effects of benzalkonium chloride on THP-1 differentiated macrophages in vitro,” PloS One, vol. 8, no. 8, p. e72459, 2013, doi: 10.1371/journal.pone.0072459.

[23] K. Z. Sanidad et al., “Effects of Consumer Antimicrobials Benzalkonium Chloride, Benzethonium Chloride, and Chloroxylenol on Colonic Inflammation and Colitis-Associated Colon Tumorigenesis in Mice,” Toxicol. Sci. Off. J. Soc. Toxicol., vol. 163, no. 2, pp. 490–499, Jun. 2018, doi: 10.1093/toxsci/kfy045.

[24] V. E. Melin, T. E. Melin, B. J. Dessify, C. T. Nguyen, C. S. Shea, and T. C. Hrubec, “Quaternary ammonium disinfectants cause subfertility in mice by targeting both male and female reproductive processes,” Reprod. Toxicol. Elmsford N, vol. 59, pp. 159–166, Jan. 2016, doi: 10.1016/j.reprotox.2015.10.006.

[25] B. Merchel Piovesan Pereira and I. Tagkopoulos, “Benzalkonium Chlorides: Uses, Regulatory Status, and Microbial Resistance,” Appl. Environ. Microbiol., vol. 85, no. 13, pp. e00377-19, Jul. 2019, doi: 10.1128/AEM.00377-19.

[26] G. Zheng, T. F. Webster, and A. Salamova, “Quaternary Ammonium Compounds: Bioaccumulation Potentials in Humans and Levels in Blood before and during the Covid-19 Pandemic,” Environ. Sci. Technol., vol. 55, no. 21, pp. 14689–14698, Nov. 2021, doi: 10.1021/acs.est.1c01654.

[27] T. C. Hrubec et al., “Altered toxicological endpoints in humans from common quaternary ammonium compound disinfectant exposure,” Toxicol. Rep., vol. 8, pp. 646–656, 2021, doi: 10.1016/j.toxrep.2021.03.006.

[28] G. Takeoka, L. Dao, R. Y. Wong, R. Lundin, and N. Mahoney, “Identification of benzethonium chloride in commercial grapefruit seed extracts,” J. Agric. Food Chem., vol. 49, no. 7, pp. 3316–3320, Jul. 2001, doi: 10.1021/jf010222w.

[29] C. Berthelot and M. J. Zirwas, “Allergic contact dermatitis to chloroxylenol,” Dermat. Contact Atopic Occup. Drug, vol. 17, no. 3, pp. 156–159, Sep. 2006, doi: 10.2310/6620.2006.05057.

[30] J. Tan et al., “Human exposure and health risk assessment of an increasingly used antibacterial alternative in personal care products: Chloroxylenol,” Sci. Total Environ., vol. 786, p. 147524, Sep. 2021, doi: 10.1016/j.scitotenv.2021.147524.

[31] O. of the Commissioner, “Antibacterial Soap? You Can Skip It, Use Plain Soap and Water,” FDA, Sep. 2020, Accessed: Dec. 20, 2021. [Online]. Available: https://www.fda.gov/consumers/consumer-updates/antibacterial-soap-you-can-skip-it-use-plain-soap-and-water

[32] U. Jabbar et al., “Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands,” Infect. Control Hosp. Epidemiol., vol. 31, no. 6, pp. 565–570, Jun. 2010, doi: 10.1086/652772.

[33] F. Ferk et al., “Benzalkonium chloride (BAC) and dimethyldioctadecyl-ammonium bromide (DDAB), two common quaternary ammonium compounds, cause genotoxic effects in mammalian and plant cells at environmentally relevant concentrations,” Mutagenesis, vol. 22, no. 6, pp. 363–370, Nov. 2007, doi: 10.1093/mutage/gem027.

[34] S. C. Antunes, B. Nunes, S. Rodrigues, R. Nunes, J. Fernandes, and A. T. Correia, “Effects of chronic exposure to benzalkonium chloride in Oncorhynchus mykiss: cholinergic neurotoxicity, oxidative stress, peroxidative damage and genotoxicity,” Environ. Toxicol. Pharmacol., vol. 45, pp. 115–122, Jul. 2016, doi: 10.1016/j.etap.2016.04.016.

[35] H.-S. Ejtahed, S. Hasani-Ranjbar, S. D. Siadat, and B. Larijani, “The most important challenges ahead of microbiome pattern in the post era of the COVID-19 pandemic,” J. Diabetes Metab. Disord., pp. 1–3, Jul. 2020, doi: 10.1007/s40200-020-00579-0.