[marcoseliziario]

Geez. Nuke'em from orbit, it's the only way to be sure.

In a more serious note, any biologist here knows if varying the type of hand sanitizer (e.g. alcohol this week, benzalconium chloride next, then something else, repeat...) would alleviate the problem?

[dchichkov]

Having a diverse skin micro-biome and healthy immune system that maintains it might alleviate the problem. Only a tiny percentage of bacteria are pathogenic, >95 percent of the bacteria are neutral or symbiotic (and they do compete with pathogenic bacteria).

Source:

* recent skin micro-biome review in the Nature magazine;

* https://stm.sciencemag.org/content/9/391/eaah6500

It is tough to eradicate pathogenic bacteria. But it is possible to outcompete pathogenic bacteria with neutral or symbiotic.

[wtallis]

The "and healthy immune system" bit would seem to make your advice inapplicable to hospitals.

[dchichkov]

Strangely enough, it might be applicable to hospitals. What you want in a hospital is an environment without pathogenic bacteria.

There are different ways to achieve it. It seems that the research like (1) points toward that bacteria establishes themselves very fast in a hospital, the environment is dynamically changing and is affected by hospital staff and patients. There is definitely competition present between MRSA and non-pathogenic bacteria.

Use of hands sanitizers creates environmental pressures on the bacteria. Both pathogenic and non-pathogenic (2). Hopefully this pressure is still beneficial. That is, it does diminish the rate of infections.

But one can easily imagine a situation where a MRSA bacteria resistant to a non-alcoholic hand sanitizer could benefit from absence of non-resistant (and non-pathogenic) bacteria. And in that case, use of such hand sanitizers would be shaping the environment in a bad way. MRSA will be catching a ride in the absence of non-pathogenic competition. In that particular case, relying on the immune systems of hospital staff to shape the bacterial micro-biome on their hands (and as a result in the hospital - see (1)) might be better, compared to the use of such hand sanitizer.

(1) Bacterial colonization and succession in a newly opened hospital: https://stm.sciencemag.org/content/9/391/eaah6500

(2) Good overview on different environmental pressures here: https://www.nature.com/collections/egehbdefja