Updated May 02, 2015.

Health care acquired infections have been a recognized challenge for a few decades now. The idea that anywhere between 700,000 and 1,000,000 patients enter a hospital for treatment every year and pick up a new infection from exposure to microbes while under hospital care is a prime example of the waste that fuels are health care delivery system's financial crisis.

In addition to hand washing protocols, sanitary wipes for surface cleaning, and now even ultra-violet light products all designed to kill germs, health care workers have been using antiseptic hand sanitizers and washes directly on their skin.

As of April 2015, the U.S. Food & Drug Administration has published a proposed rule asking manufacturers of these skin antiseptics to produce evidence that long-term daily use of these products does not put the users' health at risk.

The FDA has a few concerns.

1. The FDA wants to be sure beyond a reasonable doubt that these antiseptics are not so harsh that, while killing the germs they come into contact with through touching, they are not having side effects that may not be realized until its too late. In other words, the FDA wants to be sure that there is no gradual but harmful health damage caused by the chemicals in the antiseptics to the user.
2. Another issue in question is germ tolerance. Are germs building a tolerance to these antiseptics? And if so, how does the industry respond? Harsher chemicals in the washes and sanitizers? How far has the testing gone to determine the outer limits of safety of these sanitizing ingredients? 
3. And what of the chance of tolerance that the health care workers themselves may be building? In other words, if we know that germs can mutate to stay alive in the face of cleaners and sanitizers, are the workers who rub these sanitizers into their skin every day building up a tolerance to weaker, less harmful strains of viruses only to find themselves in harm's way of more powerful, more deadly bacteria?

These are the root of the FDA's inquiry and why they are asking manufacturers of these skin antiseptic products to produce more evidence of their safety. The FDA claims that many health care workers rub these antiseptics into their skin up to 100 times per day. It's precisely this frequency of use that concerns the FDA. When that much alcohol, iodine, and other ingredients commonly found in these sanitizers are rubbed into the skin up to 100 times per day, what does that do to a person over the length of a 20- or 40-year career?

For now, the FDA agrees with the American Cleaning Institute, the largest trade organization representing the cleaning products industry, in that these sanitizers, creams, lotions, and washes should continue to be used. Preventing health care acquired infections is one of the primary jobs for ensuring high-quality medical care. Antiseptics and sanitizing foams, gels, creams, and washes are believed to be a major help in recent years' progress in lower infection rates and reducing patient deaths by hospital acquired infection.

The American Cleaning Institute believes that the FDA should have all the data it needs from the actual decades of use that these sanitizing products have been around. The Institute argues that there has been no causal link between these cleaning products and deleterious health issues in the people who have been using them for several decades.

But the FDA is not convinced that anyone has looked close enough to see if a causal link exists. Therefore it has issued this proposed rule to gather data, while encouraging health care workers to continue to follow the infection prevention and control guidelines that medical centers have in place. Antiseptics and hand sanitizers are a foundation of those infection prevention protocols, so for the foreseeable future these products will and should continue to be used.