When and how to return school-aged children to in-person classrooms is still being hotly debated. The CDC maintains that younger children are less likely to contract and transmit the COVID-19 coronavirus than adults,1 but that doesn’t eliminate the threat of spread among school administrators, teachers, staff, and parents—and the communities they live in.

Illnesses like the flu and COVID-19 have an impact on school attendance, a parent’s or guardian’s ability to work, and cost to the education system. Not counting losses associated with employing substitutes when faculty members are out with illnesses, the total loss of funding associated with student absenteeism each year is $10.7 billion dollars in the United States, based on students missing an average of 4.5 school days per year prior to COVID-19. While illness is not the only reason students are absent from school each day, it is believed to be the primary reason.2

School Safety Guidelines
So how can students, teachers and staff members stay safe at school? CDC guidelines suggest cloth masks, physical distancing, and hand washing 20 seconds at key times throughout the day, as well as using alcohol-based sanitizers of 60% alcohol or greater when soap and water is not available.1

Distancing and masks help reduce the risk of contracting the virus by breathing in respiratory droplets, but avoiding transmission from hand to face is also required. Hand hygiene is only one part of reducing the transmission risk of transferring a virus from frequently touched surfaces (handrails, bathrooms, doors) to the mucosal membranes of the face, which include those of the eyes, nose and mouth—commonly considered the “transmission zone” or “T-zone.”

Findings from a recent Johns Hopkins University School of Medicine study further support the importance of protecting the mucosal membranes of the face, particularly the eyes. Study results demonstrate that “ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus.”3

Risks of Alcohol-Based Sanitizer
Soap and water are not always available in each class setting, and location and distancing guidelines may mean limited access. Under these circumstances, the CDC recommends alcohol-based hand sanitizer products, but these products are not without risks.

Dry, cracked skin on the hands is caused by alcohol-based sanitizers’ ability to remove the skin’s oils. Frequent use can result in changes to normal skin flora and open the door to more frequent colonization by staphylococci and gram-negative bacteria.4 Plus, alcohol has limited residual effects—as soon as it dries, there are no more antimicrobial actions, necessitating frequent re-applications which, in turn, causes more damage to the skin.5

What’s more, alcohol-based hand sanitizers may only work well in clinical settings, where hands are not heavily soiled or greasy. In fact, hand sanitizers can be ineffective in removing bacteria if too little is applied or if it is wiped off before it completely dries on the skin.6 Once alcohol dries, there are no more antimicrobial effects.

Furthermore, alcohol-based hand sanitizers don’t kill all types of bacteria and viruses. The CDC warns they are less effective at killing Cryptosporidium, norovirus and Clostridium difficile, all of which cause diarrhea and are highly contagious.7

Another safety concern with alcohol-based hand sanitizers is risk of ingestion. Ethanol-based hand sanitizers can cause alcohol poisoning if a person swallows more than two mouthfuls. In a report from the CDC,8 researchers analyzed data reported to the National Poison Data System (NPDS) from 2011–2014 on exposures to alcohol and non–alcohol-based hand sanitizers in children who were 12 years old or younger, and 65,293 (92% of reports) were alcohol-based exposures. Emergency rooms nationwide have seen instances of both intoxication and hypoglycemia in children, and older children have been known to swallow hand sanitizers to become intoxicated purposely.9

The use of alcohol-based hand sanitizers also presents a significant flammability hazard, both in liquid form and as a vapor that can bleed off at higher temperatures. Alcohol-based hand sanitizers are classified as Class I Flammable Liquid substances, which means they have a flash point of less than 100 degrees Fahrenheit. If hand sanitizer combusts, carbon monoxide and carbon dioxide can form.

Adding to the risks, there have been FDA recalls on a number of hand sanitizer products that have had 1-propanol contamination, methanol contamination, and sub-par levels of approved antiseptics.10

Theraworx Protect Is Different
As a healthcare practitioner, you can feel good about recommending clinically proven, hospital-adopted Theraworx Protect for use at home, school and work. This non-toxic, no-rinse, advanced hygiene and barrier system is safe for both hand and facial cleansing, even around the eyes, nose and mouth (T-zone)—known portals for infection. Plus, it supports the skin for up to 4-6 hours.

Top hospitals already use Theraworx Protect as part of their bundles to manage healthcare-associated infections. Now hospitals, schools, large corporations, and government agencies are choosing Theraworx Protect to help keep staff and students safe. Learn about our hand and T-zone application protocols.


  1. Centers for Disease Control and Prevention website. Preparing K-12 school administrators for a safe return to school in Fall 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/prepare-safe-return.html. Accessed August 19, 2020.
  2. CleanLink website. A closer look at hand hygiene in schools and its impact on absenteeism. https://www.cleanlink.com/news/article/A-Closer-Look-At-Hand-Hygiene-In-Schools-And-Its-Impact-On-Absenteeism–23596. Accessed August 19, 2020.
  3. Lingli Z, Zhenhua X, Gianni M. ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARSCoV-2 infection. Johns Hopkins University School of Medicine. bioRxiv 2020.05.09.086165; doi: https://doi.org/10.1101/2020.05.09.086165. Accessed August 19, 2020.
  4. Cook HA, Cimiotti JP, Della-Latta P, Saiman L, Larson EL. Antimicrobial resistance patterns of colonizing flora on nurses’ hands in the neonatal intensive care unit. Am J Infect Control. 2007;35(4):231-236. doi: https://doi.org/10.1016/j.ajic.2006.05.291. Accessed August 19, 2020.
  5. Kampiatu P, Cozean J. A controlled, crossover study of a persistent antiseptic to reduce hospital-acquired infection. Afr J Infect Dis. 2015;9(1):6-9. doi: https://doi.org/10.4314/ajid.v9i1.2. Accessed August 19, 2020.
  6. Stebbins S, Cummings DA, Stark JH, et al. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatr Infect Dis J. 2011;30(11):921-926. doi: https://doi.org/10.1097/INF.0b013e3182218656. Accessed August 19, 2020.
  7. Centers for Disease Control and Prevention website. Show me the science — when & how to use hand sanitizer in community settings. https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html. Accessed August 19, 2020.
  8. Santos C, Kieszak S, Wang A, et al. Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers — United States, 2011–2014. MMWR Morb Mortal Wkly Rep. 2017;66(8):223-226. doi: https://doi.org/10.15585/mmwr.mm6608a5. Accessed August 19, 2020.
  9. Gold NA, Mirza TM, Avva U. Alcohol sanitizer. [Updated 2020 Jun 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513254/. Accessed August 19, 2020.
  10. U.S. Food and Drug Administration website. FDA updates on hand sanitizers consumers should not use. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use. Accessed August 19, 2020.