Soap vs Sanitizers

You squirt it on your hands as you enter the grocery store, and then again on your way out. You have bottles in your car, on your desk and in your home too – and you use them often.

And no, you’re not a germophobe, it’s just that your hand-sanitizer habit is helping to protect you from colds and flu and other nasty’s, that are wet, sticky and not yours!

And even if it doesn’t, it’s harmless. Right?

Not so fast! Word on the street has it that despite how clean your hands feel after using a hand sanitizer, they’re actually still dirty.  Worse still, they’re potentially toxic and might actually lower your resistance to disease.

So are these rumors true?!  Let’s take a look at the evidence.

When it comes to safety and effectiveness, the main concern with hand sanitizers is triclosan, – the main antibacterial ingredient used in non-alcoholic hand sanitizers.

“There’s no good evidence that triclosan-containing products have a benefit,” says Allison Aiello PhD, associate professor of epidemiology at the University of Michigan. In fact, hospitals in Europe and the United States, won’t even use them because it’s thought that they don’t reduce infections or illness.

Dr. Anna Bowen, an epidemiologist at The Centers for Disease Control and Prevention, says, “Triclosan-containing products don’t provide any disease protection beyond what you get from washing with soap and water.”

Research has shown that triclosan can disrupt the endocrine system, amplifying testosterone. In animal studies, it reduced muscle strength. It may also harm the immune system. Whether these findings add up to human toxicity isn’t established yet, but the FDA is currently reviewing the issue.

A more established concern: “When you expose bacteria to triclosan, it can elicit antibiotic resistance,” says Aiello. “Once the resistance is transferred, pathogenic bacteria can become resistant to many types of antibiotics.”   She also points out that quaternary ammonium, another antibacterial found in nonalcoholic hand sanitizers, has been shown to elicit antibiotic resistance.

The main concern with triclosan, that it’s an anti-bacterial, meaning it doesn’t protect against viruses or fungi.  Which means, colds and flu are not destroyed because they are caused by viruses, not bacteria.

Alcohol-based sanitizers, on the other hand, are fairly effective and safe. Those that contain  60% alcohol are good at killing bacterial pathogens and can also kill some viruses though not all of them.  Norovirus, for example, the bug responsible for the recent cruise-ship outbreaks is not affected.

“If you can’t get to a sink quickly, an alcohol-based sanitizer is a good alternative to washing with soap and water,” says Aiello.

One caveat: They don’t work on visibly dirty hands.  The alcohol can’t get past the dirt.

So how does soap and water match up?   First, they are both safe and effective. That’s right. Good old-fashioned hand washing before you prepare food or after you go to the toilet has been shown to drastically reduce the risk of diarrhea.

“Hand-washing campaigns reduce absenteeism in schools,” says Bowen, “and that means parents miss fewer days of work, too.”

But, and it’s a big but – you have to wash your hands correctly.

According to the CDC you need to wash for about 24 seconds to remove bacteria and viruses from your hands. You need to cover all parts of your hands, front and back and under your nails and then dry your hands well.

How long is 24 seconds? Apparently it’s about as long as it takes to sing two verses of Happy Birthday.  However, as I always tell my infection control students, if you’re in public, sing it with your inner voice …or you could have more than germs to worry about!

Bottom line –  soap and water beats sanitizers hands-down.  Suds up and stay safe this cold and flu season.

School is in Session and So Too Are Germs

While many parents don’t remember much algebra or calculus, most know all too well that school + kids = sick days.

And with more than 200 cold viruses identified,  it’s no wonder parents feel like they are fighting a losing battle when it comes to keeping their kids healthy.

“Kids will be exposed to germs and inevitably get colds, even with the best preventive measures, and that’s OK,” said Jessica McIntyre, MD, family physician at Loyola University Health System and assistant professor in the Department of Family Medicine at Loyola University Chicago Stritch School of Medicine.

According to McIntyre, young children will get between 7 and 8 colds a year and school-age children will average 5-6 colds a year. Kids tend to get more colds during the school year because they are in an enclosed classroom surrounded by other children who are sharing these very common viruses.

“Parents sometimes worry that they have done something wrong to cause frequent colds, or that their child is not healthy. Actually, cold viruses help build a child’s immune system and are an unavoidable part of growing up,” McIntyre said.

Nevertheless, we bring you some tips to help keep your child’s sick days to a minimum

1. You’ve taught your kids their ABCs –  now teach them their CCCs?
   a. Clean – wash your hands and make sure your kids wash their hands frequently
   b. Cover – cover your cough and sneeze, preferably with a tissue, but if one is not available, cough or sneeze into your elbow
   c. Contain – stay at home if you are sick; germs are one thing that aren’t good to share
2. Family flu vaccines. Everyone who is 6 months or older should be vaccinated. Talk to your physician about which type of vaccine is right for your family members.
3. Have your children wash their hands as soon as they get home from school.
4. Change into “home clothes and shoes.”  It helps keep germs, allergens and dirt out of the house making it easier to keep clean. Plus, you won’t be searching the house for shoes that were kicked off under the couch.This is especially beneficial if you have a young infant at home
5. Wash their lunch box daily. Lunch boxes carry more than veggies and fruit to and from school. They also carry A LOT of germs. If they’re dishwasher safe, run them through the sanitizing cycle at the end of each day. If not, spray them down with vinegar and water and wipe them clean before packing a new lunch
6. Backpacks are another huge germ culprit. They make their way onto tables, beds and desks and can transfer nasty germs to all of these surfaces. Wash backpacks once a week to minimize the spread of germs.
7. Reduce consumption of sugary foods before and during school. Consuming just a teaspoon of sugar weakens the immune system for up to 4 hours. To help the body fight germs, make sure to offer a low sugar breakfast and low sugar lunch. Avoid processed foods as much as possible. They are generally loaded with sugars.

And if you’d still like to do more to keep your little darlings safe, there is some evidence that certain  products can be effective in cold prevention if taken regularly:
(i) Probiotics: 1 gram mixed with milk twice daily
(ii) Vitamin C: 1 gram daily
(iii) Zinc sulfate: 15 mg syrup or 10 mg tablet daily

Despite all that, if they do develop a cold, don’t stress about it!  Everyone gets sick sometimes. And while we all hate to see  kids feeling bad, just remember, when they get sick their bodies are building up their ability to fight future infections.

Physician, Heal Thyself!

An unwavering work ethic is a hallmark of many health professionals. But a new survey finds that when a doctor is sick, such dedication to duty can have serious consequences.

A poll of 150 attendees of an American College of Physicians meeting in 2010 revealed that more than half of resident physicians had worked with flu-like symptoms at least once in the last year and one in six reported working sick on three or more occasions during that time.

The survey conducted by researchers at the University of Chicago Medicine and Massachusetts General Hospital also asked the doctors whether they believed they’d ever directly transmitted an illness to a patient.  Shockingly, nearly 10 percent of respondents answered yes, and more than 20 percent believed other residents had passed on an illness to a patient. So much for the Hippocratic Oath and the promise to do no harm!

The results published in the Archives of Internal Medicine are further evidence of a culture of self-sacrifice long prevalent in medicine. Researchers say a physician’s sense of loyalty to already-overwhelmed peers, along with a commitment to patient care, often conflicts with an ethical stance against exposing patients and staff to an illness or compromised performance.

“Resisting the pressure to work when ill can be particularly difficult for young doctors,” said study author Anupam B. Jena, MD, PhD,. “A work-first, self-second attitude is often seen as ideal among peers, superiors and even patients.”

In the first known account of the reasons for presenteeism among doctors-in-training, more than half of respondents cited obligation to colleagues who’d be forced to cover their duties or an obligation to patient care as the top reasons for not taking a sick day.

Far fewer, a mere 12%, indicated they’d worked when ill due to concerns their colleagues would think they were “weak” and 8% came to work sick because they felt pressured to repay colleagues for coverage.

Seniority appeared to be a factor in the results. Second-year residents were more likely than first-years to select responsibility to patient care as a reason for presenteeism. Gender differences were also brought to light with female residents more likely to work sick and cite patient care as the reason. Female residents were also more likely to report fear of being perceived as weak as a motive for not taking time off.

While time away from the office carries a similar stigma in other high-pressure professions, a business  executive showing up sick to the boardroom is significantly less worrisome than a doctor with flu treating patients. An otherwise healthy doctor can often recover quickly, but an infected patient with an already-compromised immune system may not.

Clearly it’s time for doctors to stop playing superheroes.  Presenteeism needs to be addressed and eliminated. Given the intellect of most doctors it shouldn’t be too difficult for them to understand that refraining from work while ill is the most professional way to ensure responsible and safe care for patients.

A word to my doctors – if  what you’ve got is contagious or makes you so sick that your judgment is clouded – STAY HOME!

Cracking the Code for the Common Cold

Medicine has been chasing the elusive cure for the common cold for many long years now.  Try as they might though, it keeps eluding them.

But maybe not for much longer, or so say researchers from the University of Wisconsin, Madison. Using sinus tissue removed during surgery they have managed to grow a recently discovered species of human rhinovirus (HRV), the most frequent cause of the common cold.

The researchers found that the virus, which is associated with up to half of all HRV infections in children, has reproductive properties that differ from those of other members of the HRV family. The accomplishments, reported in Nature Medicine on April 11, should allow antiviral compounds to be screened to see if they stop the virus from growing.

The report sheds light on HRV-C, the newest member of the HRV family. Discovered five years ago, HRV-C has been notoriously difficult to grow in standard cell cultures and, therefore, impossible to study. In addition to its major role in the common cold, HRV-C is responsible for between 50 and 80% of asthma attacks. It is a frequent cause of wheezing illnesses in infants and may be especially likely to cause asthma attacks in children. HRV infections of all kinds also can greatly worsen chronic lung diseases such as cystic fibrosis and chronic obstructive pulmonary disease.

Like other scientists, Yury Bochkov, a virologist at the UW-Madison School of Medicine and Public Health was unable to grow HRV-C in standard cell lines. So he turned to nasal tissue collected following sinus surgery and was surprised to find success. He grew significant amounts of two forms of HRV-C, then sequenced the complete virus genome and engineered an identical copy of it in a plasmid vector.

Studying the reproduction of the living, growing virus, he found that HRV-C replication appeared to occur in specific kinds of cells localized in nasal epithelium tissue.  “We also found that HRV-C does not attach to the two receptors that HRV-A and HRV-B use,” Bochkov says. “HRV-C uses a distinct, yet unknown, receptor that is absent or under-expressed in many cell lines.”

Future drugs emanating from this research could be especially useful for children and adults who have asthma and other lung problems.

But we’re not there yet!  In the meantime, SRxA’s Word on Health suggests we continue doing what our mothers have been telling us for years. Drink plenty of fluids, gargle with salt water and, of course, chicken soup.

Statistical Significance is Nothing to be Sneezed at Says US Supreme Court

If you have ever had a stuffy nose or invested your hard-earned cash in the stock market, the facts of a recent Supreme Court case will probably disturb you.

The case, Matrixx Initiatives Inc. v. Siracusano involved the popular homeopathic nose spray – Zicam.

This product was responsible for the vast majority of Matrixx’s revenues, and investors loved the company because the nasal remedy sold well.  The stock price soared, but then the company learned that Zicam had caused some users to lose their sense of smell.  As it turned out,  approximately 130 users had reported the adverse side effect, the medical term for which is anosmia.

Although the common view of anosmia is that it is a trivial inconvenience, it can have a number of harmful effects.  Not only do patients find food less appetizing, their loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, and spoiled food. Loss of smell may also lead to the loss of libido.

Matrixx, however, concerned that the news would lead to a loss in sales, decided not to report the rare side effect to investors.    The company’s reasoning?  The side effect was not the kind of “material information” that securities laws would require it to disclose because it was not statistically significant when considered in the context of the patients who had used the drug.

The problem for Matrixx arose when national news got wind of the anosmia side effect.  This lead to the issue of FDA warnings and ultimately Matrixx’s decision to take the drug off the market, causing stock prices to fall.

So, investors sued the company saying that the undisclosed information was indeed “material” and might have caused them to make a different decision about whether to buy Matrixx stock.

During the trial, in a brief to the court, PhRMA said, “A collection of adverse event reports that is not statistically significant does not permit a reasonable inference that a particular medicine actually caused the reported adverse event.”

The Supreme Court disagreed.  In a unanimous opinion by Justice Sotomayor, it made clear that the word “material” does not equate with “statistically significant”.  Instead, the Court said, the important consideration is what information a reasonable investor would regard as relevant to the decision to buy stock; such an inquiry would include questions about the source and reliability of the information.  While not all reports to authorities about side effects would be material under this test, the Court held, those about the Zicam side effect would have been because they came from medical experts.

While almost everyone involved in pharmaceutical marketing is aware of the FDA’s “Fair Balance” requirements it seems that full disclosure must now include all corporate, as well as product, information.  In fact, the Supreme Court ruling may have greater repercussions for adverse event reporting by the drug industry than any guidelines the FDA has ever issued!