Soap vs Sanitizers

hand-sanitizerYou 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.

hand-sanitizer-triclosanWhen 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.

handwashing_355pxSo 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.

have u washedHow 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.

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Swimming with Seals riskier than Surfing with Sharks?

Seals  –  those cute, semi-aquatic marine mammals hunted for generations by humans may be about to wreak their revenge.  While we don’t want to get into the pros and cons of the cull, we would like to warn our readers of a new strain of flu found in New England harbor seals.

According to experts, seal flu could potentially threaten people as well as wildlife. In a report just published online in mBio, scientists from several organizations, including Columbia University and the National Oceanic and Atmospheric Administration suggest that seal flu could lead to another pandemic just as we saw with bird and swine flu.

There is a concern that we have a new mammalian-transmissible virus to which humans haven’t been exposed yet. It’s a combination we haven’t seen in disease before,” said Anne Moscona MD, professor of pediatrics and of microbiology and immunology at Weill Cornell Medical College.

A dangerous virus infecting mammals increases the risk to us – not by direct infection – but by evolutionary development of even more riskier strains,” explained Bruce Hirsch, an infectious disease specialist at North Shore University Hospital in Manhasset, N.Y.

Although transmission via direct contact between humans and harbor seals is unlikely, the virus could find other ways to get to people.  For example, the strain might pass from seals to birds, expand its presence in the environment.  And because seal flu is able to target a protein found in the human respiratory tract, it may have the potential to mutate in ways that make it easily passed to or between humans.

The researchers analyzed the DNA of a virus linked to the death of 162 harbor seals in 2011 off the coasts of Massachusetts, New Hampshire and Maine. Five autopsies revealed that the seals died from infection with a type of flu known as H3N8.

Because pandemic flu can originate in unexpected ways, preparation is essential. The Centers for Disease Control and prevention (CDC) offers some excellent tips on its website.

And we suggest for this year at least you might be better off diving with dolphins than swimming with seals!

 

 

 

Fighting flu in just two hours

As we approach midsummer, while most of us are enjoying days at the pool or beach and long evenings of grilling out, a few people have already begun the countdown to winter frosts and flu season.

For those in the latter group, SRxA’s Word on Health brings you good news!

Researchers from San Diego State University and Nebraska Medical Center have developed a synthetic protein known as EP67 that can fight off flu, in just two hours.

Until recently, EP67 had been used as an adjuvant for vaccines. When added to a vaccine, adjuvants help to activate the immune system. Which led scientists to wonder what effect the synthetic protein might have on its own?

Dr. Joy Phillips, lead author, said: “The flu virus is very sneaky and actively keeps the immune system from detecting it for a few days until you are getting symptoms. Our research showed that  introducing EP67 into the body within 24 hours of exposure to the flu virus caused the immune system to react almost immediately to the threat, well before your body normally would.”

EP67 is useful as a weapon against flu because it works on the immune system rather than the virus.  So it doesn’t matter which flu strain a patient becomes infected with.  If a new strain of flu or some other infectious disease appears, such as occurred with SARA and H1N1, EP67 could be useful as a tool even before the pathogen itself has been identified.

And even though this study concentrated on the benefits of EP67 for flu, researchers are hopeful that it might also be useful for combating other respiratory diseases and fungal infections.

Current tests are being done on laboratory animals, mainly mice, by infecting them with an influenza virus and then administering EP67 within 24 hours. They found that the treated mice did not get sick, while the untreated ones did.  Most mice infected with flu will lose approximately 20% of their body weight – this was the case with the untreated mice. The mice given EP67 lost just an average of 6%. Some mice were even given a lethal dose of flu virus, and then administered EP67 – none of them died.

All of this sounds so promising future studies are already planned to look at EP67’s effect on other pathogens and its functions within different types of body cells.

With this type of good news on the way, maybe we can all stop worrying about the winter and get back to enjoying summer before it’s gone!

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!

Kicking Up A (cytokine) Storm

The New Year brings with it many new possibilities, including, unfortunately a new flu season.

So far, the number of flu cases in 2012 is down, thanks largely to the unprecedented mild weather over most of the US. A sharp contrast to 2009 when H1N1 (or swine flu) killed more than 18,000 people worldwide or 1918 when the flu virus infected around a third of the world’s population and killed at least 50 million people.

New research shows that the reason so many people died in both of those years wasn’t the influenza virus itself, but the immune system’s reaction to it.  It turns out that the virus destroys its host by turning the body’s own defenses against itself.

While trying to destroy flu-infected cells, your immune system also destroys legions of perfectly healthy cells all over your body. This is why, even though the virus itself rarely ventures outside the lungs, the symptoms of the flu are so widespread” says , Michael Oldstone, a virologist at the Scripps Research Institute in La Jolla, Calif.

Most of the time this immune response isn’t too severe. As the virus runs its course, the response subsides. But in some cases, an infection can trigger a reaction so destructive it can be fatal. Scientists call this a cytokine storm, because of the violent way immune cells respond to a virus. Cytokines usually help fight off infections by telling the immune system which specific viral cells it should be attacking, but sometimes an overabundance of cytokines floods into a part of the body, and that’s when you get a storm.

Cytokine storms are rare, but they may be more common among younger people because they have stronger immune systems, and are more prone to overreactions. This may explain one of the more surprising outcomes of the 2009 swine flu: that it was deadlier among young people than it was among the elderly.

Cytokine storms can cause serious damage throughout the body, especially in the lungs, which is why most flu deaths are attributed to pneumonia.

After 5 years of research, Oldstone and his colleagues have identified a cell — they call S1P1 – that responds to cytokines. More importantly they’ve also figured out how to turn off that cell’s signals. This could pave the way for a new class of immune-reaction-blocking drugs that could provide protection against cytokine storms and be more effective than antiviral drugs.

Cytokine-blocking drugs could target the flu effects that cause the most damage to the body and would avoid the problems of virus mutation because they don’t affect the virus itself.

Still, it will probably be many years before those drugs reach your local pharmacy. Although preliminary experiments in mice have shown very promising results they still have to replicate these in ferrets, then primates and finally, humans.

Do you have any flu stories to share? SRxA’s Word on Health would love to hear from you.