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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The Spread of Superbugs

superbugs on the riseThe U.S. Centers for Disease Control and Prevention has just published a first-of-its-kind assessment of the threat the country faces from antibiotic-resistant organisms.

And the news is not good.  In fact it’s downright scary. The agency’s overall conservative assessment of the problem includes frightening statistics such as:

  • Each year, in the U.S., 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics
  • Each year, out of those illnesses, there are 23,000 deaths
  • Each year, those illnesses and deaths result in $20 billion of additional healthcare spending
  • Each year, an additional $35 billion lost to society in foregone productivity.

The report marks the first time the agency has provided hard numbers for the incidence, deaths and cost of all the major resistant organisms. It also represents the first time the CDC has ranked resistant organisms by how much and how imminent a threat they pose, using seven criteria:

  • health impact
  • economic impact
  • how common the infection is
  • how easily it spreads
  • how much further it might spread in the next 10 years
  • whether there are antibiotics that still work against it
  • whether things other than administering antibiotics can be done to curb its spread

antibiotic resistant bacteriaOut of that matrix, their top three “urgent” threats they identified were:

multi-drug-resistant-pseudomonas-aeruginosa-horizontal-galleryIn addition, the CDC identified 12 resistant bacteria and fungal infections which the agency dubs “serious” i.e., requiring “prompt and sustained action.”  They include the hospital-acquired infections  Acinetobacter, Pseudomonas aeruginosa, and Vancomycin-Resistant Enterococcus (VRE) ; the foodborne organisms CampylobacterSalmonella and Shigella; MRSACandida and TB.

The last category, “concerning” i.e., requiring “careful monitoring and prevention” includes rare but potent vancomycin-resistant staphylococcus aureus  (VRSA), as well as strains of streptococcus resistant to two different categories of drugs.

For each organism, the report explains why it is a public health threat, where the trends are headed, what actions the CDC is taking, and what it is important for health care institutions, patients and their families, and states and local authorities to do to help.

Commenting on the report, Ed Septimus MD, professor of internal medicine at Texas A&M Health Sciences Center in Houston says “It’s up to us to make the recommendations in this report happen. If we do nothing but say, ‘Here’s the problem,’ then the problem will continue to grow.”

Well said Doctor, well said.

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