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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Infection control controls costs

Aside from blogging, SRxA duties, and volunteering as an EMT, once a month I teach infection control to Fire and Rescue personnel.  During classes I stress the importance of the basics – training, hand-washing, good hygiene While most students probably forget the more scientific aspects of my lectures, they all remember the advice “if it’s wet, sticky and it’s not yours, don’t touch it!”

I was therefore interested, but not altogether surprised, to read a new study published in the September 2011 issue of Health Affairs, which showed that simple infection control measures could save thousands of lives and billions of dollars.

According to the U.S. Department of Health and Human Services at any given time, one of every 20 hospital patients has a hospital-acquired infection. This leads to an estimated 99,000 deaths in the U.S. each year and up to $33 billion in preventable health care costs.

The study, undertaken by researchers at the University of North Carolina at Chapel Hill, tested three interventions aimed at preventing and reducing hospital acquired infections.

The first intervention was strict enforcement of hand hygiene practices. All health care workers were expected to wash their hands with soap and running water or an alcohol-based rub on entering and leaving a patient’s room, before putting on and after removing gloves, and before and after any task that involves touching potentially contaminated surfaces or body fluids.

The second intervention was aimed at preventing ventilator-associated pneumonia and included measures such as elevating the head of the patient’s bed while the patient was on a ventilator, giving the patient daily breaks from sedation to assess whether or not the patient is ready to come off the ventilator, and providing daily oral care (teeth brushing, mouth washes, etc.) with a long-lasting antiseptic.

The final intervention was ensuring compliance with guidelines for the use and maintenance of central-line catheters. Examples included using sponges impregnated with an antiseptic, using catheters impregnated with antibiotics whenever possible, and performing two assessments per day of whether patients with central-line catheters still needed them.

Results showed that patients admitted after these interventions were fully implemented got out of the hospital an average of two days earlier, their hospital stay cost about $12,000 less and the number of patient deaths were reduced by two percentage points.

The costs for implementing these measures were modest – less than $22 / patient/day. However, adoption of the three interventions could potentially save thousands of lives and billions of dollars each year and improve the care of all patients.  Proving once again, it’s sometimes the simple things in life that are the most effective.

Now Wash Your Hands Please

Word on Health was horrified to learn that when you meet someone and shake their hand, there’s a one in five chance that they didn’t wash their hands after going to the toilet.

A recent study of 2,000 adults found that more than half did not clean up before eating and even more worryingly, 3:1 men and almost 1:5 women said they also often failed to wash their hands after going to the toilet.

Of those, almost a quarter said they were not worried about hygiene after using their toilet at home because they would only be picking up germs from other members of their family, while one in five said their hands already looked clean without the need to wash them under a tap.

Although 88% of those questioned could correctly name at least one food bacterium such as salmonella, E. coli or campylobacter, many did not realize how easy they were to pick up.

According to the Centers for Disease Control and Prevention (CDC) and leading public health officials, hand washing is the single most important method of preventing the spread of infection.

Perhaps it’s because hand washing is so basic that it’s often taken for granted. Yet the quantity and variety of germs that we carry on our hands everyday is astounding. Each square inch of our skin contains about 5,000 different bacteria.  When we forget to wash our hands, or don’t wash our hands correctly, we can spread these germs to other people.

The importance of hand washing cannot be overstressed. It is so simple and yet forgetting to do it can have such serious consequences.” says Sir John Krebs, chairman of the UK’s Food Standards Agency.

And it’s not just children or the general public that forget to wash their hands, seems health workers are just as guilty.  In the US it is estimated that hand washing alone could prevent 20,000 patient deaths per year. Despite this, studies have shown that hand washing compliance among health-care workers is poor.

Things, it seems, are so bad that  Loyola University Health System has just hosted a forum led by hand-hygiene authority Professor Didier Pittet, MD, MS, and President of The Joint Commission Mark R. Chassin, MD, FACP MPP, MPH.

This forum was designed to educate healthcare leaders about proper hand washing techniques as well as provide strategies to overcome challenges to achieving a highly effective hand-hygiene program.

For those of you who missed the forum, SRxA’s word on Health is pleased to bring you some simple hand hygiene tips:

Always wash your hands before:

  • Preparing food
  • Eating
  • Treating wounds or giving medicine
  • Touching a sick or injured person
  • Inserting or removing contact lenses

Always wash your hands after:

  • Preparing food, especially raw meat or poultry
  • Using the toilet
  • Changing a diaper
  • Touching an animal or animal toys, leashes or waste
  • Blowing your nose, coughing or sneezing into your hands
  • Treating wounds
  • Touching a sick or injured person
  • Handling garbage or something that could be contaminated, such as a cleaning cloth or soiled shoes

Of course, it’s also important to wash your hands whenever they look dirty…or before you come to shake one of ours!

For more on hand hygiene we suggest you check out the CDC’s Clean hands save lives site.