Monday, November 9, 2009

Handy Information (Marin IJ)

In today’s digital age, in which broadband is ubiquitous and multi-tasking epidemic, fifteen seconds can seem like a long time. Fifteen seconds is enough time to do all sorts of productive things: download a new iPhone app, send a hilarious text message, or set up a DVR recording. It is also long enough for the Niners to throw three incomplete passes and for the discerning reader to glean all useful information from the front page of the newspaper.

You get the picture – a lot can happen in a quarter of a minute. Which is why it can seem like an awfully long time to spend washing your hands. But, fifteen seconds is actually the minimum amount of time that you should dedicate to a proper hand washing (with soap and warm water). This advice comes from me, yes, but more importantly from the Centers for Disease Control and Prevention (CDC) – which, in these epidemic times, is one of many entities stressing the importance of good hand hygiene.

In hospitals, cleanliness has been an important topic for over a century – ever since Ignaz Semmelweis demonstrated that by disinfecting their hands between patient visits, hospital personnel could substantially decrease maternal death rates after child birth. Nowadays, hospital accreditors watch closely, eyes on the clock, to make sure medical staff follow the fifteen-second rule. Even with such scrutiny, it can be hard to comply. Imagine the success rate that daycare centers must have getting young children to stand at the sink for 15 seconds. I, for one, consider it a victory if I can get my four-year-old daughter to wash her hands at all – fifteen seconds of hand scrubbing is nearly impossible without bribery. No wonder, then, that the public clamors for easier, faster alternatives such as hand sanitizers and antibacterial soaps. So, in the spirit of infection control, let’s review a few of these competitors.

Alcohol Gel Sanitizer
This is what I use, dozens of times a day, in the Emergency Department. A little squirt of crisp, clear ethanol gel, several rubs of the hands, and I am good to go. Alcohol gel products (such as Purell) have many advantages; they are quick, convenient and have excellent across-the-board germ killing action. Says Dr. David Witt, an infectious disease expert at San Rafael Kaiser, “For most purposes, they are equivalent to a complete washing of the hands with soap and water. They should be encouraged in situations where access to soap and water is limited.” The CDC agrees. If you choose to use alcohol-based sanitizers for on-the-go situations, you should look for those containing more than 60% alcohol (lower alcohol concentrations are of questionable value.) But, before you Purell-up and bar soap-out, a few words of caution. Alcohol gels do remove natural hand oils, and can cause dry hands – although I personally don’t find this to be a problem. Also, because of their high alcohol content, use these gels with extreme caution around: small children with curious palates, alcoholics desperate for a drink, and pyromaniacs. Alcohol gels can be both intoxicating and flammable.

Tricolsan is an organic compound found in many products – such as soaps, deodorants, and cleaning supplies – and even is imbedded in things such as kitchen utensils, bedding and socks. You probably don’t have any idea how much triclosan you have in your daily life but I recommend limiting it as much as possible. Why? Because 1) antibacterial soaps (such as those containing triclosan) have not proven to be any more effective than plain soaps, 2) triclosan can stick around in the environment for quite a long time and when it degrades it forms potentially toxic dioxin products and 3) the widespread use of this product has generated (as yet unproven) concerns about creating bacterial resistance.

Natural Hand Sanitizers

These products, made with thyme, oregano or other plant oils with antimicrobial properties, advertise that they are effective in killing all sorts of germs. My wife, a longtime fan of natural products, put one such product to the test in her microbiology lab: CleanWell All-Natural Hand Sanitizer, made with Thymus Vulgaris Oil and purporting that it is “proven to kill 99.99% of germs naturally.” Apparently, among the 0.01% of germs that CleanWell does not kill naturally is E. coli – spraying this sanitizer on various dilutions of E. coli cultures did little to impede the bacteria’s growth. Thus, I would advise that such products are probably not as good as a good hand washing.

To summarize this topic, in fifteen seconds or so, keep your hands clean, especially if you are sick or in a high-risk situation (such as at a hospital, daycare center or petting zoo). And while alternatives exist, the safest hand hygiene option for most remains a quarter minute of good ol’soap and warm water. When illness lurks nearby, this is time well spent.