October 4, 2004
We have all heard how
important it is to wash our hands. At one time this meant vigorously
rubbing your hands together with plenty of soap and water. Now
there are anti-bacterial soaps and alcohol rubs. We have more
choices for the same job; but do they really all do the same job?
to hand hygiene (i.e. hand washing or use of alcohol-based hand
rubs) has been shown to terminate outbreaks in health care facilities,
to reduce transmission of antimicrobial resistant organisms (e.g.
methicillin resistant staphylococcus aureus) and reduce overall
What about the "alcohol-based
hand rubs"? How do those work?
carry between 10,000 and 10 million bacteria on each hand. We
all know the importance of good hand washing in reducing harmful
microorganisms on the skin, but what about those times when there
is no access to hand washing facilities or not enough time to
wash thoroughly? Can a hand sanitizer (alcohol gel) serve as a
suitable alternative to hand washing? ... Alcohol works immediately
and effectively to kill bacteria and most viruses. Solutions containing
60-95% alcohol are most effective. Higher concentrations are less
potent because proteins are not denatured easily in the absence
of water. Alcohol gels work by stripping away the outer layer
of oil on the skin, thereby destroying any 'transient' microorganisms
present on the surface of the hands...."
How do the "alcohol-based
hand rubs" compare to soap and water? While alcohol gels
are convenient and popular, they are not meant to replace soap
and water. Alcohol gels do not work to remove pieces of dirt and
"Food workers often
have wet hands and hands contaminated with proteinaceous and/or
fatty materials, which can significantly reduce the effectiveness
of an alcohol gel. Therefore, soap, friction and running water
still remain most effective in removing the types of pathogens
food workers might encounter.... For everyone, washing hands with
soap and water (whether plain or antimicrobial) is still a must.
Hand sanitizers should primarily be used only as an optional follow-up
to traditional hand washing with soap and water, except in situations
where soap and water are not available. In those instances, use
of an alcohol gel is certainly better than nothing at all."
While not the best choice
in all settings, the ease and convenience of the hand sanitizers
do make them beneficial in some situations.
are a major problem in health care facilities, resulting in extended
durations of care and substantial morbidity. Since alcohol gel
hand sanitizers combine high immediate antimicrobial efficacy
with ease of use, this study was carried out to determine the
effect of the use of alcohol gel hand sanitizer by caregivers
on infection types and rates in an extended care facility....
Comparison of the infection types and rates for the units where
hand sanitizer was used with those for the control units where
the hand sanitizer was not used showed a 30.4% decrease in infection
rates for the 34-month period in the units where hand sanitizer
was used. CONCLUSION: This study indicates that use of an alcohol
gel hand sanitizer can decrease infection rates and provide an
additional tool for an effective infection control program."
National Center for Biotechnology Information
Washing hands with soap
and water is still best, but what kind of soap should you use?
"Seven years ago,
only a few dozen products containing antibacterial agents were
being marketed for the home. Now more than 700 are available.
The public is being bombarded with ads for cleansers, soaps, toothbrushes,
dishwashing detergents, and hand lotions, all containing antibacterial
agents. Likewise, we hear about 'superbugs' and deadly viruses.
Germs have become the buzzword for a danger people want to eliminate
from their surroundings. In response to these messages, people
are buying antibacterial products because they think these products
offer health protection for them and their families. Among the
newer products in the antibacterial craze are antibacterial window
cleaner and antibacterial chopsticks. Antibacterial agents are
now in plastic food storage containers in England. In Italy, antibacterial
products are touted in public laundries. In the Boston area, you
can purchase a mattress completely impregnated with an antibacterial
agent. Whole bathrooms and bedrooms can be outfitted with products
containing triclosan (a common antibacterial agent), including
pillows, sheets, towels, and slippers."
Antibacterial soaps are
not only easier to locate than they were just a few years ago
-- in some cases, they are difficult to avoid.
"It's almost impossible
to find non-antibacterial products in today's supermarkets and
grocery stores. 'Over 70 percent of the liquid soap you can buy
now is labeled antibacterial,' Larson says."
While those selling the
products would like us to believe that these products will reduce
our chances of getting sick, whether or not that is the case is
still in question."The households were randomly assigned
to use cleaning, laundry and hand washing products that contained
antibacterial ingredients, or identical-looking products that
did not have antibacterial ingredients.... At the end of 48 weeks,
there was essentially no difference between the two groups in
the seven infectious disease symptoms surveyed, including runny
nose, cough, sore throat, vomiting and diarrhea...."
treatment groups in rates of any symptom by household-month were
not statistically significant (33.1% and 32.3% in the antibacterial
and non-antibacterial groups, respectively). Over the 48 weeks,
both unadjusted and adjusted relative risks for each symptom showed
no significant effect of antibacterial product use on infectious
disease symptoms (Table 2). No interaction of treatment effect
with number of months using the products was found in logistic
regression analyses for any of the symptoms. Furthermore, differences
in number of symptoms reported over the study period (Figure 2)
were not significant between the treatment groups."
There was "no significant
effect of antibacterial product use on infectious disease symptoms"?
for the findings is that the infections that
occurred might have been viral and not bacterial, Larson says.
Antibacterial products aren't supposed to have an effect on viruses.
On the other hand, there may be a popular perception that these
products will combat any infection. 'When I buy an antibacterial
product, in my mind, I'm thinking this is going to reduce my risk
of infections,' Larson says. 'Consumers don't think about the
fact that most of the infections healthy people get are cold,
flu and diarrhea caused by viruses.'"
Bacteria? Viruses? They
both are little things that make us sick, right? How different
could they be?
"Bacteria are single-celled
microorganisms visible only with a microscope. They are self-sufficient
and reproduce by dividing. Not all bacteria are harmful. But when
infectious bacteria enter your body, they can make you sick. Bacteria
make toxins that can damage specific cells they've invaded. A
virus is a capsule of genetic material. Viruses are much smaller
than bacteria. Also, unlike bacteria, they're not self-sufficient.
A virus needs a suitable host cell in order to reproduce. When
a virus enters your body, it invades some of your cells and takes
over the cell machinery, instructing these host cells to make
the parts it needs to reproduce. The virus may eventually kill
these host cells or may become latent -- part of the host cell's
genetic material. The distinction between viruses and bacteria
is important. This is because drugs that are effective against
one type of infection won't work against the other type."
Antibacterial does not
mean antiviral, but it's better than nothing... or is it?
"Doctors are particularly
concerned that antibacterial soaps could be contributing to the
growing problem of drug resistant bacteria. This may be because
it is killing the weakest bacteria, leaving the tougher, hard-to-kill
strains dominant. Dr Myron Genel, American Medical Association
Dr. Myron Genel, chairman of the AMA's council on scientific affairs
said he 'suspected' that this might be the case. 'There is no
evidence that they do any good and there is reason to suspect
that they could contribute to a problem by helping to create antibiotic-resistant
bacteria,' he said. Overuse of antibiotics has led to the emergence
of new bacterial strains that are largely untreatable because
they are resistant to existing drugs."
Questions of the Week:
What are ways to reduce your chances of getting sick from bacteria?
How are these the same as (and different from) what you should
do to avoid viruses? What role should hand washing play in reducing
your chances of getting sick and/or spreading germs? To what extent
should you depend upon antibacterial soaps (and other antibacterial
products)? In what ways are antibacterial products better and/or
worse than similar products without the antibacterial component?
What role can alcohol gels play in reducing your chances of getting
sick and/or spreading germs? To what extent should you depend
on these gels, and when are they not appropriate to use?
Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.
I look forward to reading
what you have to say.
Health Community Coordinator
Access Excellence @ the National Health Museum