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revised 2008-10-20 new videos on handwashing
http://sanitationupdates.wordpress.com/2008/10/15/global-handwashing-day-videos/

revised: click to see update on children eating hand sanitizer
new: 2007-10-26 Song to time hand washing for hygiene and disease prevention

Washing hands if done properly is one of the most important things anyone can do to avoid infectious diseases, toxics poisoning, and other means of injuring one’s self and others. Although handwashing is such an important tool in community protection, it is easily learned by the youngest members of society. However, like all safety measures and skills, it takes practice. Too often adults forget how important handwashing is and frequently shirk it.

In the field or at camp or where clean water is scarce, handwashing takes a little more planning. This is also the case when going to the store, riding in a cab, visiting the hospital clinics, or handling cash at a bank. Hand sanitizers can be an effective addition to handwashing.

Posters
Getting Sick Stinks from the University of Alaska Sitka and Handwashing from Lysol are recommended.

Soaps— plain
Regular bath or dish soap works. Antibacterial or antimicrobial soap shouldn’t be used as a rule. There is no demonstrable benefit to using these, although they are heavily advertised. There is a possible negative effect because the chemical used in them will get into the environment. Not only might beneficial microbes be harmed, but by killing off the weakest harmful microbes, resistant harmful microbes may evolve.

Tips

  • See directions below in Further Information.
  • Warm water is best because it reacts with the soap to dissolve oils and grease.
  • Sing Happy Birthday twice to properly time handwashing. (I’ve timed it. No one ever sings it slowly enough the way the songwriter intended.)
  • Practice. | Karen Fluegel | remembers at the Children’s Home, each child had their own copy of a TB booklet from the state health department. Ever day, teachers instructed students on that booklet about TB to prevent its spread.
  • Noted earlier—”don’t over clean your hands to the point the skin is broken and chapped. A healthy skin barrier is a frontline defense against germs and toxins.”
    https://ykalaska.wordpress.com/2006/03/19/ tips-avoid-bird-flu/

2006-11-07
There are some brief useful videos (on-line and downloadable) including a good recent one, but I’ll have to find the links later. OK, I can’t see my own comments when I edit. Additional info on videos are in the comments below.
Kansas animated germ

Sanitizers — 62%
These are gels or lotions such as Purell. To be effective, there should have at least 60% effective ingredients. Purell meets the criteria, as do the products offered through Forestry Suppliers.
[see | local supplies |] Unfortunately, recent studies show a lot of so-called sanitizers, especially those advertised for children, are NOT effective because they have too little sanitizing compound.

Tips

  • Use the amount of sanitizer recommended on the label.
  • Forestry Suppliers has single-use packets usable in the field. Or, transfer sanitizer from larger containers into smaller ones or ziplock baggies.
  • Keep the products out of the sun and heat. The components will degrade in the sun.
  • Use promptly, within several months. Old products will also degrade.
  • Store in smaller containers. Just like a little soda pop in a big container will lose its fizz, a little bit of sanitizer in a larger container will lose its effectiveness.
Further Information and References

See also Tips that can help you avoid avian influenza (Bird Flu), WHO SE Asia – https://ykalaska.wordpress.com/2006/03/19/ tips-avoid-bird-flu/

Handwashing Fact Sheet

When should you wash your hands?
You should wash your hands often. Probably more often than you do now because you cant see germs with the naked eye or smell them, so you do not really know where they are hiding. Food employees should always wash their hands:
* After using the toilet room;
* After touching bare human body parts other than clean hands and clean, exposed portions of arms;
* After caring for or handling support animals or aquatic animals such as fish in aquariums, shellfish or crustacea in display cases;
* After coughing, sneezing, using a handkerchief or disposable tissue; using tobacco, eating, or drinking;
* After handling soiled equipment or utensils;
* During food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks;
* When switching between working with raw food and working with ready-to-eat food; and
* After engaging in other activities that contaminate the hands, such as clearing tables, handling dirty dishes or taking out the trash.

What is the correct way to wash your hands?
It is estimated that one out of three people do not regularly wash their hands, even after using the restroom. The following four steps will help you make sure your hands are properly washed:
1. Wet your hands under warm, running water and apply a liquid, powder or bar soap.
2. Rub your hands vigorously together and scrub all surfaces. Clean under fingernails and between fingers.
3. Continue scrubbing for 20 seconds or about the length of a little tune, like Happy Birthday to You. It is the soap combined with the scrubbing action that helps dislodge and remove dirt and germs. [sing twice]
4. Rinse thoroughly under running water and dry your hands using an appropriate method, i.e., individual disposable towels; a continuous towel system that supplies the user with clean towels; or a heated-air device.

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  • Avian Influenza, including Influenza A (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care Facilities, Date of most recent amendment: 9 February 2006

| Full copy, click here |

Hand hygiene, page 37 and following

Hand hygiene, which includes hand washing with soap and water and the use of alcohol-based hand rubs is critical to prevent possible self-inoculation of the nose, mouth, and conjunctivae and the transfer of microorganisms to the environment or other patients by contaminated hands. Hands should be washed with either a plain or antimicrobial soap and water when visibly soiled or contaminated with proteinaceous material. The use of an alcohol-based hand rub for routine hand antisepsis is recommended in the health care setting for all other clinical situations. Perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to perform hand hygiene between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

Alcohol-based hand rubs

Alcohol-based hand rubs have been recommended for hand hygiene in health care settings when hands are not visibly soiled or contaminated with proteinaceous material. If hands are visibly soiled or contaminated with proteinaceous material, hand washing with soap and water must be performed. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer’s recommendations regarding the volume of product to use. Many studies have demonstrated that influenza, an enveloped virus, is susceptible to alcohols when tested in vitro and in vivo testing with a 95% ethyl alcohol hand disinfectant reduced influenza virus on hands by a log10 reduction > 2.5. Ethyl alcohol has greater activity against viruses than isopropyl alcohol, therefore, ethyl alcohol-based hand disinfection products may be preferred over isopropyl alcohol products in settings where transmission of AI is likely.

Hand washing
When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.

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From the Internet Scout | mentioned before |
Science NetLinks: Antibacterial Pollution [Real One Player]
http://www.sciencenetlinks.com/ sci_update.cfm?DocID=178

Supermarket shelves groan under the weight of countless antibacterial products, but most of us have probably never stopped to consider what happens when these hand gels and dish soaps get washed down the drain. This Science Update from Science NetLinks presents an eye-opening look at the effect these products may have on fish and other wildlife. The site includes audio and a transcript of the recently aired Science Update radio spot, as well as a further explanation of the research behind the story and a set of discussion questions for use in the classroom. Links to related Web resources are also provided. [RS]

One reference is to a more technical study, Antibacterial Household Products: Cause for Concern, by Tufts University’s Stuart Levy, is a paper presented at the Centers for Disease Control’s 2000 Emerging Infectious Diseases Conference in Atlanta. The paper is fairly technical, but a good overview for advanced students.

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Alcohol handrubs v soap from the BMJ (British Medical Journal) vol 326, issue 7379, BMJ 2003 326:50

Finnish experience shows that alcohol rubs are good for hands http://bmj.bmjjournals.com/ cgi/content/full/326/7379/50/a

Girou et al compared the use of alcohol based handrubs with standard handwashing. Such handrubs have been used in Finland since the 1980s, and handrubbing is the preferred choice for hand hygiene in health care.

Healthcare workers have accepted the method, and complaints of dry skin are fewer than with using other hand hygiene products. 2 3 Alcoholic preparations must of course contain skin emollients such as 1-2% glycerol to prevent drying of the skin.

Alcohol handrub removes methicillin resistant Staphylococcus aureus

Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. Emmanuelle Girou, Sabrina Loyeau, Patrick Legrand, Françoise Oppein, and Christian Brun-Buisson BMJ 2002 325: 362.
http://bmj.bmjjournals.com/ cgi/content/abstract/325/7360/362

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SINK THOSE GERMS By ANN POTEMPA (Published: July 20, 2004)

Soap and water effective at shutting down ‘superhighway’ for sickness, experts say. When the first ship infected with norovirus cruised into Alaska ports this summer, public health officials said they knew how to prevent more illness: Passengers needed to wash their hands. Think back to all the illness outbreaks reported this year; you heard the same message….

In December, flu cases were increasing as the vaccine supply dwindled. The next-best defense? Wash your hands.

In November, salmonella plagued a Kodiak school after teachers and students shared a potluck. Wash your hands, the principal told the kids.

Hands are a “superhighway” for germs, said Valerie Curtis, one of the leading researchers studying hand washing worldwide. “It’s a key route by which bugs hitch a ride from one person to another,” said Curtis, director of the Hygiene Centre at the London School of Hygiene and Tropical Medicine.

No matter if it’s an outbreak of viral meningitis, hepatitis A or SARS, people are reminded over and over and over that washing their hands is one of the most effective ways to prevent spreading and catching illnesses.

“You can prevent nearly half of diarrheal disease with hand washing and probably nearly a third of respiratory diseases,” Curtis said. “Which makes hand washing probably a better bet than vaccines.” Washing hands is cheap and easy, often requiring only a trip to the nearest sink….

Luby conducted his study in Karachi, Pakistan, where he had worked in the 1990s. Researchers chose 36 low-income neighborhoods there and assigned them to two groups. People in one group were regularly given soap and encouraged to wash their hands after going to the bathroom and before preparing food, eating and feeding a child; the other group was given no soap or encouragement to wash up.

The Karachi neighborhoods in the study had to use heavily contaminated water, and residents didn’t always have a clean way to dry their hands. Yet using this dirty water and soap still cut their burden of diarrheal disease in half, the study showed….

Luby took the results a step further: People who wash their hands not only make themselves healthier, they make their families and neighbors healthier too.

See full story at: http://www.adn.com/life/story/5321743p-5259682c.html

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Washing With Soap Shown To Reduce Pneumonia In Children
http://www.usmedicine.com/ dailyNews.cfm?dailyID=254 Posted: 26-Sept-2005

WASHINGTON-Research conducted in Pakistan by the Centers for Disease Control and Prevention (CDC) and P&G Beauty, a division of The Procter & Gamble Company (P&G), showed that hand-washing with soap can reduce the number of pneumonia-related infections in children under the age of five by more than 50 per cent, according to a study published in The Lancet. The research, according to CDC, is the first field study to show that hand-washing can help prevent pneumonia, the leading killer of children under the age of five worldwide.

“Hand-washing with soap is something that is within the reach of hundreds of millions of at-risk families worldwide,” said Dr. Stephen Luby, the study’s lead investigator and a medical epidemiologist at CDC, in a statement. “This research can be used by families worldwide to greatly improve the health and save the lives of their children.”…

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Hand Sanitizers, Good or Bad? By DEBORAH FRANKLIN
Published: March 21, 2006
Read the entire story here —
http://www.nytimes.com/ 2006/03/21/health/21cons.html

What started out as an informal classroom experiment at East Tennessee State University has turned up disturbing evidence about some alcohol-based instant hand sanitizers….

But a study published in this month’s issue of the journal Emerging Infectious Diseases found that at least one brand of sanitizer found on store shelves, as well as some recipes for homemade versions circulating on Web sites about crafts or directed at parents, contain significantly less than the 60 percent minimum alcohol concentration that health officials deem necessary to kill most harmful bacteria and viruses….

Mr. Reynolds had the students place their hands on agar plates of growth medium before and after one of several experimental conditions: rubbing their hands briskly under tap water; sudsing with hospital-grade soap and then rinsing with water; or rubbing their hands with a dollop of one of two types of alcohol-based hand sanitizer. The sanitizers used were a foam version from the hospital that contained 62 percent ethanol, and a gel version Mr. Reynolds’s wife bought at a local discount store.

The next day, much to Mr. Reynolds’s surprise, the culture plates from hands doused and rubbed with the store-bought gel were covered with clumps of bacteria that had, in some cases, formed a visible outline of the student’s handprint on the plate….

If anything, he said, the faulty gel seemed to mobilize the bacteria, spreading them around the hand instead of killing them….

Alcohol doesn’t cut through grime well, so dirt, blood, feces or other body fluids or soil must be wiped or washed away first, if the alcohol in the sanitizer is to be effective. In such cases, hand washing with soap and water is advised….

“Studies show that the computer keyboard, the phone receiver, and the desk are worse than the bathroom in terms of micro-organisms,” she said. “Washing with plain old soap and water should be your first choice.”…

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Website of the week — Handwashing, Mirza Muminovic, BMJ Clegg scholar,
http://bmj.bmjjournals.com/cgi/ content/full/325/7360/396/a

Infection Prevention Online Course at www.engenderhealth.org/ip/ has excellent sections on internationally accepted practices for infection prevention. A module at
www.engenderhealth.org/ip/handwash provides an overview of handwashing and explains why good practices are an essential part of infection prevention. In only eight steps, this short but concise presentation summarises good handwashing behaviour. The site is available in English and Spanish and is easy to navigate. It includes useful information, a knowledge test, an overview of three kinds of handwashing used in the clinical setting, four case studies, and a recipe for making an alcohol handrub solution.

Another site with the goal of clean hands is Handwashing for Life ( www.handwashingforlife.com). Its vision is to reduce the risks, pain, and suffering of food borne illness by providing self assessment tools, resources, and a learning centre.

Henry the Hand ( www.henrythehand.com), which is available in English, French, and Spanish, reminds the kids that Mom was right — wash your hands! Posters, comics, games, and other useful child friendly tools promote clean hands from an early age. There is even a link to the “Bad Bug Book” on the US Food and Drug Administration website, but this is obviously for adults ( http://www.cfsan.fda.gov/~mow/intro.html).

The US Centers for Disease Control and Prevention has a guideline for handwashing and hospital environmental control at
www.cdc.gov/ncidod/ hip/guide/handwash.htm.

The Clean Hands Campaign from the American Society for Microbiology
( www.washup.org)
is designed to remind Americans who have forgotten Mom’s advice about washing hands. The American Society for Microbiology is also behind a site that provides tests and a few experiments for kids
( www.microbe.org/washup/Wash_Up.asp).

Finally, the story about Little Germs is at www.purell.com/media/pdf/hhhk_germ.pdf. Unfortunately, it’s not only children who need to listen.

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Children eating hand sanitizer Avian Flu Talk had mentioned this on their site and gave the reference to the Snopes.com entry (see previous post, Hoaxes Rumors Rumours )

Snopes.com Claim: Ingestion of hand sanitizer by children can result in alcohol poisoning. Status: True. Examples: Despite the warning never to let children use sanitizer without adult supervision, some do. Of course, if it is gloppy and smells nice, every kid wants to taste it. I don’t quite see how a child, even a small one, could lick enough gel to get sick (but said child isn’t supervised, either so could have glopped on more than needed). Recommended effective gels are at least 60% alcohol which is at least 120 proof. The isopropyl alcohol used in some sanitizers is not the kind used for liquor (home brew) and can make a person sick with just a small amount eaten.

In 2004 the Ontario Firefighters heard this particularly bad school prank (alcohol burns with a blue flame which is very hot and barely visible in daylight).

It has come to the attention of the Office of the Fire Marshal (OFM) that students in some schools are misusing alcohol-based hand sanitizers. In one incident, students placed a small quantity of an alcohol-based gel sanitizer on the floor, turned off the lights and then lit it on fire. It is not known whether the product was obtained through the school or was brought in by the students.

http://www.ofm.gov.on.ca/english/Publications/Communiques/2004/2004-11.asp

And poisoning isn’t just for children–

Doctors Warn Against Using Hand Sanitizer to Get Drunk After Reports of Men Drinking It for Alcohol, By Miranda Hitti, WebMD Medical News Reviewed By Louise Chang, MD

Jan. 31, 2007 — Hand sanitizer isn’t a drink, but doctors report two cases of men who drank it for its alcohol.

Both men survived, but doctors say drinking hand sanitizer could be fatal.

The cases are described in The New England Journal of Medicine.


http://www.webmd.com/content/article/131/118125.htm

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The alcohol in Purell is the same as in homebrew or distilled liquour or vanilla or spray Lysol. This means it can sicken or kill children as well. Alcohol poisoning is possible simply from eating or drinking a sufficient amount of drinking alcohol.

“Systematic name Ethanol
Other names Ethyl alcohol, grain alcohol, hydroxyethane, moonshine, EtOH”
http://en.wikipedia.org/wiki/Ethyl_alcohol

Systematic name Propan-2-ol
Other names 2-propanol, isopropanol, Isopropyl alcohol, rubbing alcohol, or the abbreviation IPA is a common name for propan-2-ol… Isopropyl alcohol is about twice as toxic as ethanol. ”
http://en.wikipedia.org/wiki/Isopropyl_alcohol

“Systematic name methanol
Other names hydroxymethane, methyl alcohol, wood alcohol, carbinol”
http://en.wikipedia.org/wiki/Methanol

“Methylated spirit also known as Meths or denatured alcohol or Sterno — (but not Rubbing alcohol which is different) is ethanol which has been rendered toxic or otherwise undrinkable, and in some cases dyed. It is used for purposes such as fuel for spirit burners and camping stoves, and as a solvent. ”
http://en.wikipedia.org/wiki/Denatured_alcohol

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