Schaffner: handwashing is an incomplete science, but we’re working on it

Friend of the blog Don Schaffner of Rutgers University tells the Academic Minute (in a quite professorial tone) that washing keeps bacteria and other pathogens at bay and all research suggests that keeping clean is a good thing, but handwashing is an inexact process.

Don-Schaffner-214x300Dr. Donald W. Schaffner is Extension Specialist in Food Science and Distinguished Professor at Rutgers University. Dr. Schaffner has authored more than 100 peer-reviewed publications, book chapters and abstracts. Dr. Schaffner has educated thousands of Food Industry professionals through numerous short courses and workshops in the United States and more than a dozen countries around the world. Dr. Schaffner was elected a Fellow of the IFT in 2010 and AAM in 2013 and is an Editor for the ASM journal Applied and Environmental Microbiology. Dr. Schaffner is the president of the IAFP 2013-2014.

You’ve probably heard all of your life that hand washing is important to public health.

In fact, the published research supports this quite strongly. Numerous scientific research articles show the positive impact on a variety of target populations when hand washing is encouraged, or in developing countries when something as simple as a bar of soap is provided to people that could not previously afford it.

You may have even heard advice about washing your hands: Things like “wash your hands for 20 seconds”, or you may have heard the same phrase, with 15 seconds or 30 seconds being the recommended time frame. The United States Centers for Disease Control and Prevention (the CDC) recommends teaching your child to wash their hands for as long as it takes to sing the “happy birthday” song twice (approximately 20 seconds).

You might be surprised to learn however, that the scientific basis for 5, 10, 15, 20, or even 30 seconds is virtually nonexistent. Research is currently underway in our lab to better characterize the effect of wash time, as well as other parameters on the effectiveness of a good hand wash. We are quantifying the effect of soap versus no soap, antibacterial versus plain soap, the effect of water temperature, the optimum wash time, and the method of drying.

 So, wash your hands! Especially after handling raw meat, changing a dirty diaper, or after you poop. How long should you wash your hands?

We’re working on it.

Should kids be allowed to wash hands at school? Or is sanitizer enough?

Someone wrote me this morning and said at their U.S. elementary school, the 5th graders are not permitted to wash hands after mandatory bathroom times and the teacher stands outside of the bathroom with hand sanitizer squirting it as each child leaves the bathroom. The hand dryers are too loud and the teachers don’t want wet hands because there’s no paper towel.

jon.stewart.handwashing.2002This as UN deputy secretary general, Jan Eliasson, warned the world’s lack of progress in building toilets and ending open defecation is having a “staggering” effect on the health, safety, education, prosperity and dignity of 2.5 billion people.

They may not be related, but proper sanitation requires access to proper tools.

In Denmark, nearly one-quarter of foodborne illness outbreaks from 2005 to 2011 were caused by asymptomatic food handlers, according to researchers from the Statens Serum Institut in Copenhagen.

“Symptoms compatible with norovirus infection among household members, especially children, of food handlers should be taken into account, as mechanical transfer of virus particles from private homes to industrial kitchens appears to be an important cause of outbreaks,” the researchers wrote in The Journal of Infectious Diseases. “Existing guidelines recommend exclusion of symptomatic and post-symptomatic food handlers and strict hand hygiene, when household members are ill with gastroenteritis.”

handwashing.junk.apr.13A study in Finland concluded Noroviruses are easily transferred to ready-to-eat foods via foodservice workers’ handling.

Researchers at the Finnish Food Safety Authority and the University of Helsinki confirm virus-free food ingredients and good hand hygiene are needed to prevent contamination of prepared foods.

Promote hand hygiene, but the tools have to be there.

Better hygiene through humiliation?

I’ve always been a fan of shame and blame, humility and hubris, carrots and sticks.

People can be complicated.

leadAccording to The Atlantic, a number of companies have designed systems that aim to nudge doctors and nurses into washing their hands regularly. One of these devices, a badge made by Biovigil, aims to exploit a very powerful emotion: shame.

When a doctor enters an exam room, the badge chirps and a light on it turns yellow—a reminder to the doctor as well as an alert to the patient that he is about to be touched by someone with unclean hands. If the doctor doesn’t wash her hands, the light flashes red and the badge makes a disapproving noise. After the doctor waves a freshly sanitized hand in front of the badge, alcohol vapors trigger a sensor that changes the light from red to green. Other systems include HyGreen, which also uses badges; Hyginex, a wristband that can tell when a user dispenses hand sanitizer (and vibrates if he or she doesn’t); and SwipeSense, which includes a hand-sanitizer dispenser that clips onto scrubs.

Each of these devices generates a log that’s uploaded to a database of what HyGreen calls “all hand hygiene events in the hospital”—a rundown of who’s washing up, and who isn’t. The data could help hospitals engage in after-the-fact analysis of how an outbreak occurred, and, with any luck, might help them to prevent the next one.

Handwashing is never enough: Minnesota paper says require handwashing stations at petting zoos

I was talking to my friend John this morning at my church – the ice arena – while the women were skating.

amy.hubbell.skates.jul.13 We talked about getting out of the rat race, and how it was nice we had wives to sorta support us, and he mentioned he was going to the Ekka today, and I said, beware the petting zoo, and got the usual response of, I never heard there was a risk.

As the Post Bulletin in Minnesota writes, every summer, there’s an E. coli outbreak originating from a traveling petting zoo, with the latest occurring at the Olmsted County Fair.

The report that at least 13 people, including three in Olmsted County, have been sickened by Escherichia coli O157:H7 after visiting the Zerebko Zoo Tran exhibit is a reminder that even healthy, well-cared-for animals can be vectors for disease.

The Minnesota Department of Health encourages the installation of hand-washing stations near animal exhibits and the display of posters on hand-washing. Some county fairs and festivals voluntarily comply, but we believe it should go a step further and make it a legal requirement to post signs and hand-washing stations at all livestock exhibits.

Kirk Smith, an epidemiology program manager with the state Health Department, said guidelines are sent to county fair and festival managers every year, but compliance is “modest to poor, so it’s really a frustrating issue for us.”

Five percent to 10 percent of children who get infected go on to develop severe complications, said Smith, pointing an 2012 outbreak in North Carolina, where a child died of an E. coli infection after visiting a county fair.

“If parents understand that there’s any appreciable risk from a bug that can cause kidney failure that’s fatal in 5 percent of the cases, they’ll manage that risk a lot better,” Smith said.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Petting zoos can suck: Second outbreak of infection with a rare Cryptosporidium parvum genotype in schoolchildren associated with contact with lambs/goat kids in Norway

In March 2012, a second outbreak of Cryptosporidium parvum affected children following a stay at a holiday farm in Norway; the first outbreak occurred in 2009. We studied a cohort of 145 schoolchildren who had visited the farm, of which 40 (28%) were cases.

petting zoo 1Cryptosporidium oocysts were detected in faecal samples from humans, goat kids and lambs. Molecular studies revealed C. parvum subtype IIa A19G1R1 in all samples including human samples from the 2009 outbreak. A dose–response relationship was found between the number of optional sessions with animals and illness, increasing from two sessions [risk ratio (RR) 2·7, 95% confidence interval (CI) 0·6–11·5] to six sessions (RR 8·0, 95% CI 1·7–37·7). The occurrence of two outbreaks 3 years apart, with the same subtype of C. parvum, suggests that the parasite is established in the farm’s environment. We recommend greater emphasis on hand hygiene and routines related to animal contact.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

 

Sanitizers or handwashing? Or both?

Installing alcohol-based hand sanitizer dispensers in classrooms may not mean fewer sick days for kids, a New Zealand study has suggested.

genitals.hand.sanitizerThe study, published today in the journal PLOS Medicine, found absence rates at schools that installed dispensers in classrooms as part of the survey were similar at those “control” schools which did not.

The research, led by Associate Professor Patricia Priest and University of Otago colleagues, involved 68 schools in Christchurch, Dunedin and Invercargill and nearly 2,500 pupils.

In schools randomly assigned to the “intervention” group, alcohol-based hand sanitizer dispensers were installed in the classrooms over two winter terms and the children were asked to use the dispensers after coughing or sneezing and on the way out of the classroom for breaks.

Dr Priest emphasizes that the study’s findings were not relevant to the importance of hand hygiene in general, nor did it change the message of cleaning hands before eating or after using the toilet, coughing or touching pets.

In a related story, the USA Today reports that alcohol-based hand sanitizers are better at killing germs and that soap and water is generally the best option but, hand sanitizers come in handy when you aren’t close to a sink.

Fist bumps are less germy than handshakes

I went to the Apple store in Brisbane to fix my iPhone and got a lot of handshakes.

Then I watched staff shake a lot of other hands.

Wonder_Twins-fist-bumpI was a dumbass.

So says science.

“A short, sweet fist bump will transmit the least bacteria,” and even a high-five is better than a traditional shake, says David Whitworth, a senior lecturer in biochemistry at Aberystwyth University-Ceredigion in the United Kingdom.

Whitworth and a colleague systematically tested the three greetings for a study published Monday in the American Journal of Infection Control.

For the experiment, one of them repeatedly dipped a gloved hand into a container loaded with a not-too-dangerous strain of E. coli bacteria. The dirty-gloved scientist let the film dry, then shook, fist-bumped or high-fived the other person’s clean, gloved hand. Finally, the receiving gloves were tested for bacteria.

Result: The shakes transmitted about 10 times more bacteria than the fist bumps and about two times more than the high fives. The longest, firmest shakes transmitted the most.

In a separate round in which the gloves were dipped in paint rather than bacteria, the researchers found one rather obvious explanation: Bigger areas of the hands touched during the shakes. Handshakes also tended to last longer, but the researchers found more clinging germs even when they compared shakes to fist bumps and high-fives of the same duration.

Whitworth’s findings “are not surprising,” says Mary Lou Manning, an associate professor in the school of nursing at Thomas Jefferson University in Philadelphia and president-elect of the Association for Professionals in Infection Control and Epidemiology.

She is not enthusiastic about replacing handshakes with fist bumps in hospitals. The better, more hygienic idea, she says, is to promote rigorous hand-washing and ban hand-to-hand greetings altogether. “That’s already starting to happen” in a lot of places, she says.

Sanitizers not enough says UK; wash hands after visiting the farm

The UK Public Health Agency (PHA) is reminding families about the importance of washing hands after visiting the farm.

petting.zoo.handwash.10All animals naturally carry a range of organisms, some of which can be transmitted to people. Some organisms which may be contracted on farms present a serious hazard and can potentially cause severe infection, particularly in young children.

To reduce the risk of illness, both adults and children should wash their hands thoroughly using soap and water after they have handled animals or touched surfaces at the farm and always before eating or drinking.

Antibacterial hand gels and wipes are not a substitute for washing hands with soap and water, as gels and wipes may be unable to remove contamination in the way that running water can. However, using such gels after hand washing with soap and water may reduce further the risk of picking up these infections.


Dr Philip Veal, Consultant in Health Protection at the PHA, said: “Farm animals often carry a range of organisms which can be passed to children and adults. These organisms can include serious infections such as E. coli O157 which is extremely contagious and easily passed from animals to children and then within the household.

“Hand washing with soap and water will reduce the risk of picking up these infections, which can be particularly harmful to young children. By being aware and by doing these simple things we can help to avoid illness and enjoy a fun day out.”

Best practices for planning events encouraging human-animal interactions

03.Apr.14

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of

zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

Hawthorne effect: hand hygiene rates increase three-fold when auditors visible

Hand hygiene rates were found to be three times higher when auditors were visible to healthcare workers than when there were no auditors present, according to a study in a major Canadian acute care hospital.

handwash_south_park(2)The study, titled, “Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study,” published today on-line in the BMJ Quality & Safety Journal, by first author Dr. Jocelyn Srigley, who did the study as part of her Master’s thesis while a Clinical Fellow in Infection Prevention and Control at University Health Network and University of Toronto and senior author Dr. Michael Gardam, Director, Infection Prevention and Control, University Health Network and Women’s College Hospital. Link: http://qualitysafety.bmj.com/cgi/rapidpdf/bmjqs-2014-003080?ijkey=JPbRe7gYzAFsm1Z&keytype=ref

The study examined the Hawthorne effect, also known as observation bias – the tendency of people to change their behavior when they are aware of an observer – using an electronic monitoring hand hygiene system in real-time, eliminating many of the biases inherent to human observation. Ultrasound “tags” on soap dispensers transmitted a signal to a nearby receiver each time the levers were pushed, and a time-stamped hand hygiene wash was recorded in a central data base.

Two inpatient units in University Health Network were electronically monitored, with 60 healthcare workers volunteering to be part of a study of the electronic monitoring system. Staff were aware that data would be used in a variety of studies, but were “blind” to the questions asked in the studies. Auditors did not announce their presence during audits but wore white lab coats. Auditors were also blinded to the questions asked in the research. Hand hygiene dispenses were electronically measured while the auditors were visible, and were compared to the same locations prior to the arrival of the auditors at one, two and three weeks before the audit, as well as to a different area of the unit not visible to the auditor. Auditors typically did not go into patient rooms, so separate hand washing rates were determined for dispensers inside patient rooms and those in hallways. Twelve audits were included between November 2012 and March 2013.

handwash.water.jpgThe study found that there was an approximately three-fold increase in the rate of hallway hand washes per hour amongst healthcare staff when an auditor was visible (3.75 per hour), compared to a location where the auditor was not visible (1.48 per hour) and to the previous weeks (1.07 per hour). Hand washing rates with the auditor present were compared to separate groups at different time periods and locations to ensure that the differences found were not due to hand hygiene patterns that could be attributable to time of day or location. In each instance, the hand washing rates were significantly higher when the auditors were present, with the increase occurring after the auditors’ arrival, suggesting that the arrival of the auditor triggered the increase in hand hygiene.

“The difference in hand hygiene rates, when an auditor is present compared to those times when one is not, is huge in this study, and we showed this effect to be very consistent,” says Dr. Gardam, who is also an Associate Professor of Medicine at the University of Toronto.

“The magnitude of what we found calls into question the accuracy of directly observed hand hygiene rates and the usefulness of measuring and reporting them,” says Dr. Gardam. “That said, human auditing of hand hygiene has been helpful to draw attention to this important preventative measure—we just can’t stop focusing on it because our posted rates are not nearly as high as we think they are.”

Dr. Srigley says that although the researchers were “surprised at the tripling effect” of having an auditor present, there may still be some value in doing audits as there could be opportunities for in-the-moment education with health care staff. Dr. Srigley is the Associate Medical Director of Infection Prevention and Control at Hamilton Health Sciences, composed of seven hospitals in the Hamilton area.

Dr. Gardam suggests that a “front-line staff ownership” approach which engages rather than “nags” staff is a good option. This approach was first brought to University Health Network about six years by Dr. Gardam, in which front-line staff have developed their own reminders to influence staff to wash their hands, including: pancake breakfasts, public unit reporting, pledges, posters, and holding each other accountable.

“We need to change how we look at these complex problems,” says Dr. Gardam, “We need to help people change by engaging them and having them come up with local solutions.”

Tea towels should only be used once, then washed?

hitchiker.towelNever be anywhere without a towel.

A tea towel (or dish towel).

But do I need 50 clean ones a day?

New South Wales Food Authority chief scientist Lisa Szabo said last week that, “Tea towels should be replaced after every use. … It’s best to wash tea towels after each use and have a good supply of fresh ones to hand.”

That’s a lot of washing for anyone who has cooked from scratch.

So I reached out to friend of the barfblog, Dr. Don ‘Data’ Schaffner, who offered what seems to be reasonable advice: use disposable paper towels towelyafter a handwash where pathogens may be present, and a dish towel for other things. He has a paper coming out on the topic, but is a strong believer, like me, in peer-review and publish before press release.