Do they work? Do they really work? FDA says prove those hand sanitizers work

Posted on June 30, 2016 by Douglas Powell

Maggie Fox of NBC News writes that hand sanitizers are everywhere – at supermarket entrances, in public rest rooms, in schools and cafeterias. People believe they work and give them to their kids. Now U.S. the Food and Drug Administration says makers of the products need to show they’re safe and work as well as people believe they do.

It’s the latest stage in FDA’s ongoing review of cleaning and hygiene products, forced in part by pressure from Congress and a lawsuit by the Natural Resources Defense Council.

It’s not that there is any indication the products are not safe or do not work, the FDA stresses. But there are some very vague hints from just a few studies that suggest some of the ingredients might be absorbed through the skin. And since they are so heavily used by pregnant women and small children, it’s best to check out even the most unlikely risks.

“Today, consumers are using antiseptic rubs more frequently at home, work, school and in other public settings where the risk of infection is relatively low,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

“These products provide a convenient alternative when hand washing with plain soap and water is unavailable, but it’s our responsibility to determine whether these products are safe and effective so that consumers can be confident when using them on themselves and their families multiple times a day. To do that, we must fill the gaps in scientific data on certain active ingredients.”

FDA wants manufacturers to provide data for ethanol or ethyl alcohol, isopropyl alcohol and benzalkonium chloride. “Since 2009, 90 percent of all consumer antiseptic rubs use ethanol or ethyl alcohol as their active ingredient,” the FDA said.

“New safety information also suggests that widespread antiseptic use could have an impact on the development of bacterial resistance,” the agency says in its proposal.

Music festivals are great; for pathogens too

Posted on June 27, 2016 by Ben Chapman

I was at a kids birthday party recently when a parent familiar with my Canadian heritage mentioned to me that the Tragically Hip’s 2016 tour would be a string of depressing events.

Maybe, I dunno.

Gord Downie, the Hip’s lead singer, has terminal brain cancer and their 10 city tour is a farewell, according to the band’s website.

So after 30-some years together as The Tragically Hip, thousands of shows, and hundreds of tours…

We’ve decided to do another one.

This feels like the right thing to do now, for Gord, and for all of us.

I’ve seen the Hip a handful of times, a few at outdoor festivals; each time it’s been more of a community gathering than a concert. Sorta like Canada’s version of the Grateful Dead or Jimmy Buffet experiences. Except with hockey, the Group of Seven and loons.

Doug’s post yesterday reminded me of the excitement at these festivals:

Heavy drinking; lots of other substances; the pit where sweaty bodies are smashed up against each other; and, folks using bushes and other places to poop and pee to avoid the lines at the port-a-potties.

And maybe it’ll rain and move the excrement around.

Here’s a great review of outdoor festival-linked outbreaks over the past couple of decades. Spoiler alert – there are well over 10,000 illnesses reported.

Hawthorne Effect hinders accurate hand hygiene observation, study says

Posted on June 22, 2016 by Douglas Powell

Yeah, we used to have students loitering around bathrooms, but figured out fairly quick that didn’t work.

So we would train co-workers to be the spies of shit (on people’s hands).

Guess others have figured that out too.

Although there is a cultural factor. Amy don’t care much if I fart in Kansas or Australia, but in France, that’s a no-no, and I must button my shirt up appropriately and take showers so I don’t look like a homeless person, even though snotty French types would walk over children to get to wherever they were going that was so important.

To them, I fart in your general direction.

When healthcare providers know they are being watched, they are twice as likely to comply with hand hygiene guidelines. This is in comparison to when healthcare providers do not know someone is watching, according to a new study being presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC). This phenomenon—called The Hawthorne Effect—impacts the ability to capture accurate human behavior because individuals modify their actions when they know they are being observed.

The infection prevention department at Santa Clara Valley Medical Center in San Jose, California measured the differences in hand hygiene compliance rates when healthcare workers recognized the observers and when they did not. The study found a difference of more than 30 percent in hand hygiene compliance depending on whether or not they recognized the auditors. “This was not a result that we expected to see,” said Nancy Johnson, MSN, CIC, infection prevention manager, Santa Clara Valley Medical Center. Infection preventionists validated the audits conducted by hospital volunteers, which showed no difference in the group’s observations.

“The level of hand hygiene compliance when staff did not know they were being watched was surprising,” said Maricris Niles, MA, infection prevention analyst, Santa Clara Valley Medical Center, California. “This study demonstrated to us that hand hygiene observations are influenced by the Hawthorne Effect and that unknown observers should be used to get the most accurate hand hygiene data.”

Five infection prevention nurses (known to staff) and 15 hospital volunteers (unknown to staff) collected 4,640 observations between July 2015 and December 2015. The volunteers were trained in a two-hour course on the importance, identification and reporting of hand hygiene compliance.

Nancy Johnson stated that this data was recognized by our leadership. “We have rolled out many changes as a result, including an organization-wide, hand hygiene improvement plan that is actively supported by our leadership team. Moving forward, the medical center’s monitoring will be conducted by unknown observers.”

With all the dirt and the grease and the gunk: Handwashing better than sanitizers in food service

Posted on June 18, 2016 by Douglas Powell

Hands can be a vector for transmitting pathogenic microorganisms to foodstuffs and drinks, and to the mouths of susceptible hosts.

Hand washing is the primary barrier to prevent transmission of enteric pathogens via cross-contamination from infected persons. Conventional hand washing involves the use of water, soap, and friction to remove dirt and microorganisms. The availability of hand sanitizing products for use when water and soap are unavailable has increased in recent years. The aim of this systematic review was to collate scientific information on the efficacy of hand sanitizers compared with washing hands with soap and water for the removal of foodborne pathogens from the hands of food handlers.

An extensive literature search was carried out using three electronic databases: Web of Science, Scopus, and PubMed. Twenty-eight scientific publications were ultimately included in the review. Analysis of this literature revealed various limitations in the scientific information owing to the absence of a standardized protocol for evaluating the efficacy of hand products and variation in experimental conditions. However, despite conflicting results, scientific evidence seems to support the historical skepticism about the use of waterless hand sanitizers in food preparation settings.

Water and soap appear to be more effective than waterless products for removal of soil and microorganisms from hands. Alcohol-based products achieve rapid and effective inactivation of various bacteria, but their efficacy is generally lower against nonenveloped viruses. The presence of food debris significantly affects the microbial inactivation rate of hand sanitizers.

Efficacy of instant hand sanitizers against foodborne pathogens compared with hand washing with soap and water in food preparation settings: A systematic review

Journal of Food Protection®, Number 6, June 2016, pp. 896-1055, pp. 1040-1054(15)

Foddai, Antonio C. G.; Grant, Irene R.; Dean, Moira

http://www.ingentaconnect.com/contentone/iafp/jfp/2016/00000079/00000006/art00020

Handwashing compliance: Going beyond ‘monitor and forget’

Posted on May 12, 2016 by Douglas Powell

New research from Olin Business School at Washington University in St. Louis shows that motivating compliance with standard processes via electronic monitoring can be a highly effective approach, despite concerns about employee backlash.

However, the research also highlights that managers cannot simply “monitor and forget,” and that a long-term plan for supporting the retention of monitoring is critical. The findings were published online May 5 in Management Science.

Hengchen Dai, assistant professor of organizational behavior at Olin, along with co-authors Bradley A. Staats and David Hofmann from the University of North Carolina at Chapel Hill and Katherine L. Milkman from the University of Pennsylvania’s Wharton School, studied compliance with hand-hygiene guidelines among more than 5,200 caregivers at 42 hospitals for more than three years.

They collaborated with Proventix, a company that uses a radio frequency-based system to track whether health-care workers wash their hands. More than 20 million hand-hygiene opportunities — incidents when hand hygiene is expected — were captured; each with the potential to prevent, or spread, a hospital-borne illness or infection.

“Maintaining high compliance with standard processes is a challenge for many industries,” Dai said. “We examined hand-hygiene compliance in hospitals because this is a setting where consistent compliance is extremely important in an effort to eliminate hospital-acquired infections. This is an area where improvements can, and should, be made.”

Dai and her co-authors found that on average, electronic monitoring resulted in a large increase in hand-hygiene compliance during their study period. Interestingly, compliance initially increased, and then gradually declined, after approximately two years. When electronic monitoring was stopped, hand-washing rates dropped, suggesting that hand-hygiene habits weren’t formed.

In fact, researchers discovered that compliance rates for hand-washing dropped to below the levels seen before the monitoring began, a finding that is surprising to both the researchers and health-care practitioners.

“While we thought decreased compliance after the monitoring could perhaps be a possible outcome, we were still somewhat surprised to see the result,” Dai said. “We based our prediction on past research about ‘crowding out,’ whereby caregivers’ internal motivation for compliance may have been replaced by external forces associated with monitoring, such as the fear of penalties or punishments for not washing their hands.

“When the external stimulus of monitoring was removed, their compliance behavior declined below the initial level as both the external forces and internal motivations were gone,” she said. “We do not have the data to get into the underlying psychology, but it is certainly worth examining in future research.”

While the findings focused on the health-care profession, Dai said all managers should take note, no matter their field. While electronic monitoring is an important motivation and compliance tool, it’s a single piece of a larger strategy.

“Individual electronic monitoring is one tool managers can use to dramatically improve standardized process compliance, but that it is not a panacea,” Dai said. “Managers looking to build process compliance must think about how electronic monitoring fits within a broader system encompassing not only technology, but also norms, culture and leadership.

“Managers should not ‘monitor and forget,’ ” Dai said.

Try harder: UK petting farm ‘doing all it can’ after E. coli outbreak

Posted on May 8, 2016 by Douglas Powell

The owners of a petting farm at the centre of a parasitic disease outbreak that has left dozens ill said they are working with the local authority to investigate its cause.

Ian and Angela Broadhead, who run Swithens Farm, in Rothwell, Leeds, have reassured visitors that their “health, safety and welfare” is of “utmost importance” to them as they continue to work with public health experts.

The petting farm has been linked to 29 cases of cryptosporidiosis, and two cases of E.coli O157.

The Broadhead family said: “As a small family-run business the health, safety and welfare of our visitors is of utmost importance to us all.

Between January and May 2015 around 130 people were affected by outbreaks of cryptosporidiosis linked to petting farms in England.

PHE has advised all visitors to wash their hands after touching animals.

Handwashing, however, is never enough.

A table of petting zoo outbreaks is available at https://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and D. Powell, 2015

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 USA 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.

Really? CDC campaign reminds docs, nurses that “Clean Hands Count”

Posted on May 6, 2016 by Douglas Powell

Today (yesterday), World Hand Hygiene Day, the U.S. Centers for Disease Control is launching the new “Clean Hands Count” campaign urging healthcare professionals, patients, and patients’ loved ones to prevent healthcare-associated infections by keeping their hands clean.

Although hand contact is known to be a major way germs spread in medical facilities, studies show that some healthcare professionals don’t follow CDC hand hygiene recommendations. On average, healthcare professionals clean their hands less than half of the times they should.

“Patients depend on their medical team to help them get well, and the first step is making sure healthcare professionals aren’t exposing them to new infections,” said CDC Director Tom Frieden, M.D., M.P.H. “Clean hands really do count and in some cases can be a matter of life and death.”

Part of the new campaign promotes healthcare provider adherence to CDC hand hygiene recommendations by addressing some of the myths and misperceptions about hand hygiene. For example, some people wrongly believe that using alcohol-based hand sanitizer contributes to antibiotic resistance and that it is more damaging to hands than washing with soap and water. Alcohol-based hand sanitizer kills germs quickly and in a different way than antibiotics, so it does not cause antibiotic resistance, and it causes less skin irritation than frequent use of soap and water.

The initiative also encourages patients and their loved ones to ask their healthcare team to clean their hands if they don’t see them do so before providing care.

“We know that patients can feel hesitant to speak up, but they are important members of the health care team and should expect clean hands from providers,” said Arjun Srinivasan, M.D., CDC’s associate director for healthcare-associated infection prevention programs. “We know that healthcare providers want the best for their patients, so we want to remind them that the simple step of cleaning their hands protects their patients.”

That’s right, it’s up to the dying and preoccupied family to ensure medical types wash their damn hands.

visit: www.cdc.gov/handhygiene.

It’s all in the friction: Hand dryers are germ-flinging BS

Posted on April 27, 2016 by Douglas Powell

The benefits of paper towels versus conventional blow dryers for drying after handwashing are well-documented.

But what about those high-tech – and expensive – Dyson thingies that seem to be popping up everywhere.

I say, show me the data.

Caroline Weinberg writes that a study published in the Journal of Applied Microbiology showed that Dyson jet air dryers can fling germs as far as 10 feet from the device.

For the experiment, researchers dipped their gloved hands in a suspension of the bacteriophage MS2 (similar in structure to the contagious enteric viruses transmitted in poop). The hands were then dried by one of three methods. First up were Dyson jet air dryers, which are designed to push water off of your hands in 10 seconds with roughly the force of a jet engine. Next were warm air dryers, which blow warm air downwards and supposedly remove water via evaporation. The final competitor was paper towels, which use absorbent paper to remove water from your hands (and actually leave them dry).

The first part of the experiment looked at how many bacteria are blown back on you during the drying process. Researchers erected a vertical board roughly 16 inches away from each dryer and counted the viral particles that landed on it. Overall, the jet dryer dispersed 60 times more particles than the warm air dryer and 1,300 more than the paper towel. 70 percent of particles hit the board between 2.5 and 4.5 feet—roughly chest or stomach level on an woman of average height, or right at the face level of a small child. At the highest density point, the jet air dryer dispersed 167 times as many viral particles as the warm air dryer and 8,340 times as many as a paper towel.

For the second part of the experiment, researchers studied air dispersal, or how much of the bacteria is spread into the air around the machine or towel. Airborne virus counts were consistently higher around the jet dryer both over time and distance. The jet dryer dryer propelled the virus as far as 10 feet away, with high levels recorded a full 15 minutes after use. There was no significant difference in air dispersal between warm air dryers and paper towels.

This isn’t a perfect study: Because it was done in a lab setting, researchers could not account for individual behaviors or real world differences. They also only tested one example of each hand drying device (Dyson is taking the heat here, but they are not the only makers of jet air dryers) and did so over a small number of trials. Critics of the study also rightfully point out that most people don’t dip their hands in bacteria prior to using the hand dryers: they wash their hands first. And it’s true that if one were to stick perfectly clean hands into a dryer, there would not be germs to blow around.

Unfortunately, here in the real world, 95% of people using public restrooms fail to adequately wash their hands. Sure, a small percentage may use the scientifically vetted, 42-second-long, six-step hand washing process that most effectively rids your hands of all the filthy germs you’ve picked up in the bathroom and world at large. The rest of them (OK, us) are doing a quick scrub or, worse, simply passing their hands under a running faucet for a few seconds for the illusion of cleanliness. So while the hands most people place in the dryer aren’t drenched in germs, they are likely carrying, among other things, poop particles. Poop particles that the machine then proceeds to blow all over the room, including back on the very hands you just cleaned.

This isn’t the first time a study has suggested that hand dryers are germ cannons, either. A 2014 study published in the Journal of Hospital Infection also supports this finding—but it was dismissed by Dyson as funded by Big Paper Towel (in their defense, that study was literally funded by Big Paper Towel, i.e. the European Tissue Symposium,). Dyson would direct us, instead, to 2011 study published in the Journal of Applied Microbiology that found their air dryers to be more effective at preventing the spread of germs than warm air dryers. Now it was Big Paper Towel’s turn to cry foul—that study was funded by Dyson Limited. The current study in question is funded independently by the researchers’ university (though the lead author has worked with the European Tissue Symposium in the past) lending it a hopefully uncontaminated air of legitimacy.

A few months ago, shortly after this study was published, Dyson posted an ominously narrated attack ad of sorts titled “Paper’s Dirty Secret.” Don’t listen to Big Jet Dryer’s propaganda (well, maybe listen to it, because the video is hilarious—but don’t believe it). It is true that a 2012 pilot study found unused paper towels to be contaminated with small amounts of bacteria. But paper towels have been repeatedly shown to be efficient, effective, and—perhaps most importantly—not responsible for flinging extra poop germs through the air.

Food Safety Talk 99: Are you familiar with the Haugh Unit?

Posted on April 13, 2016 by Ben Chapman

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.

They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed.

Episode 99 can be found here and on iTunes.

Don and Ben talk pickles, puppies, Lord Stanley and his cup, the Internet, eggs, coffee, deli slicers and cuisine from around the world. After Dark turns into taxes safety talk.

Below are some links to some of the things that they talked about:

Going public: 167 people with the runs in Iowa

Posted on April 12, 2016 by Douglas Powell

That moment happened.

Usually it takes until puberty, but it happened.

My 7-year-old daughter, who was in a local Dettol commercial, which I had nothing to do with (that’s her, at the end, second row from the bottom, far rightin the pic below; I’ve always shamelessly promoted my children).

Yet this morning, she was too embarrassed to answer what number 1 meant, and number 2, while watching some other video this morning before school, something about poop.

And it happened.

Sure, kids find me hilarious until about 11-years-old, then it’s embarrassment for 10 years, then they come around.

Maybe the folks in Dubuque County, Iowa feel the same way, maybe they have state laws limiting what they can say.

But when 167 people have diarrhea since Oct 1, public health has to step in (not in the #2).

Seriously, no public announcement until April 11, 2011, on an outbreak that started Oct. 1, 2015?

“This is a high number of diagnosed cases that we have had,” said Patrice Lambert, executive director of the Dubuque County Health Department.

Shigellosis is a disease caused by the bacterium shigella, which causes watery and sometimes bloody diarrhea, according to Lambert.

“Wash your hands with soap and water,” Lambert said. “That’s the easiest thing to do, not only for shigellosis but for all communicable diseases.

Handwashing is never enough.

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