Microbiological failure? UK school forces teachers to shake hands with pupils to help kids feel respected

Trevor Noah of The Daily Show rarely shakes hands with guests or correspondants.

He’s big into the fist-bump.

Maybe Schaffner can design a study to figure out which is microbiologically safer.

It’d be another pop-culture hit.

Maybe someone has done it.

Whatever, the  handshaking policy introduced by a new principal has led to panic among staff and parents.

Some teachers at Tunbridge Wells Grammar School for Boys, southeast of London, are now arming themselves with hand sanitiser amid fears that shaking hands up to 150 times a day may cause them to pick up germs.

Principal Amanda Simpson is standing by her decision, which sees teachers shaking hands with every member of their class before each lesson.

One parent told local news website Kent Live that she was worried about the consequences of the mandatory handshaking.

“It will be interesting to see what happens if there’s an outbreak of Norovirus,” she said.

“I assume it was introduced because the new head wanted to introduce some element of respect – but I wouldn’t think that sort of thing would make any difference.”

Ms Simpson believes that starting every lesson “with a handshake and a smile” makes children feel welcome and appreciated.

She confirmed that hand sanitiser was available throughout the school for anyone worried about the spread of germs.

Shigella in Kansas: Proper handwashing requires proper tools

There was this one time, when I was in Kansas, and there was an outbreak of something at the local high school.

Stalker alert: I went to the boys’ bathroom.

No paper towel. No soap.

Proper handwashing requires access to proper tools.

The Shawnee County Health Department and KDHE are checking several shigellosis cases in children.

USD 501 confirms it centers on Highland Park Central Elementary, saying the district sent information to those parents.

Shigellosis is a gastro intestinal illness caused by a bacteria.

It is treatable and most people quickly recover from symptoms including diarrhea, fever, nausea, vomiting, and stomach cramps.

Shigella is found in the feces of an infected person. It’s spread by close contact, and by eating and drinking contaminated food or water.

To stop the spread, always wash your hands thoroughly with soap and water before eating. Do not share food, drinks, spoons and or straws.

No paper towel. No soap.

Proper handwashing requires access to proper tools.

Those are the kinds of questions that get full professors fired.

Handwashing is never enough, bureaucrats have no spine: E. coli O157 from animals at Ekka edition

The EKKA, Queensland’s agricultural showpiece, concluded last week in Brisbane, about the same time an uncomfortable memory was finally published in the peer-reviewed cyber-sphere.

In Aug. 2013, 56 people became sick with E. coli O157 after contact with animals, or hanging out in the animal facility at the EKKA.

No child, or family, should have to go through grief and anguish because they took the kids to a petting zoo at the local fair.

Being repeatedly told they failed because they didn’t wash their hands is condescending. And ignores the science.

Handwashing is never enough.

At the time, a Biosecurity Australia dude said, “This highlights the importance of people practising sound hygiene measures following all contact with animals, their body fluids and excretions.”

How many want bureaucrats talking about body secretions?

As Anderson and Weese found in 2011 at a temporary petting zoo in Guelph (that’s in Canada) using video observation, 58 per cent of visitors performed some form of hand hygiene (either using water, soap and water, or hand sanitizer), and two interventions (improved signage while offering hand sanitizer, and verbal hand hygiene reminders by venue staff) were associated with increased hand hygiene compliance. U.K. health officials currently recommend handwashing stations with soap and water only (no wipes or sanitizers).

And while some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious agents may be aerosolized and inhaled.

In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

The investigation into the Godstone outbreak identified evidence of environmental contamination outside the main barn, indicating acquisition of illness through both direct animal or fecal contact, and indirect environmental contact (e.g. contacting railings or soiled footwear).

Aerosolization of potential pathogens is also possible, as suggested in an E. coli O157:H7 outbreak at a county fair in Oregon, in which 60 people fell ill.

As part of the response to the Godstone outbreak, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers, because they don’t work that well under certain conditions).

Ihekweazu et al. subsequently concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect. …

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection (an STEC).”

This is what the Ekka folks had to say about the 2013 outbreak (which no one in Brisbane seems to know about).

The 2013 Ekka agricultural show displayed >10,000 animals and included sections where direct contact between visitors and animals could occur. The animal boulevard included a large animal nursery where visitors could pat and feed farm animals, including goats, lambs, calves, piglets, chicks, ducklings, donkeys, and turkeys. A milking demonstration took place in an area adjacent to the animal nursery and visitors were invited to milk a cow. Unpasteurized milk was not served. Visitors could also view the birth of lambs that took place in an enclosed booth. The birthed lambs were available for supervised petting after >24 h after veterinary clearance. Other animals displayed in the animal boulevard and other pavilions were less accessible to the public for direct contact. 

The number of visitors in the animal nursery was not restricted. Limited unsupervised handwashing facilities were available opposite the exit of the animal nursery. Hand sanitizers were available in other areas. Signs in animal contact areas encouraged visitors to wash their hands. Staff at the agricultural show regularly removed animal waste from animal contact areas. 

Stool samples from 56 of 57 case-patients showed identical virulence gene profiles, consisting of stx1, stx2, eaeA, and ehxA . The virulence gene profile of the remaining probable primary case-patient was only stx2 and ehxA. Twenty bovine, 4 ovine, and 2 caprine fecal samples were tested from animals traced to other properties after the show had ended. Serotype O157:H- was confirmed from 51 of the human cases, and also from ovine, caprine, and bovine feces, and the animal bedding sample. All O157:H- isolated from animal and environmental sources displayed the same MLVA profiles (6_8_2_9_4_7_8_2_3_8 and 11–7-13–4-5–6-4–9) (Technical Appendix Table 2), stx1a and stx2c subtypes, and sequence type ST11, and 2/51 of human isolates differed by 1 allele in 1 of the MLVA profiles. Although E. coli O157 has frequently been reported to belong to sequence type 11 (13), the MLVA profiles were novel to the Queensland collection of previously typed STEC isolates (n = 112). 

A table of petting zoo outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Mild illness during outbreak of shiga toxin-producing Escherichia coli O157 infections associated with agricultural show, Australia

Emerging Infectious Diseases, vol. 23, no 10, October 2017, Bhakti R. Vasant, Russell J. Stafford, Amy V. Jennison, Sonya M. Bennett, Robert J. Bell, Christine J. Doyle, Jeannette R. Young, Susan A. Vlack, Paul Titmus, Debra El Saadi, Kari A.J. Jarvinen, Patricia Coward, Janine Barrett, Megan Staples, Rikki M.A. Graham, Helen V. Smith, and Stephen B. Lambert

https://wwwnc.cdc.gov/eid/article/23/10/16-1836_article

During a large outbreak of Shiga toxin−producing Escherichia coli illness associated with an agricultural show in Australia, we used whole-genome sequencing to detect an IS1203v insertion in the Shiga toxin 2c subunit A gene of Shiga toxin−producing E. coli. Our study showed that clinical illness was mild, and hemolytic uremic syndrome was not detected.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012

Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

4 sick with campy linked to raw milk served at Royal Welsh Show

In 2013, at least 50 people, mainly children, became ill with E coli O157 at the Ekka, Queensland, Australia’s version of the state fair.

It starts again on Friday, and because organizers have done little except to encourage people to wash their hands, we won’t be going.

Handwashing is never enough.

Manure from ruminants is easily aerosolized in these environments, and I’ve been to many human-animal interaction events for research, and there is shit everywhere.

Although ostensibly designed to promote understanding of food production, these agricultural celebrations rarely discuss risk – until an outbreak happens.

The motto seems to be: It’d be better for us if you don’t understand.

Now, four people have been sickened with Campylobacter linked to unpasteurised or raw cow’s milk from Penlan y Môr farm near New Quay, Ceredigion and sold at the Royal Welsh Show.

Public Health Wales says the four cases all consumed or bought the milk at Aberystwyth Farmer’s Market after June 1.

But visitors to the Royal Welsh Show in Builth Wells may also have sampled or bought the milk which was available there on Wednesday, 26 July.

A table of animal-human-interaction outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

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.

Shock and shame: Science behind getting people to wash their hands

Gimmie shelter from the ravages of time.

I’d largely forgotten about my lab’s handwashing phase, probably because I was leaving the safety (shurley not) of Kansas and heading to Australia.

But was reminded from this excerpt in The New Yorker from Nate Dern’s “Not Quite a Genius,” to be published by Simon & Schuster:

Employees must wash hands.

Employees must wash their own hands.

Employees must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply, and, O.K., we apologize for the condescending tone of the posting of this rule, which seems to imply that without such a sign we would assume that our employees are disgusting children with no regard for their own hygiene.

Employees must wash hands. Greg has been fired.

Filion, K., KuKanich, K.S., Chapman, B., Hardigree, M.K., and Powell, D.A. 2011. Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria. American Journal of Infection Control 39(6): 464-470.

Background

Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents. Few interventions to improve hand hygiene have had measureable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.

Methods

Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts. Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized days of observation for 3 hours during lunch.

Results

During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene rather than HCW hand hygiene.

Conclusion

The poster intervention tool with easily accessible hand sanitizer can improve overall hand hygiene performance in a US hospital cafeteria.

Wilson, S.M., Jacob, C.J. and Powell, D.A. 2011. Behavior-change interventions to improve hand hygiene practice: A review. Critical Public Health 21: 119-127.

http://www.informaworld.com/smpp/content~content=a934338802~db=all~jumptype=rss

Despite the role of hand hygiene in preventing infectious disease, compliance remains low. Education and training are often cited as essential to developing and maintaining hand-hygiene compliance, but generally have not produced sustained improvements. Consequently, this literature review was conducted to identify alternative interventions for compelling change in hand-hygiene behavior. Of those, interventions employing social pressures have demonstrated varying influence on an individual’s behavior, while interventions that focus on organizational culture have demonstrated positive results. However, recent research indicates that handwashing is a ritualized behavior mainly performed for self-protection. Therefore, interventions that provoke emotive sensations (e.g., discomfort, disgust) or use social marketing may be the most effective.

Good science is fucking hard: Handwashing sensation finds cool water as effective as hot water for removing germs

I didn’t know Don Schaffner, food safety guru and pop sensation at Rutgers University, was a Brittney Spears fan.

But he writes, whoops, I did it again, putting publication of peer-reviewed research ahead of press release.

We had an article published in the Journal Food of Protection earlier this week. While this current research is no five second rule, I thought it might garner some press interest, so I worked with colleagues at my university to put together a press release. I do enjoy talking to the media as part of my job, and it’s especially fun when it’s my own research.

(That’s why I became a professor, because I was bored talking about other people’s research and wanted to talk about my own — dp)

I thought I would take a little bit of time and share with barfblog.com readers about the process, because you folks are into this too.

An early draft of the press release had the title “Cool Water as Effective as Hot for Killing Germs”. This led to a conversation with my colleague in media relations who explained that using the word “killing” in the headline would lead to many more hits on Google (the modern-day equivalent of “if it bleeds, it leads”). I had to explain, that while I know all about search engine optimization (SEO), I could not in good conscience tell a scientific fib. Handwashing, for the most part does not kill germs, it simply removes them from your hands, and allows them to be washed down the drain.

Which brings me to antibacterial soaps – which seem to kill germs. This particular research article did look at the question of antibacterial soaps, and basically led to the same conclusion as our other on the issue: antibacterial soaps do work better than plain soaps when it comes to reducing bacterial counts on the hands, probably because there is some actual bacterial killing going on. For a variety of reasons, antibacterial soaps tend to work people up into a lather (pun intended… who says scientists have to be serious?). I had one journalist tell me [no link for you, sleazy British Tabloid] that they had already come to the conclusion that antibacterial soaps don’t work, and could I just say that. No, I explained I could not just say that, because that’s not what our research found. Instead, we found a highly significant difference (p= 0.0003) between hand washes with an antibacterial soap, and with a similarly formulated plain soap.  In this particular study the difference was small, about 0.3 log. I know many readers of this blog are comfortable and thinking on the log scale,  but for you non-microbiologists, 0.3 log corresponds to about a 50% greater reduction. Now 50% sounds like a lot to a non-microbiologist, but when you’re doing food microbiology, sometimes the data themselves can vary by 0.5 logs, or almost 70%.  So what we ended up saying in the manuscript was,  while highly significant, the difference was “within the range of error for microbiological data (i.e., a clinically insignificant difference).” I wish I’d said that a bit more forcefully in the manuscript, but sometimes we have to make compromises in peer review. The bottom line? I believe that antibacterial soap works better than plain soap in reducing bacteria on your hands. We reach this conclusion in our meta-analysis on the subject, and even this relatively small difference can have a profound effect on public health, at least if you believe our risk assessment manuscript on the subject.

I wanted to stress in the press release, and what I’ve been leading with during my media interviews, is that wash water temperature makes no difference, at least in the range that we studied (~ 60°F to 100°F). Our data show that there was no significant difference, no matter what temperature was used in the hand wash. Water temperature has along an interesting history in the FDA model food code. It used to be that the code specified a specific water temperature for washing the hands. It turns out that that temperature was based on the temperature at which bacon grease liquefies. The current code says that hands must be washed in warm water. Elsewhere in the current code it specifies that a hand wash sink must be capable of dispensing water at 100°F,  hence our reason for doing the research.  One point that I’ve been stressing in the media interviews is that it’s all about comfort. We want people to be comfortable when their washing their hands, and so my advice is use whatever water is most comfortable for you. It remains to be seen whether we will be able to change what’s in the code. Check back in 2018 after the next Conference for Food Protection

We looked at several other factors in this research as well. We investigated the volume of soap used: 0.5 mL, one mL and two mL, and we found no difference between these volumes of soap. Of course this doesn’t mean you can use as little soap as you want, my recommendation is to use at least 0.5 mL. Using more than this doesn’t seem to make a difference. This is also consistent with what we found in our [meta-analysis](https://www.ncbi.nlm.nih.gov/pubmed/22054188).

In a recent paper published in Food Protection Trends, my PhD student Dane Jensen (who was also the lead author on this handwashing study), and I published an analysis of recommendations on handwashing signs.  Dane had a hand (pun intended, see above) in several of the handwashing research manuscripts coming out of my lab in recent years. What we found in the FPT handwashing signage research was that handwashing recommendations were all over the place. So we decided to study lather time in this current manuscript. For purposes of our research we defined lather time as the time from when the soap is applied, until the water rinse begins.  We studied five, 10, 20, and 40 second lather times.  We only saw a statistically significant difference between lather times of five and 20 seconds.  The recommendation I would draw from this finding, is to lather for at least 10 seconds.  Lathering for more than 10 seconds does not appear to offer any additional benefit.

 One of the questions that seems to come up again and again in media interviews on this topic is “who funded the research”. While I understand the motivation for the question, it’s starting to get under my skin (okay okay, I’ll stop with the puns). The question seems to imply that somehow if I take money from the industry, my results are not to be trusted. I strongly resent the implication. It’s damn difficult to get grants these days, and I don’t think it’s going to get any easier until something  changes in Washington. We funded this research using discretionary money, but I’m proud that we did it in collaboration with our co-authors from GOJO.  They were instrumental in helping us think about our experimental design, plus they gave us free soap. They are also really smart and hard-working scientists, who really sweat the details.

Is this the last word on handwashing? I doubt it. We’ve got at least one more paper from Dane’s dissertation in the pipeline, and I’ve still got more ideas. If anyone reading this believes that industry funded research is somehow tainted, and you’ve got $250,000, please get in touch.

That’s the background and shows just how much good scientists sweat the details, whereas any hack can make a claim, spread it on the Internet, supported by no data, just interpretation.

I’ve got a modest 70 peer-reviewed papers, book chapters and a book, but when I had a big lab with the money flowing, I got bored. That’s just me.

Surprisingly I still get cited in peer-reviewed journals a few times a week, so I know I’ve got a body of work that people go to.

Thee scandals of pay-for-publication journals are a smear on the scientific community, but until someone comes up with a better system, peer-review largely works.

I’ve kept my mouth shut for years while papers got written, reviewed and published.

No PR before publication.

Those who do are attention-seeking assholes and another smear on the profession.

Here’s an edited version of the Rutgers PR.

Washing our hands can keep us from spreading germs and getting sick. But a new Rutgers-New Brunswick study found that cool water removes the same amount of harmful bacteria as hot.

“People need to feel comfortable when they are washing their hands but as far as effectiveness, this study shows us that the temperature of the water used didn’t matter,” said Donald Schaffner, distinguished professor and extension specialist in food science.

In the Rutgers study, published in the June issue of the Journal of Food Protection, high levels of a harmless bacteria were put on the hands of 21 participants multiple times over a six-month period before they were asked to wash their hands in 60-degree, 79-degree or 100-degree water temperatures using 0.5 ml, 1 ml or 2 ml volumes of soap.

“This study may have significant implications towards water energy, since using cold water saves more energy than warm or hot water,” said Schaffner. “Also we learned even washing for 10 seconds significantly removed bacteria from the hands.”

While the study indicates that there is no difference between the amount of soap used, more work needs to be done to understand exactly how much and what type of soap is needed to remove harmful microbes from hands, said co-author Jim Arbogast, vice president of Hygiene Sciences and Public Health Advancements for GOJO. “This is important because the biggest public health need is to increase handwashing or hand sanitizing by foodservice workers and the public before eating, preparing food and after using the restroom,” Arbogast said.

These findings are significant, particularly to the restaurant and food industry, because the U.S. Food and Drug Administration issues guidelines, every four years, to states. Those guidelines currently recommend that plumbing systems at food establishments and restaurants deliver water at 100 degrees Fahrenheit for handwashing.

Schaffner said the issue of water temperature has been debated for a number of years without enough science to back-up any recommendation to change the policy guidelines or provide proof that water temperature makes a difference in hand hygiene. Many states, in fact, interpret the FDA guidelines as a requirement that water temperature for handwashing must be 100 degrees, he said.

The FDA is scheduled to hold a conference in 2018 to discuss the existing code and any modifications that should be made and Schaffner would like to see the water temperature policy revised at that time.

“I think this study indicates that there should be a policy change,” said Schaffner. “Instead of having a temperature requirement, the policy should only say that comfortable or warm water needs to be delivered. We are wasting energy to heat water to a level that is not necessary.”

Maybe, don’t know: Do hand sanitizers cut down on illness?

My first reaction to any food safety claim, policy or recommendation is, are fewer people going to barf?

Which greeting is the cleanest?

I usually don’t get an answer.

Because it’s really hard to associate policy with rates of barfing.

A couple of weeks ago, Karen Weintraub of The New York Times wrote: With the recent increase in use of sanitizers (hand lotions, wipes for supermarket carts, etc.) has there been any real impact on transmission of colds, flu or other diseases?

The short answer is no one knows, because no one has studied whether hand sanitizers have cut down on the number of infectious diseases among the public at large.

On a personal level, good hand hygiene clearly can make a difference in health. A 2008 study in The American Journal of Public Health concluded that improvements in hand hygiene, regardless of how the participants cleaned their hands, cut gastrointestinal diseases by 31 percent, and respiratory infections by 21 percent.

The key to stopping disease is breaking the chain that allows pathogens to be transmitted from person to person. Either hand washing or sanitizing can do that.

Sally Bloomfield, an expert in hand hygiene and an honorary professor at the London School of Hygiene and Tropical Medicine, said she always carries hand sanitizer with her when she travels. “London airport bathrooms are usually fine because they are well designed to make sure we wash our hands properly — and dry them properly,” she said, but some train “loos” leave something to be desired.

Grocery carts can be particularly risky points of transmission. Someone grabbing chicken or meat can leak the juices onto a cart and their hands, and then continue to push the cart around, transmitting pathogens like Salmonella and E. coli onto the handle. The next person who handles the cart, or the next child who sits in the top of the wagon, can then pick up the bugs.

“If you can wipe down the handle bars on the shopping cart with an alcohol-containing preparation, that’s probably a good idea,” said Dr. Cody Meissner, chief of the division of pediatric infectious disease at Floating Hospital for Children at Tufts Medical Center in Boston.

That said, Dr. Meissner and others cautioned against germaphobia. Every surface around us is coated in bacteria and other microbes, the vast majority of which are neutral or beneficial, said Liz Scott, chairwoman of the department of public health at Simmons College in Boston.

“We really need to target our hygiene practices,” she said, focusing on likely chains of transmission. That means washing your hands when you get back from the grocery store, public transit or any other public place, said Dr. Scott, who also admits to avoiding handshakes whenever possible, especially during flu season.

Fist bump.

(The pic, above left, is from a TV commercial Dettol shot at Sorenne’s school – she’s one of the blurred out kids, second row, far right).

Bathrooms and barf from around the world — in Instagram

Long before Instagram and YouTube, the barfblog crew — I can’t believe I just wrote that, I never called my lab members the crew but I did call them the kids, even if I was the immature one — we were making food safety videos and taking pictures.

Just didn’t know what to do with them.

We had an entire website devoted to handwashing signs in bathrooms — as you do.

And then when I moved to Kansas in early 2006, it sorta got lost.

Someone in the lab was taking care of it and I was posting pictures of bathrooms from our trip to France, as we sat on the coast of Marseilles, but then the University of Guelph decided the sandbox wasn’t big enough for both of us so kicked me out.

Bullies.

Then the website disappeared.

Or maybe it exists somewhere.

I know my limitations, and computer technology is one of them. Which is why I’ve been using a Mac since 1987.

Now there’s thing called Instagram, which may not be as cool as Snapchat, but whatever, I like pictures.

So Chapman created a barfblogben Instagram account, and I created a barfblogdoug account, because someone already has barfblog and it’s probably me (but linked to a previous e-mail).

I did one post — Amy did it and I immediately forgot how to do it — so I’ll put this picture in here, and maybe some time she’ll show me how to do it again.

This is from the University of Queensland bathroom in the Institute for Teaching and Learning Innovation building/centre/whatever it’s called.

(All those people who used to work with me, if you know where that website it, send me a note).

KState changes handwashing recommendations

Twelve years after Chapman and I set out for Prince George, B.C., where Chapman announced his fears of both bears and jello-swim nights at the local college, and then went to Kansas State University, where I met a girl (who’s still my best friend and wife), where I got sexually advanced upon in an unpleasant manner by a professor dude, where I had lunch with the president, got a job offer, and enjoyed a great career, my former boss sent me this:

KState has changed its handwashing recommendations.

They disconnected the blow dryers in those groovy all-in-one handwashing units.

One reason I was offered the job is because I took the prez to the bathroom and showed him how shitty their handwashing recommendations were.

But that story is old.

No one should be recreating their past glory days (and if I ever quote a Bruce Springsteen song again, put me out of my misery).

Change does sometimes happen: usually not as fast as any of us would like.

Duty calls: Tweet when you barf (maybe FSA should tell Heston)

This is what is infuriating about food safety government types: they have the budgets, they have the knowledge, but they don’t have the wherewithal to confront an issue on a public scale.

heston-blumenthalThey can say, oooohhh, we use social media to track when people are barfing but they do no evaluation of their alleged interventions.

Telling people to wash their hands doesn’t mean people will wash their hands.

Elizabeth Cassin of BBC writes if you’re suffering with projectile vomiting and watery diarrhea, reach for your phone and post an update.

While it won’t ease your suffering, a tweet or two could help researchers track the spread of the winter vomiting bug (which the rest of the world calls Norovirus).

The UK Food Standards Agency has been using social media to track levels of norovirus, a highly contagious illness which spreads via food and through person-to-person contact. The symptoms usually last for one to two days, with the person remaining infectious for a further two days.

If you’ve ever had, it you know what it means: vomiting, diarrhea, pain, and the general feeling of having been run over by a car.

In 2013, the Foods Standards Agency started looking at new ways to track the virus. They analysed Google searches but found that social media was a better source of data. “It’s more about the immediacy… what’s happening in their lives right now,” says Dr Sian Thomas.

On the other hand, “if you’re in hospital or a nursing home and you’re sick, then they might take a sample and send it to a laboratory for analysis,” she says.

The FSA compared this official sample data with the volume of relevant tweets and concluded that “there’s a really good correlation between the number of mentions on Twitter of ‘sick’ and a range of search terms, with the incidents of illness as defined by laboratory reports.”

“Our current estimate is that between 70-80% of the time, we are able to accurately predict an increase the next week.”

If the team predict a national outbreak, they plan to run a digital campaign explaining how to look after yourself.

“The intervention is really quite basic,” she notes. “It’s about washing your hands, it’s about looking after yourself, and not coming in to contact with other people while you’re sick.”

Norovirus can be dangerous for children or the elderly. Fortunately for healthy adults though, the illness is usually a minor, if messy, inconvenience.