Our two-year old, Sorenne, has been reluctant to wash her hands lately. Today during a particularly messy diaper change, she reached down to see what was going on, got poop on her index finger, and decided to wipe it on my forearm saying, “Blech, poop yucky!”
I decided this was a good time to try the “don’t eat poop” slogan. I explained to Sorenne, “Don’t put your fingers in your mouth. Poop will make you sick. Don’t eat poop, ok?” She repeated, “Don’t eat poop!” enthusiastically. I added a little explanation that included her favorite French iPod app, “Feed me!” and reminded her that the monster gets sick when he eats something bad. “Turn green!” she chimed in. “Yuck. Don’t like it!”
That’s what happens if you eat poop, Sorenne. You’ll get sick. So wash your hands. And for the first time in ages, she very happily washed her hands with soap.
But it’s a far cry from the 96% of adults who say they always wash their hands in public restrooms, based on a separate telephone survey conducted at the same time.
Men do a lot worse than women overall — just 77% scrubbed up, compared with 93% of women.
The study was sponsored by the American Society for Microbiology and the American Cleaning Institute (formerly the Soap and Detergent Association). It involved discreetly observing 6,028 adults in public restrooms in August to see whether they washed their hands.
Great. More people are attempting to wash their hands. But are they doing it correctly? Does any attempt count, or only if handwashing is done according to government prescriptions. What is the best way to wash hands? Can’t people with PhDs agree?
A study by researchers at the University of Bradford and published in the current Journal of Applied Microbiology evaluated three kinds of hand drying and their effect on transfer of bacteria from the hands to other surfaces: paper towels, traditional hand dryers, which rely on evaporation, and a new model of hand dryer, which rapidly strips water off the hands using high velocity air jets.??
In this study the researchers quantified the effects of hand drying by measuring the number of bacteria on different parts of the hands before and after different drying methods. Volunteers were asked to wash their hands and place them onto contact plates that were then incubated to measure bacterial growth. The volunteers were then asked to dry their hands using either hand towels or one of three hand dryers, with or without rubbing their hands together, and levels of bacteria were re-measured.
The researchers found the most effective way of keeping bacterial counts low, when drying hands, was using paper towels. Amongst the electric dryers, the model that rapidly stripped the moisture off the hands was best for reducing transfer of bacteria to other surfaces.
Yet tomorrow’s N.Y. Times reports it’s a draw, and that “the best available evidence suggests that as far as germs go, the method of drying is less important than the amount of time invested: the longer the better.”
So my pants would be fine as long as I used them enough.
Dr. O. Peter Snyder at the St. Paul-based Hospitality Institute of Technology and Management summarized key aspects of handwashing and drying in a paper available at, http://www.hi-tm.com/Documents/Safehands.html. Snyder says that after hands are washed and rinsed, they must be thoroughly dried.
Blow dryers should not be used because they accumulate microorganisms from toilet aerosols, and can cause contamination of hands as they are dried by the drier (Knights, et al., 1993; Redway,et al., 1994).
Snyder notes that it is also apparent that many individuals do not dry their hands thoroughly when using a blow drier; hence, moisture, which is conducive to microbial growth, remains on hands, or people dry their hands on their clothing.
Proper handwashing requires access to the proper tools – and that means vigorously running water, soap and paper towel.
We’ve reviewed the literature on handwashing and how best to motivate people to wash hands, and conclude in a paper to be published shortly that,
“Although the role of hand hygiene in preventing infectious disease is well recognized, studies repeatedly show that compliance remains low. … Education and training have been cited often as essential to developing and maintaining hand hygiene compliance but, with few exceptions, this approach has not produced sustained improvement. … Hand hygiene was enhanced by provoking emotive sensations of discomfort, unpleasantness and disgust. Evidence suggests handwashing is a ritualized behavior mainly carried out as self-protection from infection and that patterns of handwashing behavior are likely established in childhood. Therefore, interventions that focus on culture, perception and behavior change may prove to be the most successful. How that success is measured must be carefully considered, as there is no standardized method for measuring hand hygiene compliance and current techniques have significant limitations.”
I have finally decided to give my body a break and cut down on the amount of caffeine I consume daily. The problem is that I am not a morning kinda’ guy and when restaurant operators decide to tell me just how much they like me when I visit, I look like Christopher Walken ready to snap. This morning I decided to visit a local mom and pop restaurant to perform a routine inspection. These smaller type of establishments typically use the 3 compartment sink method for dishwashing as commercial dishwashers are not required. I feel that staff are not compelled to wash dishes using this method which includes washing with soap and water, rinsing, sanitizing (i.e. 50 ppm chlorine), and as a final step air drying, especially when the boss isn’t kicking around. A commercial dishwasher equipped with an approved sanitation cycle would be more appropriate. So when I asked the owner how the dishes are washed, he cursed, then gave me the wrong answer.
There seems to be a tendency for operators to mix soap with chlorine in the sanitizing step of the method, that is, in the third sink prior to air drying. In doing so, the sanitizer is not operating at its full potential. Soap is alkaline in nature as it uses sodium and potassium hydroxides to make surfactants. Bleach (chlorine) operates optimally at lower pH’s therefore added soap will decrease the efficacy of the bleach and should not be used.
The Times story says, In its medical literature, the Food and Drug Administration states that hot water comfortable enough for washing hands is not hot enough to kill bacteria, but is more effective than cold water because it removes oils from the hand that can harbor bacteria.
But in a 2005 report in the Journal of Occupational and Environmental Medicine, scientists with the Joint Bank Group/Fund Health Services Department pointed out that in studies in which subjects had their hands contaminated, and then were instructed to wash and rinse with soap for 25 seconds using water with temperatures ranging from 40 degrees Fahrenheit to 120 degrees, the various temperatures had “no effect on transient or resident bacterial reduction.”
They found no evidence that hot water had any benefit, and noted that it might increase the “irritant capacity” of some soaps, causing contact dermatitis.
“Temperature of water used for hand washing should not be guided by antibacterial effects but comfort,” they wrote, “which is in the tepid to warm temperature range. The usage of tepid water instead of hot water also has economic benefits.”
I’ve spent the summer on the east coast alongside my classmate Stephan, while we do internships for school. Though we have similar interests in veterinary medicine, we have very different philosophies about food safety. I am a bit like Monk, at times going overboard on cleanliness and my tendency to be a “germaphobe” with excessive handwashing.
Stephan represents the other side of the spectrum, more of a “the more bugs I’m exposed to, the more my immunity builds.” This is definitely a valid viewpoint. Hand sanitizer opponents say that antibacterial soaps and gels may cause more harm than good. They remove bad bacteria, but can also remove the good bacteria, the bacteria that protect skin surfaces from the bad bacteria. Antibacterials may also help breed drug-resistant bacteria.
The bottom line is that regular soap works great in moderation, and it should always be used before consuming food or sticking your fingers in your mouth. What kind of soap is best? I tend to lean towards the foaming liquid soap, mostly because it comes in great scents, but basically soap is better than no soap. Follow Doug’s mantra to wash your hands and don’t eat poop.
When asked about swine flu – oh, sorry, the H1N1 flu – U.S. President Barack Obama said during his prime-time 100-day press commencement conference that handwashing and staying at home if sick were key to controlling any potential spread of flu.
As we’ve said, proper handwashing with the proper tools — soap, water and paper towel — can significantly reduce the number of foodborne and other illnesses, even the emerging swine flu.
The steps in proper handwashing, as concluded from the preponderance of available evidence, are:
• wet hands with vigorously flowing water;
• use enough soap to build a good lather;
• scrub hands vigorously, creating friction and reaching all areas of the fingers and hands for at least 10 seconds to loosen pathogens on the fingers and hands;
• rinse hands with thorough amounts of water while continuing to rub hands; and
• dry hands vigorously with paper towel.
If any of the tools for handwashing are missing, let someone know.
However, even with reminders and access to the proper tools, not everyone will practice good hygiene. Those signs that say, ‘Employees Must Wash Hands’ don’t always work. We’re working in settings like high schools and hospitals to figure out the best way to not only tell people to wash their hands, but to use new media and messages to really compel individuals to wash their hands.
A video is available at: http://www.youtube.com/watch?v=piwl-Mfwc_s
and a poster at http://fsninfosheets.blogspot.com/2008/02/dude-wash-your-hands.html.
Courtlynn’s here and that meant a quick meal at Subway last night on our way home from the airport. The restaurant was fairly deserted and we only saw one male employee working. After we received our order to go, I ducked into the women’s restroom. While washing my hands, I reached for the soap and saw the sign pictured here. I rinsed with water and hoped the friction from the paper towel would be of some benefit. But I’m not serving meals to others and only had to hand Doug his sandwich in the car before eating my half. Proper handwashing requires the proper tools: water, soap, paper towels.
Katie, a.k.a. the woman who lives under our stairs, used to be a sandwich artist at Subway in the Soo. She says they got “into a lot of shit” if they didn’t keep the soap dispensers filled.
As part of the first Global Handwashing Day, students Mayra Rivarola and Skyler Wilkinson visited 11 restaurant bathrooms in Aggieville, Manhattan (Kansas) to ensure patrons were at least provided the tools to properly wash their hands.
All of the bathrooms rated highly. Only 1-of-the-11 had a failure, a lack of paper towel.
Two women were hospitalised after a New Zealand cafe mistakenly served dishwashing liquid as mulled wine.
The Southland Times newspaper reported that Chico’s Restaurant Ltd in the mountain resort of Queenstown on South Island pleaded guilty to a charge of selling food containing extraneous matter — the chemical sodium hydroxide — that caused injury.
An investigation showed the two liquids had been mixed up after 20 litres of dishwashing liquid was delivered in a container formerly used to hold Mountain Thunder mulled wine.
Under New Zealand’s no-fault accident law, victims do not sue for damages. Instead, treatment costs and income loss are met by the nation’s Accident Compensation scheme.
The company will be sentenced next month and faces a possible fine.
Jon Stewart did an admirable job hosting the Oscar’s last night, although he’s better on The Daily Show.
One of his best lines, however, comes from a 2002 hosting gig on Saturday Night Live, where he said,
“If you think the 10 commandments being posted in a school is going to change behavior of children, then you think “Employees Must Wash Hands” is keeping the piss out of your happy meals. It’s not.”
That came to mind as I read Friday’s N.Y. Times blog entry about handwashing and the lack of soap at Socialista where some celebrities now are being encouraged to keep hepatitis A shots.
Jennifer Lee writes that “Employees Must Wash Hands Before Returning to Work,” signs are required by the city health code in all bathrooms in restaurants and bars. Sometimes the signs are in Spanish and Chinese, as well as English.
The Health Department issued a Hepatitis A warning on Thursday after discovering there was no soap behind the bar at Socialista, a code violation, when it found that a bartender who worked there was infected with Hepatitis A.
City Room called up the Soap and Detergent Association, a Washington-based industry trade association, to get their thoughts on the missing soap.
Brian Sansoni, the association’s vice president of communications, was quoted as saying,
“Surely a place that charges $12 for a cocktail can afford a 99-cent container of liquid soap. … Soap-making was known as early as 2800 B.C, It’s not necessarily a new technology. … You can get soap in bar form, liquid form, foam. It’s not like we’re trying to find Kryptonite here. We’re talking about soap. As basic as soap is, we hear too many cases of too many places with not enough soap.”