tag:theconversation.com,2011:/uk/topics/hand-hygiene-6865/articlesHand hygiene – The Conversation2024-01-23T18:38:01Ztag:theconversation.com,2011:article/2217002024-01-23T18:38:01Z2024-01-23T18:38:01ZStrep A explainer: Why invasive cases are increasing, how it spreads and what symptoms to look for<figure><img src="https://images.theconversation.com/files/570704/original/file-20240122-27145-c07mvm.png?ixlib=rb-1.1.0&rect=12%2C48%2C1968%2C1488&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increase in cases of diseases caused by group A Streptococcus has been seen in several countries including Canada.</span> <span class="attribution"><span class="source">(National Institute of Allergy and Infectious Diseases (NIAID))</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>A jump in the number of people with serious illness caused by group A Streptococcus — also referred to as Streptococcus pyogenes or Strep A — has made headlines recently. There has also been a <a href="https://www.cbc.ca/news/canada/toronto/ontario-strep-deaths-invasive-group-a-streptococcal-disease-1.7085755">higher than usual number of deaths</a> from group A Streptococcus infections, including in children, leaving people with questions about why and how these infections are spreading, and what symptoms to be aware of.</p>
<p>Shortly after the number of COVID-19 infections diminished worldwide, a <a href="https://www.bbc.com/news/health-64122989">considerable increase</a> in patients diagnosed with diseases caused by group A Streptococcus began in different parts of the world. </p>
<p>Specifically in Canada, Public Health Ontario is currently reporting a large increase in <a href="https://www.publichealthontario.ca/-/media/Documents/I/2023/igas-enhanced-epi-2023-2024.pdf?rev=f16466608245457a984dcfa738930ad4&sc_lang=en">invasive group A Streptococcus cases</a>. A similar <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429">increase in cases</a> has also been reported in multiple countries across Europe, mainly affecting children under 10 years old. </p>
<h2>Why did these bacteria suddenly become a global concern?</h2>
<p>To answer this question, it is essential to know some specifics of this disease to gain a better understanding of its cause. Group A Streptococcus exclusively affects humans, and its spread occurs <a href="https://doi.org/10.1016/S2666-5247(21)00332-3">via airborne droplets as well as person-to-person contact</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopic view of group A Streptococcus bacteria" src="https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=938&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=938&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=938&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1179&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1179&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570753/original/file-20240122-23-nvfuw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1179&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Group A Strep bacteria have several factors that promote infection and allow it to invade, colonize and survive in different tissues.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Among the different illnesses caused by this organism are respiratory tract infections such as tonsillitis and pharyngitis (symptoms of classic <a href="https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html">strep throat</a>), as well as superficial skin infections and skin infections <a href="https://doi.org/10.4103%2F1947-2714.101997">known as pyoderma</a>. </p>
<p>However, Group A Streptococcus can sometimes develop into invasive infections that put patients’ lives at risk, such as <a href="https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html">necrotizing fasciitis</a>, <a href="https://my.clevelandclinic.org/health/diseases/21539-septicemia">septicemia</a> (blood poisoning) and <a href="https://www.cdc.gov/groupastrep/diseases-public/streptococcal-toxic-shock-syndrome.html">streptococcal toxic shock syndrome</a>. </p>
<p>To generate this wide range of diseases in different parts of the body, the organism has several factors that promote infection and allow the bacteria to invade, colonize and survive in different tissues. These include molecules such as superantigens, exotoxins and adhesins that help pathogens evade the host immune system.</p>
<p>A new variant of group A Streptococcus called M1UK was <a href="https://doi.org/10.1016/S1473-3099(19)30446-3">first reported in the United Kingdom</a>, where it has been linked to an increase in scarlet fever cases as well as an increase in invasive infections. </p>
<p><a href="https://doi.org/10.1038/s41467-023-36717-4">Members of the M1UK sublineage</a> exhibit an ability to enhance the expression of the superantigen SpeA due to a single genetic mutation. The over-production of SpeA may be responsible for increased transmission and survival, as well as the aggressiveness of these infections, although this is currently being studied.</p>
<h2>What could account for the current spike in cases?</h2>
<p>Up to <a href="https://doi.org/10.1542/peds.2009-2648">approximately 10 per cent of school-aged children</a> will commonly carry these bacteria in their throats and upper respiratory tract without having any symptoms, and over time will develop some level of immunity to it. </p>
<p>It is likely that during the COVID-19 pandemic, children were at home and not being exposed to the bacteria as much as before and so their immune systems are probably <a href="https://doi.org/10.1016%2FS0262-4079(21)00716-8">not as good at fighting these infections</a>. Without this exposure, some children are likely to be more susceptible to infection. </p>
<p>The spread of the new M1UK strain is also probably why there’s an increased number of cases, although this is something that is currently being studied.</p>
<h2>Should people be concerned about these rising numbers?</h2>
<p>Generally, Canadians should not be overly concerned because serious infections with group A Streptococcus are still quite rare. </p>
<p>However, people should also not ignore strep throat, and should get treatment from a doctor and be wary of symptoms that might suggest an invasive infection. </p>
<p>Strep throat requires treatment, as untreated strep throat can lead to other problems including invasive infections.</p>
<h2>How to protect yourself and when to seek medical care</h2>
<figure class="align-center ">
<img alt="A health professional out of frame swabbing a girl's throat" src="https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570754/original/file-20240122-24-has9cu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A rapid strep test can diagnose strep throat. If the test is positive, antibiotics can be prescribed.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Because group A Streptococcus are common and many carriers are asymptomatic, it can be difficult to avoid exposure. Practising good hand hygiene, covering coughs and sneezes, staying home when you’re sick and not sending children to school if they have a very sore throat are all good measures.</p>
<p>If you believe you have a strep infection such as <a href="https://www.aboutkidshealth.ca/article?contentid=11&language=english">strep throat</a> with painful swallowing, fever, swollen tonsils or a rash, talk to a family physician to determine if the infection is caused by group A Streptococcus. A <a href="https://www.healthlinkbc.ca/tests-treatments-medications/medical-tests/rapid-strep-test-strep-throat">rapid strep test</a> can be done with a throat swab. If the test is positive, antibiotics can be prescribed. </p>
<p>Invasive group A strep infections are very dangerous and are a medical emergency, although initial symptoms may not be obvious. These could include fever, chills, flu-like symptoms and nausea or vomiting, but in particular red and warm skin infections that may be very painful and spread rapidly.</p>
<p>There is strong evidence that <a href="https://doi.org/10.1542/peds.105.5.e60">prior viral infections such as chickenpox</a> can predispose people for developing invasive group A Streptococcus. Children with chickenpox should be watched carefully for symptoms of invasive group A Strep. </p>
<p>Currently, there is no vaccine against group A Streptococcus, although there is a vaccine for chickenpox. Multiple research teams around the world, <a href="https://www.mccormicklab.ca/">including our own lab</a>, are working towards developing an effective vaccine against this human pathogen.</p><img src="https://counter.theconversation.com/content/221700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John McCormick receives funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Council of Canada (NSERC) and the Leducq Foundation. </span></em></p><p class="fine-print"><em><span>Juan Manuel Diaz receives funding from Canadian Institutes of Health Research. </span></em></p>An increase in serious illnesses caused by group A Streptococcus has recently made Strep A a growing concern in Canada and elsewhere. Here’s why and how it’s spreading, and what symptoms to look for.John McCormick, Professor of Microbiology and Immunology, Western UniversityJuan Manuel Diaz, Postdoctoral Associate, department of Microbiology and Immunology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1977832023-02-28T13:26:32Z2023-02-28T13:26:32ZOne easy way to fight antibiotic resistance? Good hand hygiene<figure><img src="https://images.theconversation.com/files/512265/original/file-20230224-2018-lwzgz6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Washing your hands reduces your risk of transmitting and contracting harmful bacteria from other people and the environment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-doctor-uses-hand-santizer-royalty-free-image/1254704741">SDI Productions/E+ via Getty Images</a></span></figcaption></figure><p>Can washing your hands help stop the evolution of antibiotic resistance? Mathematically, <a href="https://doi.org/10.1093/emph/eoac038">it’s possible</a>.</p>
<p><a href="https://medlineplus.gov/antibiotics.html">Antibiotics</a> save lives by killing bacteria that cause infections. But antibiotics don’t just kill infection-causing bacteria or stay in the area of the body where the infection is occurring. Instead, antibiotics spread across the body and inhibit or kill any sensitive bacteria they encounter.</p>
<p>While bacteria that are more sensitive to the antibiotics are killed off, those that are able to survive will continue to reproduce with less competition. This results in increasing abundance of resistant bacteria that can <a href="https://www.cdc.gov/drugresistance/about/how-resistance-happens.html">undermine the effectiveness of the antibiotic</a>. </p>
<p><a href="https://scholar.google.com/citations?user=WcKtVOkAAAAJ&hl=en">I am a researcher</a> who studies the evolution of antibiotic resistance. During my medical training, I was taught about the importance of hospital hygiene practices like <a href="https://www.cdc.gov/drugresistance/protect-yourself-family.html">hand-disinfection</a>. It is well established that good hygiene can help prevent transmission of harmful bacteria from other people or from the environment. I came to wonder how hygiene affects the evolution of antibiotic resistance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse washing hands with foamy hand sanitizer from dispenser." src="https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512266/original/file-20230224-1668-g30sai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Hand-washing is an essential component of hospital hygiene practices.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/using-hand-sanitizer-royalty-free-image/182440832">nano/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>So I teamed up with my colleagues <a href="https://portal.research.lu.se/en/persons/magnus-aspenberg">Magnus Aspenberg</a>, <a href="https://portal.research.lu.se/en/persons/sara-maad-sasane">Sara Maad Sasane</a>, <a href="https://scholar.google.se/citations?user=M2HsaIsAAAAJ&hl=sv">Fredrik Nilsson</a> and <a href="https://scholar.google.com/citations?user=ZgN-OgMAAAAJ&hl=en">Sam Brown</a>, experts in mathematics, statistics and microbial evolution, to answer this question. </p>
<p>We built a <a href="https://doi.org/10.1093/emph/eoac038">mathematical model of antibiotic resistance evolution</a>. In this model, resistant and sensitive bacteria compete in the microbial communities living in patients and transmit from one patient to another. We studied the effects of two parameters: hygiene (or use of an alcohol-based hand rub), which limits how much bacteria spreads between patients, and antibiotic use, which selects for resistant bacteria by killing sensitive ones.</p>
<p>We found that hygiene and antibiotic use interact. Antibiotic use had less of an effect on the evolution of antibacterial resistance as hygiene levels increased. This is because evolution toward resistance depends on variation in bacterial sensitivity to antibiotics. By affecting the distribution of resistant and sensitive bacterial strains across patients, hygiene limits the bacterial diversity needed to evolve resistance.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ZvhFeGEDFC8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The effectiveness of antibiotics is under threat from bacteria rapidly evolving resistance against them.</span></figcaption>
</figure>
<p>Research on the evolution of antimicrobial resistance has focused more on evolutionary selection than hygiene. Most studies investigate, for example, whether a <a href="https://doi.org/10.1371/journal.pcbi.1004689">high or a low dose of a drug</a> is better to prevent resistance. Incorporating hygiene and other interventions into research on antibiotic resistance could help build a more comprehensive understanding of how bacteria evolve to become resistant.</p>
<p>The <a href="https://www.cdc.gov/drugresistance/protect-yourself-family.html">role of good hygiene</a> in preventing illness is already well accepted in practice. Our findings underscore its importance by highlighting the role it plays in the evolutionary process of bacterial resistance.</p><img src="https://counter.theconversation.com/content/197783/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The work was supported by grants from the Wenner-Gren Foundations, the Royal Physiographic Society of Lund (the Fund of the Hedda and John Forssman Foundation), the Sten K Johnsson Foundation, the Crafoord Foundation, the Cystic Fibrosis Foundation, and the Centers for Disease Control and Prevention (BAA 2017-OADS-01).</span></em></p>Using a mathematical model, researchers found that good hygiene can reduce the harmful effects of antibiotic use.Kristofer Wollein Waldetoft, Postdoctoral Fellow in Infection Medicine, Georgia Institute of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1994252023-02-16T14:27:52Z2023-02-16T14:27:52ZWater cuts in South Africa are hurting hospitals and clinics - there’s an increased risk of infections<figure><img src="https://images.theconversation.com/files/508956/original/file-20230208-23-ovwtlo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p><em>South Africa is a water scarce country. <a href="https://theconversation.com/changes-in-south-africas-rainfall-seasons-could-affect-farming-and-water-resources-147371">Changing</a> rainfall patterns and the escalating <a href="https://theconversation.com/power-cuts-in-south-africa-are-playing-havoc-with-the-countrys-water-system-197952">electricity crisis</a> are making the situation worse. Treating and distributing water requires electricity. Some of the country’s biggest cities have had to impose water restrictions and residents in other parts have gone <a href="https://www.iol.co.za/pretoria-news/news/residents-in-part-of-mamelodi-east-without-water-supply-for-13-months-ce20ee94-9cef-44cb-ad0c-4d0d63f9428a">months</a> without regular water supply. Unfortunately, health facilities have not been spared. There <a href="https://www.news24.com/news24/southafrica/news/just-in-joburg-water-crisis-two-public-hospitals-struggling-residents-fuming-as-reservoirs-run-dry-20221004">have been</a> numerous <a href="https://allafrica.com/stories/202208080266.html">media</a> reports of <a href="https://health-e.org.za/2022/03/24/water-shortage-free-state-hospitals-down-to-the-last-drop/">hospitals and clinics</a> around the country being hit by <a href="https://www.iol.co.za/news/south-africa/kwazulu-natal/department-of-health-intervenes-in-prince-mshiyeni-hospital-water-crisis-a2ed5015-03b4-4469-a935-9eaf75879eee">water shortages</a>. The Conversation Africa’s Ina Skosana spoke to epidemiologist Husna Ismail about the dangers of clinics and hospitals running out of water.</em></p>
<hr>
<h2>How common are hospital acquired infections?</h2>
<p>The World Health Organization (WHO) defines <a href="https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control">healthcare-associated infections</a>, or “hospital” infections, as those affecting patients admitted to a healthcare facility. These are infections not present at the time of admission. They also include infections that appear shortly after discharge. Healthcare-associated infections are a significant cause of illness and death in hospitals. </p>
<p>In low- and middle-income countries such as South Africa, the WHO estimates that <a href="https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control">15 out of every 100 patients</a> in hospitals will get an infection. In high-income countries the estimate is seven patients out of 100. </p>
<h2>Which are the major infections?</h2>
<p>Common types of <a href="https://www.nicd.ac.za/centres/centre-for-healthcare-associated-infections-antimicrobial-resistance-and-mycoses/">healthcare-associated infections</a> include bloodstream, cerebrospinal fluid, respiratory system, surgical sites, skin and soft tissue, and urinary tract infections. Intravenous and other devices are likely sources of infections in hospital settings. </p>
<p>Microorganisms such as bacteria, viruses, fungi and parasites cause infections. The most common bacterial agents are <em>Staphylococcus aureus</em>, <em>Klebsiella pneumoniae</em>, <em>Acinetobacter baumannii</em>, <em>Pseudomonas aeruginosa</em> and enterococci. </p>
<p>Patients are at higher risk of getting infections if they have underlying conditions. These include but are not limited to diabetes, renal failure and malignancies. Long stays in hospital, surgical or invasive procedures, insertion of medical devices, intravenous tubing, artificial joints replacement, also pose a risk. Patients may develop infection caused by microorganism with emerging antimicrobial resistance while on antimicrobial treatment or been treated a few months to a year before. This makes individuals with antimicrobial resistance less able to fight infection. </p>
<h2>Which infections are related to the availability of water?</h2>
<p>Delivery of quality healthcare should take place in a hygienically clean and safe environment. This environment must have an adequate supply of clean running water and good sanitation for both patients and staff. The cornerstone of all infection prevention and control programmes is hand hygiene. Hand wash stations with water, soap, clean towels or alcohol-based hand rub should be available in key areas such as toilets and at the points of care. Standards for water quality, sanitation and environmental health should be met. Hand sanitisers must have at least 70% alcohol by volume. </p>
<p>Pathogens such as <em>Legionella</em> and non-tuberculous mycobacteria can contaminate the deep infrastructure such as pipes and drains or outlets of hospital water distribution systems. Other bacteria and moulds tend to adhere to surfaces at or near taps and sinks. Hospital management teams should have systems to address Water, Sanitation and Hygiene (WASH) malfunction or other related issues such as infrastructure. </p>
<p>Infection prevention and control programmes in healthcare facilities are important approaches to help protect vulnerable patients, as well as staff and visitors. </p>
<h2>How can hospitals maintain infection control - even during water cuts?</h2>
<p>Municipal water supplies to hospitals and communities must be pathogen-free and regularly monitored. Municipalities should have water quality assurance systems in place to ensure clean water. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583638/#S8title">Contaminated municipal water</a> can cause outbreaks that affect community and healthcare settings. </p>
<p>Hospital management should have a risk assessment plan for water shortages. They should communicate with municipalities about the provision of an alternative supply of clean water to the affected areas. Possible solutions could include a permanent (quality assured borehole water) or temporary (watertanks) backup water supply. Those solutions must also be maintained properly to avoid contamination and subsequent infection of patients.</p><img src="https://counter.theconversation.com/content/199425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In hospitals, infection prevention and control cannot be met without a hygienically clean, and safe environment that has an adequate supply of clean running water.Husna Ismail, Epidemiologist, National Institute for Communicable DiseasesOlga Perovic, Principal Pathologist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1758562022-02-10T14:05:21Z2022-02-10T14:05:21ZSoapy plants can improve hand hygiene: southern Africa has plenty<figure><img src="https://images.theconversation.com/files/443688/original/file-20220201-24-1dwcow1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Good hygiene practices such as disinfecting surfaces and regularly washing hands with soap and running water are important in preventing all infections.</p>
<p>The cost of commercial sanitisers and soap – and access to water – can be a problem for low-income communities. The United Nations has <a href="https://www.unicef.org/press-releases/2-5-schools-around-world-lacked-basic-handwashing-facilities-prior-covid-19-pandemic">reported</a> that about three billion people (40% of the world’s population) don’t have soap and water available in their homes. </p>
<p>In these settings, the use of soapy plant species to sanitise hands and disinfect surfaces might be an option. Modern soap has its origins in the sap of plants that contain chemicals called saponins. Chemically, the structures of saponins and of commercial soap are similar. </p>
<p>Saponins can destroy viruses and other microorganisms in the same way commercial soaps and detergents do. </p>
<p>Yet there is very little literature on the use of plants for hand hygiene. To address this, we conducted a literature review of research about saponin-rich plants from around the word with a specific focus on southern African flora. We set out to report on the occurrence and distribution, pharmacology and toxicity, mechanism of action, and overall availability of saponin-rich plants in southern Africa.</p>
<p>We compiled a <a href="https://www.mdpi.com/2223-7747/10/5/842">checklist</a> of plants that are rich in saponins and easily accessible to communities in southern Africa. Some of them have been used traditionally for hygiene, and others appear to have useful properties that weren’t widely known. </p>
<p>We found research on 51 species in the region. South Africa, Zimbabwe, Zambia, Mozambique, Lesotho, Namibia and eSwatini were reported to contain a wealth of saponin-containing plants. Only 15 of these species had actually been reported as being used for soaps or shampoos in various communities. These include <a href="https://www.cocktailsafe.org/soap-bark-quillaja-saponaria-safety-in-cocktails.html">soap bark</a>, <a href="http://redlist.sanbi.org/species.php?species=4063-1">soap creeper</a>, <a href="http://pza.sanbi.org/pouzolzia-mixta">soap nettle</a>, <a href="https://pfaf.org/user/Plant.aspx?LatinName=Acacia+concinna">soap pod tree</a>, “<a href="http://pza.sanbi.org/dicerocaryum-senecioides">boot protectors</a>” and <a href="http://pza.sanbi.org/deinbollia-oblongifolia">dune soapberry</a>. Leaves, twigs, roots, stem barks, fruits, seeds, and flowers of these plants are rubbed or agitated in water, forming a lather, which is then used for washing, bathing, and hair shampooing. </p>
<p>We also looked for scientific data to support any antimicrobial claims about soapy plants. Numerous studies showed evidence that saponins possess potent antiviral, antibacterial, and antifungal activities. </p>
<h2>Saponins and harmful microorganisms</h2>
<p>Soap is able to detach dirt from a surface and disperse it into water, leaving the surface clean. It also has the extra property of being able to destroy microorganisms. Like commercial soap, saponins have been shown to be able to destroy microorganisms such as viruses, bacteria and some fungi. They can destroy the outer coat that protects viruses. This makes the viruses more susceptible to being denatured. Saponins in soapy plants use the same mechanism to kill bacteria and fungi. </p>
<p>Saponins are relatively non-selective in their disruption of cells. This makes them effective against a wide range of microorganisms that cause communicable diseases. </p>
<p>The extent to which microorganisms are susceptible to saponins depends on the types of saponins, and the types and structures of the targeted microorganisms. In enveloped viruses like the coronaviruses, the disease-causing proteins that are encoded by the viruses are protected by a lipid coat that makes it difficult to kill them. This is unlike the non-enveloped viruses like rotaviruses, which can be easily controlled by chemical substances because they don’t have the protective envelope.</p>
<p>But soap and saponins do work against coronaviruses. <a href="https://medicine.yale.edu/news-article/why-soap-works/">Soap</a> is made of molecules which easily bond with water at one end but avoid water at the other end. When you wash your hands with soap, the water-hating ends will try to move away from water. As they do so, they interact with the lipid coating of the coronaviruses, <a href="https://en.unesco.org/news/how-soap-kills-covid-19-hands">disrupting and destroying them</a>. Since saponins are soap, they will do the same to coronaviruses.</p>
<p>Saponins also work against bacteria and fungi. Some bacteria have an external membrane that protects their genetic material. <em>Escherichia</em> <em>coli</em>, a common disease-causing agent, is one of these bacteria. But soap can disrupt this layer, which is basically made up of lipid.</p>
<p>Soaps and saponins are also useful against fungi because keeping the skin clean will prevent the growth and spread of fungi. Soaps and saponins help with thorough cleaning. Soaps are safer than antifungal agents, which can be toxic to mammalian cells.</p>
<p>Our review suggests that the sap of soapy plants found in southern Africa could be useful as disinfectants or sanitisers. The use of plants to formulate crude antimicrobial products could increase access to hygiene and also lead to better conservation of the plants.</p><img src="https://counter.theconversation.com/content/175856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David R. Katerere is a trustee of PharmaConnect Africa, a nonprofit that advances access to medicines in Africa.</span></em></p><p class="fine-print"><em><span>Yvonne Kunatsa received funding from the National Research Foundation (NRF). </span></em></p>Saponins from plants can destroy viruses and other microorganisms in the same way commercial soaps and detergents do.David R. Katerere, Research Platform Chair for Pharmaceutical and Biotech Advancement in Africa (PBA2), Tshwane University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1700882021-10-19T12:22:23Z2021-10-19T12:22:23ZSimple safety tips for trick-or-treating after Fauci greenlighted Halloween 2021<figure><img src="https://images.theconversation.com/files/426809/original/file-20211017-17-lqcsev.jpg?ixlib=rb-1.1.0&rect=77%2C0%2C8660%2C5730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Experts give trick-or-treating the green light this year.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-kids-at-a-halloween-party-royalty-free-image/1270677135">Anchiy/E+ Collection via Getty Images</a></span></figcaption></figure><p>The air is getting chillier, pumpkins are perched on porches and kids across the country are planning their spooky costumes. As a <a href="https://www.purdue.edu/hhs/nur/directory/faculty/sorg_meg.html">professor of pediatric nursing</a> and a mom to four young children, I know the excitement and anxiety that pandemic holidays bring to children and parents alike. </p>
<p>Halloween 2020 brought creative ways to trick or treat while minimizing the spread of infection (<a href="https://www.usatoday.com/story/news/nation/2020/10/29/halloween-2020-trick-treat-chutes-catapults-socially-distance/6057569002/">candy catapult</a>, anyone?). But scientists have since determined that the <a href="https://health.ucsd.edu/news/releases/Pages/2020-10-30-infection-by-confection-covid-19-risk-trick-or-treating.aspx">risk of transmission of COVID-19 via candy wrappers</a> is low. </p>
<p>Still, the extremely contagious delta variant of the coronavirus continues to show moderate-to-high rates of infection in many areas of the country, and it continues to sicken children and teens at a <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">higher rate</a> than the dominant strain that devastated the world in 2020. Parents may be wondering if participating in Halloween fun and games is safe, or if they would be better off staying home this year. </p>
<p>Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said that <a href="https://www.npr.org/2021/10/12/1045202813/trick-or-treating-halloween-is-safe-fauci-says">kids can indeed still enjoy</a> a safe, fun Halloween. But here are a few simple precautions that trick-or-treaters can take.</p>
<figure class="align-center ">
<img alt="A woman wearing a face mask sends candies down a chute to a boy trick or treating" src="https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Candy chutes were a popular way to trick or treat while maintaining social distance in 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-wearing-a-face-mask-sends-candies-down-a-chute-to-a-news-photo/1229391943">Aimee Dilger/SOPA Images/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>1. Mask up</h2>
<p>Children under 12 are not yet eligible to receive a COVID-19 vaccination, which means the majority of kids going door to door are still at an increased risk for contracting the virus. </p>
<p>Because COVID-19 spreads through respiratory transmission, masking remains an effective way to reduce the spread of infection for kids age 2 and older. Unfortunately, Halloween costume masks are not a substitute for masks designed to limit the spread of viral particles. Parents can get creative about making a <a href="https://www.usatoday.com/story/tech/reviewedcom/2021/09/21/halloween-costumes-ideas-kids-can-wear-masks/42632645/">face mask part of a child’s costume</a>. Or, kids can wear a face mask under their costume mask. Parents should make sure their child is able to breathe comfortably if choosing this option. </p>
<p>Children and parents, regardless of vaccination status, should wear a mask when attending indoor parties or when going door to door due to the close interactions with other people. Those giving out candy should also wear a face mask.</p>
<h2>2. Keep hands clean</h2>
<p>Washing hands and using hand sanitizer remains a priority. Even though the likelihood of spreading COVID-19 via candy wrappers is <a href="https://health.ucsd.edu/news/releases/Pages/2020-10-30-infection-by-confection-covid-19-risk-trick-or-treating.aspx">relatively low</a>, that risk decreases even further when proper hand hygiene is practiced prior to passing out candy.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>Kids should wash their hands before they eat their candy in case they picked up any germs while out and about. The candy wrappers themselves are not considered contagious, so there’s no need to quarantine the candy before eating it.</p>
<h2>3. Celebrate outside</h2>
<p>Other ways families can celebrate while maintaining a low risk status are to keep gatherings and activities outside, where people are <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/safe-activities-during-covid19/art-20489385">less likely to contract the virus</a>, and to keep groups small.</p>
<p>Kids who are demonstrating signs of illness should be kept home to rest and avoid exposing others to their germs. Those 12 years old and older should get the COVID-19 vaccination to protect against serious infection.</p>
<p>It feels nice to be staring at the beginning of the 2021 holiday season with some semblance of normalcy. While the risk of COVID-19 isn’t entirely in the past, families should enjoy trick-or-treating while taking reasonable precautions.</p><img src="https://counter.theconversation.com/content/170088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meg Sorg does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s no need to pull out the candy catapult this year, but a few reasonable precautions can keep COVID-19 transmissions in check.Meg Sorg, Clinical Assistant Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648322021-08-04T10:03:39Z2021-08-04T10:03:39ZCOVID: why you still need to wash your hands<p>Hygiene was a significant part of the health measures to control the coronavirus at the start of the pandemic. But as evidence began to emerge of airborne spread, the focus switched to masks and, more recently, <a href="https://theconversation.com/covid-19-its-freezing-outside-but-you-still-need-to-open-your-windows-154044">ventilation</a>. </p>
<p>Indeed, for some the focus has switched so sharply from surface transmission to airborne transmission that they now view hygiene measures – such as hand gelling and deep cleaning handrails – as pointless. Derek Thomson, a writer for The Atlantic, coined the term “<a href="https://www.theatlantic.com/ideas/archive/2020/07/scourge-hygiene-theater/614599/">hygiene theatre</a>” to describe these sorts of “rituals that make us feel safer but don’t actually do much to reduce risk”. </p>
<p>So are these hygiene measures really giving us a false sense of security? Are they a waste of time and money? And why do we even bother with hygiene when COVID <a href="https://www.thelancet.com/article/S0140-6736(21)00869-2/fulltext">mainly spreads through the air</a>?</p>
<p>Since the days of <a href="https://theconversation.com/florence-nightingale-a-pioneer-of-hand-washing-and-hygiene-for-health-134270">Florence Nightingale</a>, hygiene, and specifically hand hygiene, has been recognised as an effective measure to stop the spread of infectious disease. Over the last year, public health advice has recommended hand hygiene to break the cycle of COVID transmission along with other measures, such as distancing and mask wearing. There has been less focus on explaining how hands can act as an intermediary for infection transmission.</p>
<p>SARS-CoV-2 is one of the more resistant coronaviruses and can survive on glass, steel and both polymer and paper banknotes for <a href="https://www.sciencedirect.com/science/article/pii/S0048969721012584#bb0050">up to 28 days</a>, according to a recent review. We aren’t certain what the minimum infectious dose of SARS-CoV-2 is, but recent reports suggest that only a <a href="https://pdfs.semanticscholar.org/6ebf/a661fc65f421c541b23a7700714ff0dd70d5.pdf">few hundred virus</a> particles (called “virions”) are enough to infect a susceptible person. And our face is a handy portal for these viruses to enter our body. </p>
<p>Many infections begin when we touch our mouth, nose or eyes. Scientists researching this behaviour find that people are constantly touching their faces. Respiratory viruses, such as influenza and SARS-CoV-2, while spread primarily by respiratory droplets can also be spread by contaminated hands touching the mucous membranes of the nose, mouth and eyes. </p>
<p>The risk of this happening depends on several factors including the degree of hand contamination, the rate of hand contact with our nose, eyes and mouth, and the infectivity of the virus strain. This is particularly relevant at present as new variants, such as delta, with <a href="https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v1">greater infectivity and transmissibility</a>, continue to emerge. </p>
<p>The consequences of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115329/">face touching</a> as a potential for self-infection with <a href="https://www.tandfonline.com/doi/abs/10.1080/15459620802003896?journalCode=uoeh20">respiratory viruses</a> is <a href="https://www.nejm.org/doi/10.1056/NEJM197306282882601?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed">not a new concept</a>. Most recently, <a href="https://www.ajicjournal.org/article/S0196-6553(20)30965-2/fulltext">researchers observed</a> 100 YouTube videos of random people and reported that the average facial contact was 22 contacts an hour – higher in men and increasing with fatigue and distraction. The researchers argued that changing personal behaviour is a simple and cost-effective way to reduce the risk of catching an infectious disease.</p>
<h2>Swiss cheese model</h2>
<p>COVID control needs a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314268/">multi-layered prevention approach</a> comprising personal and shared interventions as outlined in the so-called <a href="https://theconversation.com/covid-crisis-in-india-why-its-public-health-strategy-failed-159861">Swiss cheese model</a> of risk. No measure is perfect (it has holes, like a slice of Swiss cheese) but combining different measures has a much greater chance of stopping the virus from spreading.</p>
<p>The eyes, nose and mouth provide an easy route of entry to the body for a virus such as SARS-CoV-2. While respiratory droplet and airborne spread have been demonstrated to be the main mechanism of COVID spread, researchers continue to investigate the relative contribution of surfaces and hands to the COVID infection cycle. </p>
<p>And the World Health Organization <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted">has not ruled out surface spread</a> of COVID. Even if it only accounts for a small percentage of transmission, a small percentage of a big number (about <a href="https://www.worldometers.info/coronavirus/">half a million new cases per day</a>) is still a big number.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1422234091311837186"}"></div></p>
<p>Importantly, researchers need to understand if the newer variants of concern behave differently. Hygiene is not theatre, it’s one component of infectious disease prevention and control, and a component people have control over.
And, despite the takeover by COVID in all our communications, other infectious diseases <a href="https://www.theguardian.com/science/2021/jul/09/non-covid-respiratory-illnesses-rise-uk-medical-experts-say-people-mixing-easing-lockdown">still circulate and cause infection</a>.</p><img src="https://counter.theconversation.com/content/164832/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fidelma Fitzpatrick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hand washing isn’t just ‘hygiene theatre’.Fidelma Fitzpatrick, Senior Lecturer, Clinical Microbiology Royal College of Surgeons in Ireland and Consultant Microbiologist, Beaumont Hospital, Dublin, Ireland., RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1609702021-06-28T12:19:08Z2021-06-28T12:19:08ZA pediatric nurse explains the science of sneezing<figure><img src="https://images.theconversation.com/files/404942/original/file-20210607-28202-fqpkbt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sneezing with your eyes closed is a reflex you can consciously override.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/boy-sneezing-against-tree-royalty-free-image/1127920667">Robert Kneschke/EyeEm via Getty Images</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">curiouskidsus@theconversation.com</a>.</em></p>
<hr>
<blockquote>
<p><strong>Why do we sneeze? – Naomi, 9, San Francisco, California</strong></p>
<p><strong>Why do people sneeze with their eyes closed? Is there a way for people to sneeze with their eyes open? – Carlos, 11, Riverview, Florida</strong></p>
<p><strong>Why do adults make a loud noise when they sneeze? – Artie, 8, Brooklyn, New York</strong></p>
</blockquote>
<hr>
<p>Aaaaa-choo! While your first thought may be to say “Gesundheit!” your second might be to ask: “Where did that sneeze come from?”</p>
<p>Sneezing is a phenomenon that occurs in <a href="https://theconversation.com/curious-kids-do-sharks-sneeze-77399">both people and animals</a>. It happens when your body <a href="https://www.healthline.com/health/why-do-we-sneeze">forcibly expels air</a> from your lungs through your nose and mouth. </p>
<p>Most of the time, sneezing happens when something infectious, like a virus or bacteria, or irritating, like an allergen or chemical, enters your nostrils. Your body uses sneezing as a <a href="https://www.livescience.com/44362-why-do-we-sneeze.html">defense mechanism</a> to clear your nose of mucus – also known as snot – and prevent foreign objects and particles from entering your airway.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/bFxgVkslD-k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Lydia Bourouiba and her lab at MIT study the physics of sneezes.</span></figcaption>
</figure>
<p>But sneezing can also occur as a reaction to more unusual stimuli. </p>
<p>Chemicals like piperine or capsaicin found in foods like <a href="https://www.loc.gov/everyday-mysteries/food-and-nutrition/item/why-does-pepper-make-you-sneeze">black pepper and chili peppers</a> can irritate the nerve endings inside your nose’s mucous membranes and lead to a sneeze. </p>
<p>Another type of sneeze is <a href="http://www.jpps.com.pk/article/childhoodpsychogenicsneezing_2342.html">psychogenic</a>, meaning it’s caused by something more mental than physical. Though not fully understood, researchers believe it occurs when a strong emotion triggers your brain to send a chemical signal to your nose that makes you sneeze. </p>
<p>And finally, about one in four people experience something called <a href="https://www.ncbi.nlm.nih.gov/books/NBK109193/">photosneezia</a>, or a photic sneeze reflex, where light, particularly sunlight, can <a href="https://theconversation.com/curious-kids-why-does-the-suns-bright-light-make-me-sneeze-158133">trigger a sneeze</a>.</p>
<h2>Is it possible to sneeze without closing your eyes?</h2>
<p>Despite a <a href="https://www.bbc.com/news/health-42701590">popular myth</a> that sneezing with your eyes open will make them pop out, it’s actually possible to keep your eyes open when you sneeze. </p>
<p>Closing your eyes during a sneeze is an <a href="https://www.verywellmind.com/what-is-the-autonomic-nervous-system-2794823">autonomic reflex</a>. This means that your body does it without you needing to consciously think about it. Scientists believe that your body makes your eyes close when you sneeze to <a href="https://www.livescience.com/32108-why-do-my-eyes-close-when-i-sneeze.html">decrease the likelihood of germs getting into them</a>. </p>
<p>It’s possible to fight that reflex and intentionally keep your eyes open. But it might be better to keep them closed to avoid getting the germs you expelled into your eyes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person sneezing with visible droplets against black backdrop." src="https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406255/original/file-20210614-23-cmrqqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sneezes are powerful for a reason! The force helps expel unwanted particles from your nose to protect your airway.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-sneezing-royalty-free-image/589143352">Lester V. Bergman/Corbis Documentary via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why do you make noises when you sneeze?</h2>
<p>Some people have very loud sneezes, while others have more delicate sneezes.</p>
<p>The noise you make when you sneeze is a result of air escaping your mouth or nose. Generally, the more air you breathe in, the <a href="https://www.abc.net.au/news/2019-09-11/can-you-control-how-loud-you-sneeze/11472994">louder your sneeze</a> will be. Like closing your eyes, inhaling prior to a sneeze is largely a reflex but could be consciously controlled as well. </p>
<p>Some people even hold in or “swallow” their sneezes, though health experts don’t recommend this due to <a href="https://www.healthline.com/health/holding-in-a-sneeze">potential risk for injury</a>. Some sneezes can be so powerful they expel mucous droplets as forcefully as <a href="https://doi.org/10.1016/j.compbiomed.2016.01.022">100 miles per hour</a>!</p>
<h2>What is proper sneezing etiquette?</h2>
<p>Although sneezing is sometimes just a reflex, or the result of an allergy or chemical irritation, sneezing can also be a symptom of a contagious illness or upper respiratory infection. </p>
<p>When you feel the urge to sneeze, best practice is to sneeze into a tissue or your sleeve to catch the germs that may come out with the air you expelled. If you caught your sneeze with a tissue or touched your nose and mouth, <a href="https://www.cdc.gov/handwashing/when-how-handwashing.html">good hand hygiene</a>, like washing with soap and water or using hand sanitizer, is especially important to help prevent spreading germs.</p>
<p>Whether you sneeze with your eyes open or closed, loudly or quietly, covering your mouth and nose when you sneeze and washing your hands for <a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">20 seconds</a> after can help protect others from getting sick.</p>
<hr>
<p><em>Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to <a href="mailto:curiouskidsus@theconversation.com">CuriousKidsUS@theconversation.com</a>. Please tell us your name, age and the city where you live.</em></p>
<p><em>And since curiosity has no age limit – adults, let us know what you’re wondering, too. We won’t be able to answer every question, but we will do our best.</em></p><img src="https://counter.theconversation.com/content/160970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meg Sorg does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People sneeze for many reasons and in many ways. One of them is to protect your airways from irritants and infectious disease.Meg Sorg, Clinical Assistant Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574102021-03-29T02:20:05Z2021-03-29T02:20:05ZWe know hand dryers can circulate germs through the air. Why are they still used everywhere?<figure><img src="https://images.theconversation.com/files/392126/original/file-20210329-17-1jgdj3.jpg?ixlib=rb-1.1.0&rect=79%2C14%2C4713%2C3176&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Airborne contaminants, dirty toilet seats, mould and mildew: long before the coronavirus pandemic came around, the hygiene-focused among us knew public washrooms are grimy places.</p>
<p>Most adults visit the bathroom around <a href="https://www.sciencedirect.com/science/article/pii/S0002937802004246?via%3Dihub">8-10</a> times a day. With an average hand-drying time of 30 seconds, we can expect between 4-5 minutes of daily dryer use per person (and more for people with an <a href="https://www.nature.com/articles/s41598-020-60967-7">overactive</a> <a href="https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00619-0">bladder</a> or similar disorders).</p>
<p>In an attempt to facilitate the hand washing process, are hand dryers adding to the filth by blowing contaminants around? And if so, why are they still common?</p>
<h2>The need to dry</h2>
<p>Drying hands is an essential part of the hand washing process. Wet hands can further the spread of microbes, since moisture facilitates their transfer from the skin to other <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/residual-moisture-determines-the-level-of-touchcontactassociated-bacterial-transfer-following-hand-washing/096E367EA0A0363A4BD750AE8A174DE2">surfaces</a>. </p>
<p>Compared to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249283/">shaking your hands</a> dry after a wash, using an air dryer or paper towel greatly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538484/">reduces</a> the number of surface bacteria that <a href="https://pubmed.ncbi.nlm.nih.gov/12515399/">remain</a>.</p>
<p>Warm air dryers remove moisture from the hands through <a href="https://www.sciencedirect.com/science/article/abs/pii/S002561961200393X">evaporation</a>, while jet air dryers remove it by using <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2010.04838.x">sheer force</a> to disperse the droplets into the air.</p>
<figure class="align-center ">
<img alt="Bathroom wall with both paper towels and air dryer." src="https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some bathrooms offer both paper towels and air dryers. Should you prioritise one of them?</span>
<span class="attribution"><span class="source">Christian Moro</span></span>
</figcaption>
</figure>
<p>It’s worth remembering hand dryers don’t <em>create</em> microbes and there’s usually only minimal bacteria on their <a href="https://aem.asm.org/content/84/8/e00044-18.abstract">nozzles</a>, too. In many cases air dryers can even be fitted with filters that help clean and remove contaminants from the air. </p>
<h2>Put a lid on it!</h2>
<p>Nonetheless, while dryers themselves aren’t necessarily unclean, their forced air can help circulate bacteria around the space. This is why the main focus should be on preventing bacteria from surfaces ever becoming aerosolised (entering the air) in the first place.</p>
<p>If a toilet’s lid is left open when it’s flushed, a fine aerosolised mist of microbes <a href="https://www.tandfonline.com/doi/full/10.1080/02786826.2013.814911">enters the air</a>. And this cloud of faecal matter can spread over an area of up to six square metres. </p>
<p>Research has shown even after flushing many times, a toilet can <a href="https://pubmed.ncbi.nlm.nih.gov/16033465/">continue</a> to emit contaminants into the air. In other words, a person infected with a virus could be spreading these germs for several hours after visiting the <a href="https://pubmed.ncbi.nlm.nih.gov/29651169/">bathroom</a>. </p>
<p>Public washrooms can therefore act as reservoirs for especially nasty bacteria, such as those which are resistant to <a href="https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0500-z">antibiotics</a>.</p>
<p>So are paper towels the solution?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-and-handwashing-research-shows-proper-hand-drying-is-also-vital-132905">Coronavirus and handwashing: research shows proper hand drying is also vital</a>
</strong>
</em>
</p>
<hr>
<h2>Problems with paper</h2>
<p>Paper towels remove water by absorption and take contaminants with them when they’re binned. However, they can cause plumbing problems if flushed down the toilet, which require time and money to fix. </p>
<p>Additionally, paper towels need to be continuously purchased, restocked and disposed of as waste — all of which leads to increased costs. In a worst-case scenario towels may run out, prompting people to exit without drying their hands at all.</p>
<p>Granted, in a hospital setting a dryer’s forced air may move microbes onto items handled by health professionals and patients, such as phones or <a href="https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/from-the-hospital-toilet-to-the-ward-a-pilot-study-on-microbe-dispersal-to-multiple-hospital-surfaces-following-hand-drying-using-a-jet-air-dryer-versus-paper-towels/FA51D26C9C3DC261D35F122EF97593D5">stethoscopes</a>. So paper towels may be a more suitable option here.</p>
<p>But they still don’t provide an entirely sterile environment and can be <a href="https://www.journalofhospitalinfection.com/article/S0195-6701(18)30366-9/abstract">contaminated</a> by microbes circulating in the area.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Toilet paper stuck to shoe leaves bathroom" src="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If contaminated paper towels are discarded on the floor, people stepping on them can transfer germs via their shoes to outside areas.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Weighing the environmental impact</h2>
<p>Although hand dryers do produce carbon emissions, studies have <a href="https://www.abc.net.au/news/science/2018-11-07/paper-towels-warm-air-jet-hand-dryers-environment-hygiene/10468580">shown</a> warm air dryers (which rely on evaporation) generate up to <a href="https://dspace.mit.edu/handle/1721.1/103115">70% more emissions</a> than newer, fast jet dryers (which force out a rush of cold air). </p>
<p><a href="https://theconversation.com/the-great-bathroom-debate-paper-towel-or-hand-dryer-51197">Environmentally speaking</a>, warm air dryers and paper towels perform roughly the same, on average. </p>
<p>Using recycled paper towels doesn’t seem to help much, either. This is because they can’t be recycled further, due to chemicals added to increase their absorptive properties as well as the overall energy required to manufacture them.</p>
<p>In the US, around <a href="https://www.abc.net.au/news/science/2018-11-07/paper-towels-warm-air-jet-hand-dryers-environment-hygiene/10468580">six million tonnes</a> of paper towels end up in landfill each year.</p>
<h2>The dry debate continues</h2>
<p>Some <a href="https://theconversation.com/whats-the-most-hygienic-way-to-dry-your-hands-54196">research</a> has concluded paper towels make a more hygienic method for drying hands. Meanwhile, aggressive jet hand dryers seem to have shown the greatest potential for dispersing bacteria and particles <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/full/10.1111/jam.13014">over wider distances</a>. </p>
<p>But there isn’t a clear winner in practise. A recent critical review <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/jam.14796">concluded</a> there wasn’t enough research weighing up both options and that until more robust studies were conducted, evidence-based public policy recommendations couldn’t be made. </p>
<p>This echoes both the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters">World Health Organisation’s</a> and <a href="https://www.cdc.gov/handwashing/faqs.html">Centre for Disease Control’s</a> hesitance to offer recommendations for whether drying hands with air dryers is more or less effective than using paper towels.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-great-bathroom-debate-paper-towel-or-hand-dryer-51197">The great bathroom debate: paper towel or hand dryer?</a>
</strong>
</em>
</p>
<hr>
<h2>Tips for a healthy bathroom regimen</h2>
<p>While hand dryers can circulate contaminants around a space, the aim should be to stop germs from becoming aerolised in the first place. If the contaminants aren’t in the air to begin with, their dispersion from hand dryers is less of a worry.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="No standing on the toilet seat." src="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Common sense goes a long way in bathroom hygiene.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://link.springer.com/chapter/10.1007%2F978-3-030-47483-6_1">Health</a> <a href="https://link.springer.com/referenceworkentry/10.1007%2F978-981-13-6106-7_118-1">education</a> on this front is important. Simple recommendations include:</p>
<ul>
<li><p>closing the toilet lid before flushing</p></li>
<li><p>wearing a mask where recommended or required, especially for those who have respiratory tract symptoms or a cough</p></li>
<li><p>coughing or clearing your throat directly into a tissue and immediately throwing it in the bin</p></li>
<li><p>washing your hands regularly with soap and water and not forgetting to dry them, as wet hands are more likely to spread bugs and diseases. </p></li>
</ul>
<p>In areas where infection control and prevention are paramount, such as hospitals or food production areas, measures such as increased airflow and air filters can also help.</p>
<h2>The bottom line</h2>
<p>Using paper towels comes with recurring costs, logistical problems and environmental considerations. Meanwhile, air dryers can further circulate vapourised bacteria.</p>
<p>Managers of public washrooms have much to consider when deciding which method of hand drying to provide. In some scenarios, hand dryers do present as a better option, which is why we continue to see them in public washrooms.</p>
<p>Regardless of what option you choose, don’t forget drying is an essential part of the hand-washing process. Both air dryers and paper towels are, by a long way, better than using nothing at all. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CMjdfhsjsCg","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p><img src="https://counter.theconversation.com/content/157410/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What side are you on, paper or dryer? In either case, here’s the bottom line on what to do after using the toilet.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, PhD Student, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1520292021-01-19T14:28:36Z2021-01-19T14:28:36ZCOVID-19 policy briefs must be realistic: a review by young southern African scientists<figure><img src="https://images.theconversation.com/files/379221/original/file-20210118-21-movumy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hand hygiene is important to fight COVID-19 but how can you do that without water</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Just over a year after the coronavirus was first reported in China countries are still reeling from its effects. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19 disease, has infected over <a href="https://coronavirus.jhu.edu/map.html">90 million</a> people globally and resulted in more than <a href="https://coronavirus.jhu.edu/map.html">1.9 million</a> deaths. In January 2021, South Africa has the highest number of cases on the <a href="https://africacdc.org/covid-19/">African continent</a> and has seen a <a href="https://businesstech.co.za/news/trending/455928/mkhize-declares-second-wave-of-covid-19-in-south-africa-as-new-cases-pass-6000-in-a-day/">surge</a> in daily infections since December.</p>
<p>The race to find and provide effective vaccines and therapeutics continues. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext">Non-pharmaceutical interventions</a> are still needed to limit the transmission of COVID-19. They include isolating cases, quarantining contacts as well as relevant, accurate and timely risk communication. Hand and respiratory hygiene, infection control and prevention are also vital.</p>
<p>Evidence-based research and interventions are important in the fight against COVID-19. But it is equally important to pay attention to <a href="https://preventepidemics.org/covid19/science/insights/3-ws-to-reduce-the-risk-of-covid-19/">social measures and people’s everyday experiences</a>. These contribute to adherence to government regulations relating to COVID-19. Adherence isn’t always easy or possible in certain circumstances. For example, living conditions may make it difficult to keep a safe distance, and access to <a href="https://mg.co.za/article/2020-04-12-covid-19-and-the-call-for-solidarity-challenges-for-informal-settlements/">water</a> may be limited.</p>
<p>In view of these potential difficulties, <a href="https://www.sayas.org.za/">a group of young scientists</a> who are part of <a href="https://www.zimbabweyas.org/">South Africa Young Academy of sciences</a> came together to discuss how policy briefs that focus on non-pharmaceutical interventions could be made more accessible for the general public and policy makers alike. The group comprised experts in the behavioural, social, natural, health and human sciences.</p>
<p>In particular, we drew from policy briefs compiled by a public health initiative called <a href="https://resolvetosavelives.org/">Resolve to Save Lives</a>. This initiative puts together data on COVID-19 trends in Africa from multiple sources. These briefs target decision makers involved in the COVID-19 response in Africa, including national task forces and emergency operation centres. </p>
<h2>Issues and possible solutions</h2>
<p>The <a href="https://preventepidemics.org/covid19/perc/">briefs</a> are intended to inform public health and social measures in Africa. They are based on social, economic, epidemiological, population movement, and security data from 20 African Union member states. The briefs highlight the various strategies African governments have taken in responding to COVID-19 and whether these are effective or not. </p>
<p>We discussed the briefs in a <a href="https://www.youtube.com/watch?v=NrB6za1jr1w&feature=youtu.be">closed webinar</a>. It aimed to assess whether the briefs take into account the real experiences of people in our communities. The people invited to the webinar included academics, students and representatives of non-governmental organisations.</p>
<p>The webinar highlighted some big issues. These are listed below.</p>
<p>Environmental factors are important in the southern African region’s responses to COVID-19. Most countries in the region did not have a disaster management plan in place, and this contributed to environmental challenges. An example is the disposal of used masks in the streets, with many ending up in rivers and other <a href="https://twentytwo13.my/issues/used-face-masks-sanitiser-bottles-end-up-in-rivers/">water bodies</a>. There is, therefore, a need for a disaster management plan which would guide the safe disposal of these waste materials. </p>
<p>There is an overuse of hand sanitisers (for example in shopping malls when people move from one store to the next), which may lead to <a href="https://theconversation.com/coronavirus-heavy-use-of-hand-sanitisers-could-boost-antimicrobial-resistance-136541">antimicrobial resistance</a>. Some ways to limit the negative impact of overuse of hand sanitisers on the skin should entail thorough washing of hands with water and soap when available. There should also be extreme caution and avoidance of diluting and combining different sanitisers. A point also highlighted by <a href="https://theconversation.com/coronavirus-heavy-use-of-hand-sanitisers-could-boost-antimicrobial-resistance-136541">Winston Morgan</a>, a reader in toxicology and clinical biochemistry at the University of East London, in his assertion that we should “avoid combining pre-prepared products with other ones”.</p>
<p>While government task teams have some diversity and interdisciplinary experts, there is a <a href="https://www.biznews.com/thought-leaders/2020/06/05/government-misreads-people-covid-19-friedman">bias towards the health and “core science”</a> professionals. Psycho-social and political sciences should also be represented in policy decision making processes. The role of traditional leaders, faith groups and businesses must also be taken into consideration. It is important to have this <a href="https://preventepidemics.org/wp-content/uploads/2020/09/PERC_RespondingtoCovidData.pdf">multi-sectoral response</a> as COVID-19 is more than just a health problem. </p>
<p>Governments should strengthen evidence-based risk communication and engage community leaders and trusted people to encourage adherence to public health measures and dispel misinformation. In addition, there needs to be an open and honest conversation between traditional leaders and governments on cultural practices and people’s need to perform rituals. </p>
<p>For example, in many communities, initiation schools are an integral part of community life. Such rituals are an integral part of many communities and people want to practise and observe <a href="https://health-e.org.za/2020/11/20/initiation-schools-covid-19/">traditional rites</a>. But these events may be high risk as the initiates might find it difficult to observe COVID-19 safety protocols. Working closely with traditional leaders who have in-depth understanding of such rituals can assist in ensuring adherence.</p>
<h2>Looking ahead</h2>
<p>It is important to acknowledge that COVID-19 has affected all aspects of people’s lives. The young scientists’ webinar was an opportunity to understand the similarities and differences in challenges associated with COVID-19 in communities across southern Africa. </p>
<p>It highlighted the need for policies that are appropriate for people’s real lives. These need to be “living documents”. This can only happen if communities are consulted in making decisions affecting their lives. Pharmaceutical and non-pharmaceutical interventions have to be adopted alongside one another.</p><img src="https://counter.theconversation.com/content/152029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Puleng Segalo receives funding from the National Research Foundation and the National Institute for the Humanities and Social Sciences.. </span></em></p><p class="fine-print"><em><span>Adeyemi Oladapo Aremu receives funding from the National Research Foundation, Pretoria, South Africa. </span></em></p><p class="fine-print"><em><span>Pradeep Kumar receives funding from the National Research Foundation, the South African Medical Research Council, and the University of the Witwatersrand, Johannesburg. </span></em></p>African leaders can make strategies to fight COVID-19 more accessible to the people.Puleng Segalo, Professor of Psychology, University of South AfricaAdeyemi Oladapo Aremu, Associate professor, North-West UniversityPradeep Kumar, Associate Professor of Pharmaceutics at Department of Pharmacy and Pharmacology, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1481282020-10-20T14:52:02Z2020-10-20T14:52:02ZSouth Africans aren’t being protected from fake sanitisers: what needs to be done<figure><img src="https://images.theconversation.com/files/364241/original/file-20201019-19-1o3mzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The WHO recommends sanitisers with an alcohol content of at least 70%.</span> <span class="attribution"><span class="source">Phill Magakoe / AFP via Getty Images</span></span></figcaption></figure><p>A wave of panic buying struck many countries when national states of disaster were announced in response to the global COVID-19 pandemic. Overnight, toilet paper, cleaning products and hand sanitisers became the most sought-after products on the <a href="https://www.bbc.com/news/stories-52126847">market</a>. </p>
<p>This was true in South Africa too. Production facilities for raw materials of hand sanitisers experienced an increase of nearly 400% in bulk <a href="https://www.chemengonline.com/sasol-roquette-join-growing-list-of-manufacturers-adapting-plants-to-produce-hand-sanitizer/">orders</a>. Suppliers could not keep up with sudden mass orders for hundreds of thousands of <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">litres</a>. </p>
<p>In response to the shortage, governments across the world adopted temporary policies. These allowed for the production of hand sanitiser by entities that weren’t registered manufacturers and for alcohol <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">distillers</a> to shift their production to hand sanitisers. </p>
<p>In South Africa’s economic hub, Gauteng province, non-specialist companies were speedily registered to secure government contracts. The surge in demand also opened doors for exploitation and corruption. Some companies supplying government departments saw an opportunity to supply hand sanitisers at inflated prices – at an estimated R66 million ($398,532) above market <a href="https://www.dailymaverick.co.za/article/2020-08-30-gauteng-healths-deadly-r500m-ppe-rip-off/">prices</a>. </p>
<p>Concern has been growing about safety issues related to hand sanitisers – in South Africa as well as other countries. But South Africa has been behind the curve in putting in place measures to ensure products are safe.</p>
<h2>Filling a gap</h2>
<p>In the absence of a vaccine, hand hygiene has become a critical part of the response to COVID-19. Washing hands at regular intervals during the day is viewed as essential. If water and soap are unavailable, hand sanitisers have served as a useful alternative. </p>
<p>The purpose of a hand sanitiser is to disrupt the enveloping lipid membrane of SARS-CoV-2. This kills the <a href="https://wwwnc.cdc.gov/eid/article/26/7/20-0915_article">virus</a>. The World Health Organisation (WHO) has recommended that consumers use an alcohol-based sanitiser with an alcohol content of at least 70%, based on effective and fast anti-microbial <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">activity</a>. </p>
<p>The WHO further <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">recommends</a> that hand sanitisers comprise ethyl alcohol (ethanol) or isopropyl alcohol (2-propanol) as the active ingredient, in addition to inactive ingredients listed as follows:</p>
<ul>
<li><p>Water as a diluent;</p></li>
<li><p>Glycerol to prevent drying out users’ skin; and</p></li>
<li><p>Hydrogen peroxide to inactivate contaminating bacterial spores in the <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">solution</a>.</p></li>
</ul>
<p>The guide, as well as statements issued by the US Food and Drug Administration, recommends that perfumes or dyes not be added due to risk of allergic <a href="https://www.fda.gov/media/136289/download">reactions</a>. The Australian Department of <a href="https://www.legislation.gov.au/Details/F2020L00340#:%7E:text=Therapeutic%20Goods%20(Excluded%20Goods%E2%80%94Hand%20Sanitisers)%20Determination%202020,-%2D%20F2020L00340&text=This%20instrument%20excludes%20specified%20hand,to%20the%20COVID%2D19%20emergency.">Health</a> goes so far as to say that hand sanitisers may not contain any other active or inactive ingredients. These include colourants, fragrances or emollients.</p>
<p>But the policing of these conditions has been weak in countries like South Africa.</p>
<h2>Maintaining standards</h2>
<p>In the US, the Food and Drug Administration has played a leading role in identifying inferior products. By early October more than 200 products had been <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">recalled</a> that contained either methanol, 1-propanol or less than the required amount of alcohol. </p>
<p>Methanol is a cheaper alcohol, but repeated use of methanol-based hand sanitiser can cause it to be absorbed through the skin. This can cause chronic toxicity, hallucinations or even death in <a href="https://www.mdpi.com/1660-4601/15/7/1440">extreme cases</a>. As for 1-propanol, not to be confused with 2-propanol, the substance can be toxic and life-threatening when ingested and is therefore not an acceptable ingredient for <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">hand sanitisers</a>. </p>
<p>Countries across the globe have detected other toxic substances in hand sanitisers that can also pose acute or chronic toxicity. These include <a href="https://www.bbc.com/news/uk-england-birmingham-51979932?intlink_from_url=&link_location=live-reporting-story">glutaraldehyde</a>, <a href="https://chemycal.com/news/eca0070d-04ff-48fa-867e-81fb3d18913d/Danish_EPA__Hand_disinfection_products_are_recalled">polyhexamethylene biguanide</a> and <a href="https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/73385a-eng.php#:%7E:text=Ethyl%20acetate%3A%20Frequent%20use%20of,respiratory%20system%20irritation%20and%20headaches">ethyl acetate</a>. </p>
<p>Sub-potent levels of alcohol have been recorded in the <a href="https://nltimes.nl/2020/06/24/hand-sanitizers-public-spaces-always-scratch-report">Netherlands</a>, the <a href="https://english.alarabiya.net/en/News/gulf/2020/04/02/Coronavirus-Dubai-recalls-these-6-hand-sanitizers-for-containing-methanol">UAE</a>, <a href="https://thenewdaily.com.au/finance/consumer/2020/07/16/hand-sanitiser-ineffective/">Australia</a>, <a href="https://www.inewsguyana.com/food-and-drug-recalls-substandard-purcill-hand-sanitizers/#:%7E:text=The%20Government%20Analyst%20Food%20and,as%20stated%20on%20the%20labels.">Guyana</a>, <a href="https://businesstoday.co.ke/kebs-kenya-bureau-of-standards-quality-concerns-kebs-bans-hand-sanitizers/#:%7E:text=KEBS%20Bans%20More%20Sanitizer%20Brands%20Over%20Quality%20Concerns%20In%20July,brands%20over%20the%20same%20reason&text=The%20Kenya%20Bureau%20of%20Standards,failure%20to%20meet%20quality%20threshold.">Kenya</a>, <a href="https://www.nafdac.gov.ng/public-alert-no-003-2020-alert-on-illegal-distribution-and-sale-of-unregistered-hand-sanitizers/">Nigeria</a> and <a href="https://www.iol.co.za/news/africa/rwanda-food-and-drug-authority-recalls-locally-manufactured-hand-sanitiser-45986888">Rwanda</a>. Zambia <a href="https://www.themastonline.com/2020/06/20/zamra-recalls-unsafe-sanitisers-disinfectants/">recalled</a> products from a number of producers, including South Africa. </p>
<p>In South Africa, the Bureau of Standards recently issued a press release, raising concerns about substandard sanitisers produced by “unscrupulous” manufacturers who were falsely claiming that their products had been <a href="https://www.sabs.co.za/Media/SABS-comments-on-the-illegal-us-of-its-Mark-on-sanitizers.asp">certified</a>. Reference was made to low-quality versions that can trigger skin allergies and can damage the skin, often presenting as a form of eczema.</p>
<p>In May 2020, a <a href="https://www.timeslive.co.za/news/consumer-live/2020-07-08-investigation-your-hand-sanitiser-might-not-be-keeping-you-as-safe-as-you-think/">laboratory</a> found that two out of the 11 hand sanitisers bought from retailers in the city of Pietermaritzburg contained 1-propanol. Four contained only between 46% and 67% alcohol while claiming to contain 70%.</p>
<p>Yet no hand sanitiser products in South Africa have been recalled. The country also has no regulatory system in place to assess hand sanitisers intended for household use. Companies have been <a href="https://ipasa.co.za/wp-content/uploads/2020/04/Comm-to-Industry_Covid-19_Reg-Status-of-Equipment-to-prevent_09April2020_vF.pdf">required</a> to voluntarily comply with the national standard on disinfectant alcohol-based hand-rubs, but this is woefully inadequate. </p>
<p>Part of the <a href="https://www.gov.za/sites/default/files/gcis_document/201409/321864670.pdf">Consumer Protection Act</a> seeks to ensure that consumers are provided with adequate evidence-based information. This is critical, especially since consumers are inundated with all sorts of brands and types of sanitisers that are intended for frequent use. </p>
<h2>What needs to be done</h2>
<p>A number of urgent steps need to be considered.</p>
<p>Firstly, labelling requirements should be standardised and enforced. The following information should be indicated on every bottle of hand sanitiser: </p>
<ul>
<li><p>an alcohol content of at least 70%; </p></li>
<li><p>a list of the active and inactive ingredients and the adverse effects they may cause; </p></li>
<li><p>instructions for use;</p></li>
<li><p>mandatory warnings;</p></li>
<li><p>the batch code and expiry date; and</p></li>
<li><p>the full address of the manufacturer. </p></li>
</ul>
<p>Secondly, public awareness programmes about correct hand hygiene techniques and the safe use, storage and effectiveness of hand sanitisers should be launched. </p>
<p>Thirdly, products that don’t comply with specifications or are not properly labelled should not be sold or provided in public spaces. </p>
<p>Fourth, a national task team should be established to investigate the regulatory framework and current levels of compliance. </p>
<p>Fifth, imports of raw material used in manufacturing of hand sanitisers and ready-to-use formulated products should be regulated more effectively. Likewise, products that are exported from South Africa to neighbouring <a href="https://www.timeslive.co.za/politics/2020-05-29-sa-exporting-millions-of-facemasks-hand-sanitiser-patel/">countries</a> should be monitored better. </p>
<p>Finally, environmental health inspectors or the <a href="https://www.nrcs.org.za/">National Regulator for Compulsory Specifications</a> should mercilessly track down fake products and have them confiscated and destroyed.</p>
<p><em>Dr Tracy Muwanga, a trans-disciplinary postdoctoral fellow in the faculties of Law and Natural and Agricultural Sciences at the University of Pretoria, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/148128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Willeke de Bruin receives funding from the University of Pretoria's UNICEF One Health for Change project. </span></em></p><p class="fine-print"><em><span>Lise Korsten does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hand hygiene is a critical part of the response to COVID-19. Washing hands at regular intervals during the day is essential. If water and soap are unavailable, hand sanitisers are an alternative.Lise Korsten, Professor in the Department of Microbiology and Plant Pathology and Co-Director at the Centre of Excellence in Food Security, University of PretoriaWilleke de Bruin, Postdoctoral fellow - Faculty of Natural and Agricultural Sciences, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1412712020-06-24T08:41:14Z2020-06-24T08:41:14ZFrom hospitals to households, we can all be better at remembering to wash our hands<figure><img src="https://images.theconversation.com/files/343648/original/file-20200624-56963-oylt04.jpg?ixlib=rb-1.1.0&rect=5%2C17%2C3836%2C2540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">F. Cary Snyder/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>While Australia gradually opens up from COVID-19 lockdown, Victoria is still struggling to contain the outbreak. The Black Lives Matter protest in Melbourne on June 6, which attracted thousands of face-masked and hand-sanitised protesters, <a href="https://www.sbs.com.au/news/did-australia-s-black-lives-matter-protests-cause-a-spike-in-covid-19-cases">did not prove</a> to be the public health nightmare many commentators (particularly politically conservative ones) had predicted. But Melbourne is nevertheless contending with a <a href="https://www.abc.net.au/news/2020-06-22/coronavirus-hotspot-suburbs-in-melbourne-victoria-darebin-hume/12379090">worrying spike</a> in case numbers arising from infection clusters around staff working in quarantine sites and extended family gatherings.</p>
<p>From the beginning of the COVID-19 pandemic, we were told two behaviours were crucial to keeping us safe: <a href="https://www.technologynetworks.com/immunology/articles/the-rationale-behind-social-distancing-and-hand-washing-332559">social distancing and handwashing</a>. The coronavirus crisis has brought the mundane act of washing our hands into public discussion, and the internet is now awash (ahem) with advice, from the <a href="https://www.youtube.com/watch?v=4hrFmYXCU04&feature=youtu.be">practical</a> to the <a href="https://www.youtube.com/watch?v=NAsTmxF9m9s">surreal</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/NAsTmxF9m9s?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Judi Dench on hand with some helpful, if mildly unsettling, advice.</span></figcaption>
</figure>
<p>If there’s one place where you would expect hand cleanliness to be beyond reproach, it’s hospitals. But this isn’t necessarily the case.</p>
<p>Surprisingly, hand hygiene is a vexing issue in hospitals all over the world. Repeated studies have shown it is common for hospital staff to follow hand hygiene protocols <a href="https://www.cdc.gov/handhygiene/">less than 50% of the time</a>. This is as true in <a href="https://pubmed.ncbi.nlm.nih.gov/29778435/">Australia</a> and <a href="https://search.informit.com.au/documentSummary;dn=435246019845891;res=IELNZC">New Zealand-Aotearoa</a> as it is globally. As any infection control nurse will tell you, specialist doctors are <a href="https://www.fiercehealthcare.com/healthcare/doctors-are-worst-hand-hygiene-offenders">often among the worst offenders</a>.</p>
<h2>Who teaches hospital staff how to handwash?</h2>
<p>Like most Western-style hospitals, all Australian hospitals have infection control experts, typically nurses, whose job is to educate, advise and monitor compliance on infection control protocols among hospital workers. This is lifesaving work, because hospitals are <a href="https://www.ncbi.nlm.nih.gov/books/NBK441857/">prime breeding grounds</a> for deadly <a href="https://www.chkd.org/Patients-and-Families/Health-Library/Way-to-Grow/Multi-Drug-Resistant-Organisms,-a-Few-Facts-about/">antibiotic-resistant bacterial strains</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">Washing our hands of responsibility for hospital infections</a>
</strong>
</em>
</p>
<hr>
<p>The main line of defence in hospitals against these potentially fatal infections is <a href="https://www.cdc.gov/infectioncontrol/guidelines/mdro/prevention-control.html">prevention</a>, hence the strict protocols around hand hygiene, and widespread use of gloves, robes, masks and safety googles.</p>
<p><a href="https://www.cdc.gov/handhygiene/providers/index.html">Proper hospital hand hygiene</a> involves using gloves, hand sanitiser, and frequent handwashing. Protocols dictate that gloves should be used in situations where health workers might expect to come into contact with blood, bodily fluids or other contaminants. Staff should wash or sanitise their hands before and after every patient contact, and in all situations where there has been contact with potentially contaminated material. </p>
<p>Infection control nurses undertake routine hand hygiene audits, and hospital staff can be disciplined if they fail to comply with the protocols.</p>
<h2>Three types of handwashers</h2>
<p>What makes hospital staff more or less likely to comply? It turns out there are different categories of handwasher, and therefore different ways to help people remember to do it.</p>
<p>While working on a project looking at communication in a <a href="https://www.tandfonline.com/doi/abs/10.5172/hesr.2006.15.2.156">multidisciplinary hospital team</a>, infection control education became one of the areas of interest. Part of the study focused on the hand hygiene habits of hospital staff in a ward with particularly high infection risks.</p>
<p>Based on observations, interviews and informal conversations, we discovered nursing staff tended to fall into one of three broad categories: “hero healthworkers”, “family members”, and those who were “working for the whitegoods”.</p>
<p>Overall, most health-care workers practised good hand hygiene most of the time. But when there was time pressure — such as during short-staffed shifts, or when multiple patients were in particular need at the same time — nearly everyone had moments of non-compliance. But, fascinatingly, there were patterns to this non-compliance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343695/original/file-20200624-132951-1i3xtnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
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<span class="attribution"><span class="source">Kelly Sikkema/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>No matter how busy things were, “hero healthworkers” always practised hand hygiene before approaching a patient’s bed. But if time was short, sometimes they did not wash or sanitise their hands on leaving the patient. Nurses (and doctors) who exhibited this behaviour tended to make comments suggesting they valued patients’ health above their own. </p>
<p>“Family members” always practised good hand hygiene when leaving a patient, but sometimes missed out on washing or sanitising before interacting with a new one. In each case, these staff members had vulnerable people in their household – mostly young children, and in a couple of cases older relatives. Interviews and informal discussions revealed deep concern around infection risks and “taking something home”. </p>
<p>The third group was mostly meticulous in their practice when observed by a superior, but much less conscientious when only peers were around. Nurses who fitted this pattern tended to be disparaged by their colleagues as “working for the whitegoods” – treating nursing less as a professional vocation and more as “just” a job to earn money.</p>
<p>These patterns were observed — sometimes with minor variations — in more than a dozen wards over three different hospital sites during subsequent research projects.</p>
<h2>How to improve things</h2>
<p>None of these behaviours appear to have been conscious, even among the least conscientious “whitegoods” group. Many staff recognised their own behaviour patterns when they were pointed out, but said they had not been explicitly aware of them. </p>
<p>Identifying these characteristic behaviour patterns allowed the infection control educator to target education efforts more effectively. “Hero healthworkers” were educated on the risks to other staff by potentially transmitting infection to work surfaces and other places in the hospital by not handwashing after seeing a patient. “Family members” were reminded of the risks to patients of transmitting infections in the opposite direction. And those who only complied when being directly supervised were counselled on the need to have high standards at all times. </p>
<p>This shift in education strategy was employed along with a number of other infection control interventions, resulting in a significant reduction in multidrug-resistant infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-clean-is-your-hospital-room-to-reduce-the-spread-of-infections-it-could-probably-be-cleaner-122185">How clean is your hospital room? To reduce the spread of infections, it could probably be cleaner</a>
</strong>
</em>
</p>
<hr>
<p>One insight we can take from this for our day-to-day realities in the middle of COVID-19 is to be reflective about our own handwashing practices. When are we conscientious, and when do we let our standards slip? Is there a pattern in our own behaviours that we can identify, and what are the subconscious beliefs driving those practices? Can we use that knowledge to change our behaviours? </p>
<p>The simple act of handwashing is perhaps more complex than we realise. But it is one of the things that will determine how well we fare in the current pandemic.</p><img src="https://counter.theconversation.com/content/141271/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Debbi Long does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even in hospitals, where hand hygiene is vital, staff don’t always remember to wash their hands. What hope is there for the rest of us? Thankfully, research on handwashing behaviours has some answers.Debbi Long, Senior Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1336682020-03-16T15:26:03Z2020-03-16T15:26:03ZHomemade hand sanitiser recipes that could help protect against coronavirus<figure><img src="https://images.theconversation.com/files/320617/original/file-20200315-50523-xqazd1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4104%2C2488&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-cleaning-gel-pouring-sanitising-onto-1672466596">KSai23/Shutterstock</a></span></figcaption></figure><p>To slow the spread of coronavirus we’re being told to <a href="https://www.gov.uk/government/news/public-information-campaign-focuses-on-handwashing">wash our hands more</a>, preferably with soap and water, or failing that, with hand sanitisers. The resulting rush to buy hand sanitisers has led to empty shelves in supermarkets and chemists. But it hasn’t taken long for recipes for hand sanitisers to appear online. But do they work? </p>
<p>Let’s take a look at a <a href="https://www.thespruce.com/make-your-own-homemade-hand-sanitizer-606145">popular one</a>:
</p><p>Combine in a bowl,<br>
2/3 cups rubbing alcohol (99.9% isopropyl alcohol)<br>
1/3 cup aloe vera gel<br>
Stir. Decant into a soap or pump bottle<br>
Give it a good shake every now and then.<br>
</p><p></p>
<p>Aloe vera is a moisturiser that will stop your skin drying out. That’s useful, since cracks in the skin can increase the risk of bacterial infection. The main active ingredient in this sanitiser is the isopropyl alcohol (isopropanol). Most commercial hand sanitisers contain either ethanol, isopropanol, n-propanol or a combination of any two. </p>
<p>Mixtures of 60%-80% alcohol by volume kill microorganisms, so the 66% alcohol concentration in the recipe looks about right if pure rubbing alcohol (also known as “surgical spirits”) is used. A quick look at Amazon, though, shows that it is usually sold as a pre-prepared working dilution between 50% and 70%, to be used directly on surfaces. Mixing even the 70% solution with the aloe vera will make the final alcohol concentration too low to be useful.</p>
<p>Although it’s hard to get hold of, pure ethanol could be used in the recipe instead of isopropanol. Ethanol is the alcohol found in spirits, and another homemade sanitiser that has gained some attention uses vodka. </p>
<p>Most vodka contains about 40% alcohol – not nearly enough for an effective hand sanitiser. But Balkan 176, the strongest vodka available in the UK, comes in at a staggering 88% ethanol. This could be used to make another 66% alcohol hand sanitiser with three parts vodka to one part aloe vera. At around £45 for 700ml it would make an expensive product, but since it was sold out on all the sites that we looked at, maybe there’s a market for it.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320618/original/file-20200315-50523-2myjpt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not to be rubbed on hands.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-view-bottle-vodka-glasses-standing-206840308">Tadeusz Wejkszo/Shutterstock</a></span>
</figcaption>
</figure>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407053/#!po=32.3529">2017 study showed</a> that both ethanol and isopropanol preparations made to the official World Health Organization (WHO) formulations inactivate the Sars and Mers viruses, which are coronaviruses related to the one that causes COVID-19. These <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf">formulations contain</a> final concentrations of either 80% ethanol or 75% isopropanol along with 1.45% glycerol and 0.125% hydrogen peroxide. </p>
<p>Everything in these formulations is mixed in distilled water or simply cold boiled water. The hydrogen peroxide is used to inactivate any contaminating bacteria in the mix, but is not an active ingredient in the sanitiser. The glycerol is a humectant, a substance to help retain moisture, and can be replaced with any other emollient or moisturiser to help with skincare – including aloe vera. </p>
<h2>Compared with WHO formulation</h2>
<p>How do these homemade recipes compare with the WHO formulations? Well, not too badly since both contain the alcoholic active ingredient and an emollient. The problem might be that the 66% alcohol concentration is towards the lower end of the effective range. </p>
<p><a href="https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/surgical-hand-disinfection-with-alcohols-at-various-concentrations-parallel-experiments-using-the-new-proposed-european-standards-method/BE6FBC0BCA36993BF7B3C7F27C6F0D09">Studies have shown</a> that higher alcohol concentrations work better, and we know that the WHO 75% isopropanol or 80% ethanol formulations can kill other coronaviruses. The homemade products may not be strong enough to inactivate the virus quite as effectively as the WHO formulation. On the other hand, some commercial hand sanitisers contain as little as 57% alcohol, so these homemade products would be better than that.</p>
<p>In our opinion, if you want to make a homemade hand sanitiser you should go with a modified version of the first recipe, upping the rubbing alcohol to the WHO-recommended concentration: three-quarters of a cup of isopropanol and a quarter of a cup of aloe vera gel. You could even substitute glycerol for the aloe vera gel. It’s cheaper, but it won’t smell as nice. </p>
<p>Always follow the safety instructions on whichever alcohol you use and remember this is only for cleaning your hands. Don’t bathe in it and definitely don’t drink it!</p><img src="https://counter.theconversation.com/content/133668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With shelves cleared of hand sanitiser, many people are starting to to make their own.Shobana Dissanayeke, Senior Lecturer, Biological Sciences, Royal Holloway University of LondonJames McEvoy, Senior Lecturer, Biomedical Sciences, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1334322020-03-12T05:03:51Z2020-03-12T05:03:51ZAustralian schools are closing because of coronavirus, but should they be?<figure><img src="https://images.theconversation.com/files/320038/original/file-20200312-15006-1o80fdp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/handwashing-teachers-that-schools-teaching-children-196373114">Shutterstock</a></span></figcaption></figure><p>The World Health Organisation overnight declared that the coronavirus responsible for COVID-19 is <a href="https://www.abc.net.au/news/2020-03-12/coronavirus-updates-who-declares-pandemic/12047598">now a pandemic</a>, and called on countries to take “urgent and aggressive action”.</p>
<p>The <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2">virus has affected</a> more than 113,702 people and resulted into 4,012 deaths globally. At the time of publication, there have been 126 <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert">people diagnosed with COVID-19</a> in Australia and three deaths linked to the virus. These numbers are likely to increase.</p>
<p>Australia has <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert?utm_source=health.gov.au&utm_medium=redirect&utm_campaign=digital_transformation&utm_content=covid19-travellers#travellers-and-visitors">issued restrictions</a> for travellers from China, South Korea, Iran and Italy. <a href="https://www.theguardian.com/world/2020/mar/11/coronavirus-mass-school-closures-and-industry-shutdown-on-the-cards-says-victorias-premier">Four schools</a>, two in New South Wales and two in Victoria, closed temporarily after students and a staff member tested positive for the virus. </p>
<p><a href="https://theconversation.com/newsletter"><img src="https://images.theconversation.com/files/320030/original/file-20200312-116261-a6ugi0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" alt="Sign up to The Conversation" width="100%"></a></p>
<p>In recent days, Victorian premier Dan Andrews has <a href="https://www.theguardian.com/world/2020/mar/11/coronavirus-mass-school-closures-and-industry-shutdown-on-the-cards-says-victorias-premier">warned the public to prepare</a> for statewide school closures. Federal education minister Dan Tehan said the trigger for more widespread school closures had not yet been reached, but it seems “clear now that the idea of containing the virus is getting harder and harder”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1237541581348995072"}"></div></p>
<p>There is currently no vaccine to protect people against COVID-19, so public health authorities will need to use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837128/">non-pharmaceutical interventions</a> in response to the outbreak. These can include isolating infected people, quarantining those exposed to the virus, and <a href="https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/1471-2458-12-977">closing schools</a>. </p>
<h2>Current policy and guidelines</h2>
<p>The federal government recently released the <a href="https://www.health.gov.au/sites/default/files/documents/2020/02/australian-health-sector-emergency-response-plan-for-novel-coronavirus-covid-19_2.pdf">Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19)</a>. It says:</p>
<blockquote>
<p>State and territory governments are responsible for the operational aspects of public health responses […] They will […] implement social distancing measures as per national recommendations and local risk assessment […] and support outbreak investigation and management in residential aged care facilities, schools, prisons and other institutions.</p>
</blockquote>
<p>This makes clear there is no specific national plan for schools to contain the virus. The statement seems to suggest the current plan is to “support outbreak investigation” as opposed to preventing the outbreak. </p>
<p>Supporting the outbreak investigation is a <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000436">reactive measure</a>, which leaves schools vulnerable to outbreaks without a strategy to prevent them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-now-a-matter-of-when-not-if-for-australia-this-is-how-were-preparing-for-a-jump-in-coronavirus-cases-132448">It's now a matter of when, not if, for Australia. This is how we're preparing for a jump in coronavirus cases</a>
</strong>
</em>
</p>
<hr>
<p>There is <a href="https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-schools-and-early-childhood-centres-students-and-parents_0.pdf">general</a> <a href="https://www.education.gov.au/coronavirus-covid-19">advice</a> available for schools but this focuses on international students or those recently returned from a high-risk country, and those who have had contact with someone who is infected. </p>
<p>Without a concrete national plan, individual schools rely on state and territory advice, which varies significantly (see <a href="https://education.nsw.gov.au/public-schools/school-safety/novel-coronavirus">NSW</a> and <a href="https://health.nt.gov.au/news/coronavirus">NT</a>). This may mean there will be an untimely and inconsistent response to containing COVID-19 in schools across Australia.</p>
<h2>What can schools do?</h2>
<p>Measures schools can use to <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3549276">prevent infections fall into two groups</a>: improving personal hygiene, and enforcing <a href="https://link.springer.com/article/10.1186/1471-2458-12-679">social distancing</a> to reduce the possibility of contact between infected and non-infected people. Australian <a href="https://link.springer.com/article/10.1186/1471-2458-9-117">research simulating and modelling social distancing</a> suggests this is likely to be effective against a novel virus, like the COVID-19 virus, if introduced quickly. </p>
<p><strong>1. Promote good hygiene and minimise activities that involve personal contact.</strong> </p>
<p>Schools can provide <a href="http://www.koreascience.or.kr/article/JAKO201223052005430.page">age-appropriate and repeated instruction</a> about personal hygiene and interpersonal physical contact. This includes: how to frequently wash hands, correct use of masks and gloves, strategies to avoid personal contact (such as no handshaking or sharing pens), and correct etiquette for sneezing and coughing (into elbow, turn away where possible).</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/IisgnbMfKvI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Schools can provide instruction on proper hand washing.</span></figcaption>
</figure>
<p>Schools can place sanitisers in high-traffic locations such as at the entrance to classrooms and gyms, and next to elevators and main hallways. They can also increase cleaning of contact surfaces such as stair rails, desks, computer lab stations and keyboards.</p>
<p><strong>2. Make changes to school timetables to minimise student exposure.</strong></p>
<p>These include staggering recess and lunch breaks to avoid having the whole school on the playground at one time and ensuring fewer students interact at break times. </p>
<p>Strategies should also be put in place for students moving between classrooms to avoid hallway crush. A wise step would be to rotate teachers between classrooms, not students.</p>
<p>Suspending <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/519F9392797E2DDCCA257D47001B9948/$File/Social-2019.PDF">large school events</a> and school excursions can also help.</p>
<p><strong>3. Ensure students who have returned from ANY overseas country self-isolate for at least two weeks.</strong> </p>
<p>The global spread of the virus, which is now at the <a href="https://www.bbc.com/news/world-51839944">pandemic stage</a>, is at the point that any air and cruise ship travel is a significant risk.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-your-child-getting-coronavirus-heres-what-you-need-to-know-131909">Worried about your child getting coronavirus? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<p><strong>4. Provide online education for quarantined and self-isolated students.</strong> </p>
<p>This responsibility will fall on states and territories and many have already developed online systems. The difficulty will be in lifting them to scale. UNESCO has provided a <a href="https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures/solutions">list of online resources to help support students</a>.</p>
<p><strong>5. Ensure vulnerable students are supported</strong></p>
<p>Extra support should be provided to vulnerable students and schools with high proportions of vulnerability. Australian Indigenous communities are at <a href="https://www.theguardian.com/world/2020/mar/06/indigenous-coronavirus-taskforce-meets-as-remote-communities-restrict-access">particular risk</a> from COVID-19 infection, as are students in special schools for those with disabilities. </p>
<p>Both these groups of students, who are often disadvantaged socioeconomically, will also need specialist support if they are to receive alternative education online.</p>
<h2>What about closing schools?</h2>
<p>According to UNESCO <a href="https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures">14 countries have closed schools</a> nationwide <a href="https://www.bbc.com/news/world-51737226">including Japan and Italy</a>. These are called proactive closures as they include schools where infections have not been identified. </p>
<p>A further 13 other countries, including Australia, have reported some closures of schools. Some of these are reactive, responding only when an infection is identified in a school. So far in Australia all school closures have been reactive.</p>
<p>There are variations in the length of time schools have closed and when decisions were made to close them. <a href="https://www.bbc.com/news/world-asia-51663182">Japan</a> issued a national directive for school closures when there were 186 confirmed infections in the country, compared to <a href="https://www.theguardian.com/world/2020/mar/04/italy-orders-closure-of-schools-and-universities-due-to-coronavirus">Italy</a> when there were 2,500. </p>
<p>A review of several studies suggests widespread, proactive <a href="https://bmjopen.bmj.com/content/bmjopen/3/2/e002149.full.pdf">school closures</a> have been effective at reducing the rate of new influenza cases, but research on the length of time they should be shut is inconclusive. </p>
<p>Evidence <a href="https://www.sciencedirect.com/science/article/pii/S1473309909701768#bib31">suggests that, during the 1918 influenza pandemic</a>, widespread school closures (it is not clear what proportions were proactive or reactive) and other non-pharmaceutical interventions in particular communities were associated with lower death rates. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-tips-on-what-to-tell-your-kids-about-coronavirus-133346">8 tips on what to tell your kids about coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>The rationale for closing schools during pandemics is that children are thought to be important vectors of transmission. They are more infectious and susceptible to most influenza strains, and high contact rates in schools favour transmission. </p>
<p>In the case of the 2009 swine flu H1N1 pandemic, <a href="https://www.sciencedirect.com/science/article/pii/S1473309909701768#bib31">60% of cases infected</a> were 18 years old or younger. But the COVID-19 seems to not affect children as much as the elderly. Children show milder symptoms and there are fewer infections among them. That said, they may still be significant vectors in transmission.</p>
<p>We need a <a href="https://www.health.gov.au/sites/default/files/documents/2020/02/australian-health-sector-emergency-response-plan-for-novel-coronavirus-covid-19_2.pdf">national approach</a> to virus containment and educational provision, with schools at the centre of our response to the COVID-19 pandemic.</p><img src="https://counter.theconversation.com/content/133432/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are several things Australian schools can do, that involve encouraging better hygiene and social distancing. They could close too, but that’s not always necessary.Rachel Wilson, Associate Professor in Education, University of SydneyWilliam Mude, Public Health Lecturer, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329052020-03-05T16:40:45Z2020-03-05T16:40:45ZCoronavirus and handwashing: research shows proper hand drying is also vital<figure><img src="https://images.theconversation.com/files/318345/original/file-20200303-66074-17luy9t.jpg?ixlib=rb-1.1.0&rect=36%2C45%2C5970%2C3962&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-washing-hands-before-operating-hospital-633360866">shutterstock/santypan</a></span></figcaption></figure><p>With the number of people infected with coronavirus increasing around the world on a daily basis, the World Health Organization (WHO) has advised everyone to <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">regularly and thoroughly clean their hands</a>. This can be either with an alcohol-based hand rub or with soap and water. The hope is that good hand hygiene will limit the spread of the virus.</p>
<p>To wash your hands effectively, it needs to be done with clean water and soap. Hands should be rubbed together for at least 20 seconds, followed by rinsing. The use of soap is particularly important for handwashing to be effective as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037063/">research</a> has shown that washing with soap significantly reduces the presence of microbes (viruses and bacteria) on hands. But one often overlooked part of handwashing is hand drying – which is also integral to effective hand hygiene. </p>
<p>Hand drying not only removes moisture from the hands but it also involves friction, which further reduces the microbial load and the environmental transfer of microorganisms. And the transmission of microbes is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809004/">more likely to occur</a> from wet skin than dry skin. </p>
<h2>How you dry matters</h2>
<p>But it’s not just as simple as drying your hands off in any old way, because how you dry your hands also matters. And this is particularly the case in hospitals and doctors surgeries.</p>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/1757177418815549">Our research review</a> has examined the importance of hand drying and the implications of wet hands for patients and healthcare workers. The findings highlight that hot air hand dryers and cloth roller towels can be a problematic way of drying your hands – especially in a hospital.</p>
<p>Our review mainly looked at the impact of hand drying on bacteria, not viruses. But what we found is still relevant when looking at the possible transmission and spread of coronavirus in hospitals and GP surgeries – particularly given the advice from the WHO regarding frequent handwashing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drying your hands properly removes a significant number of microorganisms after hand washing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drying-hands-after-cleaning-bubble-747331132">ALPA PROD/Shutterstock</a></span>
</figcaption>
</figure>
<p>Disposable paper towels offer the most hygienic method of hand drying. Indeed, warm air and jet air dryers are not recommended for use in <a href="https://europeantissue.com/pdfs/090402-2008%20WUS%20Westminster%20University%20hygiene%20study,%20nov2008.pdf">hospitals and clinics</a> for hygiene reasons. These types of hand dryers can increase the dispersion of particles and microorganisms into the air, contaminating the environment. </p>
<p>Cloth roller towels are also not recommended as they become a general use towel when the roll comes to an end – and can be a source of pathogen transfer to clean hands. </p>
<h2>Importance of hand drying</h2>
<p>Our review also found that the most appropriate methods for hand drying within a clinical environment – such as a hospital – differed to that recommended for public washrooms. This is because of the higher risk of contamination and cross-infection in hospitals. So while it is important to dry your hands properly wherever you are, paper towels are always the preferred option if you are in hospital as a patient or a visitor – or a member of staff.</p>
<p>As part of our review, we also looked at government policy on hand drying and found that disposable paper towels are recognised as being the quickest and most effective way of removing residual moisture that may allow for the transmission of microorganisms. This is good to know given the current concerns around the spread of the coronavirus. </p>
<p>In this sense, our research serves as a timely reminder that proper and effective hand drying is integral to hand hygiene whether you’re in a hospital, doctor’s surgery or just in the office.</p><img src="https://counter.theconversation.com/content/132905/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our findings also highlight that hot air hand dryers and cloth roller towels can be a problematic way of drying your hands.Julian Hunt, Research Officer Human and Health Sciences Central, Swansea UniversityJohn Gammon, Deputy Head of the College of Human and Health Sciences, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329152020-03-04T14:31:40Z2020-03-04T14:31:40ZYes, washing our hands really can help curb the spread of coronavirus<figure><img src="https://images.theconversation.com/files/318367/original/file-20200303-66064-lhrpi4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>Much of the media discussion about coronavirus revolves around diagnosis and management of suspected cases. But the first piece of advice that is essential for anyone worried about contracting the coronavirus is something your grandparents might have suggested: wash your hands. It’s at the top of the list of many of the players trying to prevent the spread of the disease. This includes the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">World Health Organisation</a> (WHO), the US Centers for Disease Control and Prevention and other health authorities around the world.</p>
<p>But, ask the cynics, could preventing the spread of disease really be as simple as washing my hands?</p>
<p>The answer is yes. Because the science says so.</p>
<p>Hand washing is a tried and true, <a href="https://www.cdc.gov/handwashing/why-handwashing.html">scientifically proven</a> preventive strategy that reduces the likelihood of transmitting both viral and bacterial borne diseases. It has been shown to decrease both respiratory and <a href="https://doi.org/10.1186/s12889-017-4746-1">diarrhoeal</a> diseases in countries across the world. One review <a href="https://doi.org/10.1002/14651858.CD004265.pub3">found</a> that hand washing reduced diarrhoea cases by 30%. This is because it prevented bacteria being transmitted from faeces to the mouth.</p>
<p>It may seem like a low-cost – and incredibly simple – intervention. But not emphasising it would be a huge missed opportunity.</p>
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Read more:
<a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">Why hand-washing really is as important as doctors say</a>
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<p>The American Centers for Disease Control and Prevention recommends the following five‑step approach:</p>
<p>1) Wet your hands and turn off the tap (to save water),</p>
<p>2) Lather,</p>
<p>3) Rub your hands together for at least 20 seconds (possibly while singing Happy Birthday twice),</p>
<p>4) Rinse, and</p>
<p>5) Dry.</p>
<p>Do this multiple times a day, especially before eating. Using hand sanitiser is another option, as long as it is composed of 60% or more alcohol.</p>
<p>The benefits of hand washing over other preventive measures are clear: soap is easy to access. Both soap and an alcohol-based products for cleaning hands are cost effective interventions.</p>
<p>But millions of us don’t wash our hands as often and as well as we should. A <a href="https://www.jpmph.org/journal/view.php?id=10.3961/jpmph.2007.40.3.197">study done</a> in South Korea indicated that 93.2% of 2,800 survey respondents did not wash their hands after coughing or sneezing.</p>
<h2>The history</h2>
<p>The current outbreak of the new coronavirus disease (COVID-19) was first reported on <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">31 December 2019</a> in Wuhan, China. By <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200302-sitrep-42-covid-19.pdf?sfvrsn=edd4f123_2">early March</a> 2020 more than 90,000 people from 71 countries had been infected. More than 3,000 people have died so far. It is not clear what the fatality rate is and this may not be known until the outbreak is over – but it has been quoted as around 2.5% by the WHO.</p>
<p>Other diseases carry much higher fatalities. For example, tuberculosis claims the lives of <a href="http://www.stoptb.org/assets/documents/global/plan/plan2/General%20TB%20Factsheet%20-%20November%202015%20final.pdf">4,100</a> people worldwide every day. And the Ebola virus <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">fatality rate is 50%</a>.</p>
<p>Nevertheless, the spread of the new virus has set off alarm bells, with China famously building two hospitals in <a href="https://qz.com/1792705/coronavirus-the-engineering-behind-wuhans-rapidly-built-hospitals/">10 days</a>, cruise ships being quarantined and cities effectively being <a href="https://www.nytimes.com/2020/03/02/business/economy/china-coronavirus-economy.html">shut down</a>.</p>
<p>The reason for the panic is that Corona-19 (more correctly named SARS-CoV-2) is a newly discovered virus. We don’t know exactly how infectious it is or who is at risk and why. As the WHO director-general said: we are entering <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020">uncharted territory</a>.</p>
<p>Apart from hand washing it’s important to try not to touch one’s face and not shake hands. Face masks are really only useful for those who already have the virus or are caring with someone known to have the virus. Proper use of face masks is <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">explained</a> by the WHO.</p>
<p>Consideration should also be given to the fact that a run on medical masks could cause a shortage for public health-care workers who need them for <a href="https://bhekisisa.org/health-news-south-africa/2020-02-21-south-africa-could-face-tb-mask-shortage-because-of-coronavirus-outbreak/">protection against other diseases</a> such as drug-resistant TB. This is particularly true in South Africa.</p>
<h2>What the science says about hand washing</h2>
<p>Research shows that hand washing isn’t just effective in preventing transmission of coronavirus. MIT recently conducted <a href="http://news.mit.edu/2020/slow-epidemic-airport-handwashing-0206">a study</a> to identify the most effective mitigation strategy for hand hygiene that could contribute most to the reduction of global epidemic risk. Researchers used modelling and data‐driven simulations.</p>
<p>The study found that if 60% of travellers moving through airports worldwide had clean hands, global disease spread could be curbed by almost 70%. And if this rate could be maintained in only 10 of the busiest airports internationally, an astounding 37% of infections could be prevented.</p>
<p>Research has also shown that hand washing can prevent about 30% of diarrhoea-related sicknesses and about 20% of <a href="https://www.cdc.gov/handwashing/why-handwashing.html">respiratory infections</a>. Some scientists go as far as to <a href="https://asthma.ca/wp-content/uploads/2017/08/asthma_handwashing_eng.pdf">argue</a> that 80% of diseases can be prevented by proper hand washing.</p>
<p>Not everyone is convinced. Hand washing has been treated with scepticism as a significant disease prevention and eradication measure by some who favour “hard science interventions”.</p>
<p>This is not without precedent.</p>
<p>A Hungarian-born physician in the mid-19th century, <a href="https://www.vinehealthcare.com/2020/02/15/ten-amazing-medical-breakthroughs/">Ignaz Semmelweis</a>, was ostracised and shunned by his colleagues because he was so bold as to make a link between decreased maternal mortality and hand washing for doctors who went directly from the dissection halls to deliver babies.</p>
<h2>Huge gaps</h2>
<p>Despite the growing body of research showing its effectiveness, hand washing habits are inadequate.</p>
<p>The MIT study assumes that 30% of people do not wash their hands at all after using a bathroom, and that correct hand washing is practised at such low rates that only 20% of people in airports actually have clean hands.</p>
<p>In South Africa, a national hand hygiene behaviour strategy estimated that only <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5573-8">20%</a> of South Africans washed their hands with soap at critical times such as before, during and after preparing food, after going to the toilet, after sneezing or coughing, after touching animals, after changing nappies of babies, and after caring for an ill person.</p>
<p>Hand washing is simple and should already be part of everyone’s daily routine. If it became a habit for everyone in the world, it would not just prevent mortality and illness from coronavirus. It could be the start of a more viable strategy to prevent death from other bacterial and viral diseases.</p>
<p>While the full implications of this global pandemic are still unfolding, and a <a href="https://theconversation.com/heres-why-the-who-says-a-coronavirus-vaccine-is-18-months-away-131213">vaccine</a> has yet to be developed, we need to act without delay using the one tool we already have.</p><img src="https://counter.theconversation.com/content/132915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the IDRC (Canada), UK Wellcome Trust, UK National Institutes for Health Research, Bloomberg Philanthropies and the South African Medical Research Council. In the past, she has also received funding from the Bill and Melinda Gates Foundation, WHO and UNFPA.</span></em></p><p class="fine-print"><em><span>Susan Goldstein is Associate Professor at the SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), School of Public Health, University of the Witwatersrand.
</span></em></p>Hand washing is a tried and true, scientifically proven preventive strategy that reduces the likelihood of transmitting both viral and bacterial borne diseases.Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandSusan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1266032020-02-06T19:04:03Z2020-02-06T19:04:03ZEarly exposure to infections doesn’t protect against allergies, but getting into nature might<figure><img src="https://images.theconversation.com/files/310417/original/file-20200116-181629-1a46wfy.jpg?ixlib=rb-1.1.0&rect=56%2C551%2C4658%2C2834&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-girl-having-fun-countryside-234031096">Katya Shut/Shutterstock</a></span></figcaption></figure><p>Over the past few decades, allergies and asthma have become common childhood diseases, especially in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69283-0/fulltext">developed countries</a>. Almost <a href="https://www.allergy.org.au/images/stories/reports/ASCIA_AIDA_Report_2013.pdf">20% of Australians</a> experience some kind of allergy, whether it’s to food, pollen, dust, housemites, mould or animals. </p>
<p>When people suffer from food allergies, hay fever or asthma, their immune system incorrectly believes the trigger substances are harmful and mounts a defence.</p>
<p>The response can range from mild symptoms, such as sneezing and a blocked nose (in the case of hay fever), to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaphylaxis">anaphylaxis</a> (from severe food allergies or bee stings) and asthma attacks.</p>
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Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
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<p>We used to think the rise in allergic conditions was because we weren’t exposed to as many early infections as previous generations. But the science suggests that’s not the case. </p>
<p>However it seems being out in nature, and exposed to diverse (but not disease-causing) bacteria, fungi and other microorganisms may help protect against asthma and allergies. </p>
<h2>Remind me, what’s the hygiene hypothesis?</h2>
<p>In 1989, researcher David Strachan examined allergy patterns in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/">more than 17,000 children in England</a>. He noticed young siblings in large families were less likely to have hay fever than older siblings or children from small families. </p>
<p>He proposed that these younger siblings were exposed to more childhood illness at a younger age, as more bugs were circulating in these large families and the younger children were less likely to wash their hands and practise good hygiene. </p>
<p>Greater exposure to these childhood infections helped “train” their immune systems not to overreact to harmless things like pollen. </p>
<p>Strachan coined the term “hygiene hypothesis” to explain this phenomenon, and the idea has been appealing to our dirty side ever since. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313857/original/file-20200206-149778-nxy4t1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Yes, it’s a good idea for kids to wash their hands regularly to avoid getting sick.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-washing-hand-soap-720854251">Wor Sang Jun/Shutterstock</a></span>
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<p>Strachan wasn’t the first to notice exposure to “dirty environments” seemed to prevent allergic disease. A century earlier, in 1873, Charles Blackley noted <a href="https://archive.org/details/b20418620/page/4">hay fever was a disease of the “educated class</a>”, and rarely occurred in farmers or people living in less sanitary conditions.</p>
<h2>Ditching the hygiene hypothesis</h2>
<p>However, Blackley and Strachan were wrong about one important thing: the association between sanitation and allergies is <em>not</em> due to reduced exposure to early childhood infections (or “pathogens”). </p>
<p>Large studies from <a href="https://www.ncbi.nlm.nih.gov/pubmed/15121716">Denmark</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/17909141">Finland</a>, and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18269673">United Kingdom</a> have found no association between the number of viral infections during childhood and allergic disease. In other words, exposure to disease-causing pathogens doesn’t appear to prevent allergies.</p>
<p>In fact, exposure to childhood viral infections, in addition to making a child sick, <a href="https://www.sciencedirect.com/science/article/pii/S0091674907002382">may contribute to the development of asthma</a> in predisposed children.</p>
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Read more:
<a href="https://theconversation.com/what-causes-asthma-what-we-know-dont-know-and-suspect-96409">What causes asthma? What we know, don't know and suspect</a>
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<p>Many researchers now argue the term “hygiene hypothesis” is not only inaccurate <a href="https://journals.sagepub.com/doi/abs/10.1177/1757913916650225">but potentially dangerous</a>, because it suggests avoiding infection is a bad thing. It’s not. </p>
<p>Good hygiene practices, such as hand washing, are critical for reducing the spread of infectious <a href="https://www.sciencedirect.com/science/article/pii/S0140673615601271">and potentially deadly diseases such as influenza</a> and the <a href="https://www.who.int/csr/don/17-january-2020-novel-coronavirus-japan-ex-china/en/">Wuhan coronavirus</a>.</p>
<h2>What about ‘good’ exposure to bacteria?</h2>
<p>For healthy immune function, we need exposure to a diverse range of bacteria, fungi and other bugs – known as microbes – in the environment that <em>don’t</em> make us sick.</p>
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<img alt="" src="https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313862/original/file-20200206-149778-1u4obxw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">We need exposure to a range of organisms found in nature.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-blonde-haired-boy-australian-bush-1606807921">caseyjadew/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
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<p>Within urban environments, recent research shows <a href="https://esajournals.onlinelibrary.wiley.com/doi/abs/10.1002/fee.2077">people who live closer</a> to green, biodiverse ecosystems tend to be healthier, with less high blood pressure and lower rates of diabetes and premature death, among other things.</p>
<p>More specifically, <a href="https://www.nature.com/articles/nri2871">research has found</a> growing up on a farm or near forests, with exposure to more biodiverse ecosystems, reduces the likelihood of developing asthma and other allergies. </p>
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Read more:
<a href="https://theconversation.com/children-living-in-green-neighbourhoods-are-less-likely-to-develop-asthma-96190">Children living in green neighbourhoods are less likely to develop asthma</a>
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<p>This is potentially because exposure to a diversity of organisms, with a lower proportion of human pathogens, has “trained” the immune system not to overreact to harmless proteins in pollen, peanuts and other allergy triggers.</p>
<h2>How can we get more ‘good’ exposure?</h2>
<p>We can try to expose children to environments more like the ones in which humans, and our immune systems, evolved. </p>
<p>Most obviously, children need to have exposure to green space. Playing outdoors, having a garden, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/25388016">living near green space</a> (especially near <a href="http://www.pnas.org/content/early/2012/05/01/1205624109.short">a diverse range of native flowering plants</a>) is likely to expose them to more diverse microbes and provide greater protection from allergic diseases. </p>
<p>Infants who are breastfed tend to have more diverse gut microbiomes (a larger variety of bacteria, fungi and other microscopic organisms that live in the gut), which makes them <a href="https://www.ncbi.nlm.nih.gov/pubmed/21782228">less likely to develop allergic diseases</a> in childhood.</p>
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Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
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<p>Having a varied diet that includes fresh and <a href="https://www.sciencedirect.com/science/article/pii/S095816691630266X">fermented foods</a> can help cultivate a healthy gut microbiome and reduce allergic disease. As can <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.2004.06436.x">using antibiotics only when necessary</a>, as they kill off good bacteria as well as the bad.</p>
<p>So keep washing your hands, especially in cities and airports, but don’t be afraid of getting a little dirty in biodiverse environments. </p>
<p><em>This article was co-authored by Chris Skelly, International Programme Director, <a href="https://www.humi.site/">Healthy Urban Microbiomes Initiative</a> and Head of Programmes (Research and Intelligence), Public Health Dorset.</em></p><img src="https://counter.theconversation.com/content/126603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Johnston Flies helps lead the Healthy Urban Microbiome Initiative, a non-profit developed to understand and recreate the immune-boosting power of biodiverse microbial exposure in our cities. Emily's salary is currently funded through an Australian Research Council (ARC) Laureate Fellowship (awarded to Prof Barry Brook) at the University of Tasmania.</span></em></p><p class="fine-print"><em><span>Philip Weinstein receives funding from The Environment Institute, University of Adelaide.</span></em></p>We used to think the rise in allergies was because we weren’t exposed to as many early infections as previous generations. But that’s not the case.Emily J Flies, Postdoctoral Research Fellow (U.Tasmania), University of TasmaniaPhilip Weinstein, Professorial Research Fellow, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1221852019-09-02T02:00:36Z2019-09-02T02:00:36ZHow clean is your hospital room? To reduce the spread of infections, it could probably be cleaner<figure><img src="https://images.theconversation.com/files/288847/original/file-20190821-170941-1l7zzzz.jpg?ixlib=rb-1.1.0&rect=31%2C7%2C5246%2C3505&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hospital cleaning is an important way to prevent the spread of infections.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Imagine you need to go into hospital. First, you are likely to be seen in the emergency department, and then moved to a ward room for further treatment and recovery. </p>
<p>Unknown to you, the last patient in your room had an infection caused by a multi-drug resistant pathogen (bug) – meaning the standard antibiotics can’t fight it.</p>
<p>Unfortunately, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26365827">research suggests</a> if you are admitted to a room where the last patient had this kind of infection, you are significantly more likely to be infected by that same pathogen than if you were admitted to a room where the last patient wasn’t infected. </p>
<p>The consequences of a hospital infection can be serious, including a much longer stay in hospital and even death.</p>
<p>However, transferring the pathogen from patient to room to patient is less likely when the room is thoroughly cleaned.</p>
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Read more:
<a href="https://theconversation.com/1-in-10-patients-are-infected-in-hospital-and-its-not-always-with-what-you-think-120095">1 in 10 patients are infected in hospital, and it's not always with what you think</a>
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<p>All Australian hospitals employ cleaning staff who play an important role in patient safety. But some of this cleaning could be more effective.</p>
<p>Our research team developed a “bundle” of <a href="https://doi.org/10.1016/j.jmii.2015.02.112">evidence-based</a> hospital cleaning initiatives, and trialled this across 11 Australian hospitals. </p>
<p>We found it <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30714-X/fulltext">reduced the incidence of hospital-acquired infections</a>. And in a paper <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz717/5540717">recently published</a>, we estimate implementing this bundle across the 11 hospitals saved more than A$1 million in health-care costs.</p>
<h2>Reducing infection risk</h2>
<p>Infections during a hospital stay affect <a href="https://theconversation.com/1-in-10-patients-are-infected-in-hospital-and-its-not-always-with-what-you-think-120095">one in ten patients</a>.
Hospital staff are aware of the dangers of infections, and reduce the risks by keeping their hands clean. </p>
<p>But staff and visitors can still transfer pathogens to patients, because these pathogens can remain dormant (but still alive) on surfaces for a long time. Some pathogens can survive in hospitals for days, or even months. </p>
<p>We can break the cycle of infection by creating cleaner hospitals with fewer dormant pathogens.</p>
<p>Hospital-grade cleaning products kill or remove common pathogens. But the product used is just one element of cleaning – the right technique is also important. Technique includes using the product according to the instructions, not contaminating already clean areas, using sufficient pressure to clean, and cleaning in the right spots.</p>
<p>Frequently touched surfaces such as light switches, emergency call-bells and bed rails are commonly contaminated with pathogens. These surfaces require extra cleaning.</p>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-superbugs-and-how-can-we-control-them-44364">Explainer: what are superbugs and how can we control them?</a>
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<p>How frequently cleaning needs to occur in hospitals and the best methods to use are disputed. Decisions are complicated because you can’t see the bugs with the naked eye. </p>
<p>In Australia, there is considerable <a href="https://www.idhjournal.com.au/article/S2468-0451(17)30080-9/fulltext">variation in approaches to hospital cleaning</a> including in the use of cleaning products, the type of auditing used to check cleaning, and the training cleaning staff receive.</p>
<h2>A cleaning ‘bundle’</h2>
<p>Our research team developed a “bundle” of hospital cleaning initiatives based on expert opinion and <a href="https://doi.org/10.1016/j.jmii.2015.02.112">scientific evidence</a>. This included the use of a fluorescent gel, training and feedback to cleaning staff. </p>
<p>The fluorescent gel is invisible to the naked eye, but visible under a UV light. The gel is applied to surfaces before cleaning, and auditors can use the UV light to determine whether a surface was thoroughly cleaned.</p>
<p>After cleaning, if it’s been done properly, the gel should no longer be visible. <a href="https://www.ncbi.nlm.nih.gov/pubmed/18851687">Research has shown</a> this approach, when combined with constructive feedback to cleaning staff, can greatly improve cleaning.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288849/original/file-20190821-170906-agvn5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Although a room may look clean, it doesn’t mean bugs aren’t lurking.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<p>We applied our cleaning bundle in 11 Australian hospitals and examined cleaning performance and infection rates before and after the change to cleaning. Our approach <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30714-X/fulltext">reduced the risk</a> of an important drug-resistant bacteria (vancomycin-resistant enterococci) by 37%. </p>
<p>We also saw an improvement in cleaning success, measured by how often the florescent gel was removed after cleaning. Effective cleaning of frequently touched surfaces in patients’ rooms improved from 64% at the start of the trial to 84% at the end.</p>
<h2>Investing in cleaners and cleaning</h2>
<p>Spending money on improvements to cleaning practice should be given the same consideration as expensive new machines or new drugs. Improving cleaning reduces the risk of infection, which in turn saves lives, means fewer longer stays in hospital and the intensive care unit, and saves money. </p>
<p>We estimate the infections prevented by the cleaning “bundle” saved <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz717/5540717">more than A$1 million in health benefits across the 11 hospitals</a> by reducing treatment costs and length of hospital stays. </p>
<p>Of course, cleaning is not the only answer to dealing with hospital-acquired infections. Hand hygiene, identifying and isolating patients with certain infections, and correct insertion and maintenance of devices such as urinary catheters and drips are all important ways to reduce the spread of infections. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/infections-complications-and-safety-breaches-why-patients-need-better-data-on-how-hospitals-compare-86748">Infections, complications and safety breaches: why patients need better data on how hospitals compare</a>
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<p>While the risk of infection for patients will never be zero, <a href="https://www.ajicjournal.org/article/S0196-6553(18)30076-2/fulltext">cleaning staff play an important role</a> in patient safety. Yet they often go unrecognised. </p>
<p>Next time you visit a hospital, why not thank a member of the cleaning team for their role in reducing your risk of infection.</p>
<p>And patients should remember it’s more difficult to clean when tables, chairs and rooms are full of items. So reducing clutter will make it easier for cleaning staff to do their job.</p><img src="https://counter.theconversation.com/content/122185/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Mitchell has received funding from the National Health and Medical Research Council (Australia), the HCF Foundation, Australasian College for Infection Prevention and Control and industry grants.
The REACH study was funded by the National Health and Medical Research Council (Australia) as a 2014–17 Partnership Project (GNT1076006), led by Queensland University of Technology in conjunction with Wesley Medical Research.
Brett Mitchell is Editor-in-Chief of Infection Disease and Health, an international, peer-reviewed journal. </span></em></p><p class="fine-print"><em><span>Adrian Barnett receives funding from the National Health and Medical Research Council (Australia), including for the REACH study which was as a 2014–17 Partnership Project (GNT1076006), led by Queensland University of Technology in conjunction with Wesley Medical Research. </span></em></p>If hospitals are not thoroughly cleaned, patients may be at higher risk of infection. We tested a new approach to hospital cleaning, and found it could reduce infections and save money.Brett Mitchell, Professor of Nursing, University of NewcastleAdrian Barnett, Professor of Statistics, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/981522018-06-14T05:58:51Z2018-06-14T05:58:51ZResearch Check: can tea towels cause food poisoning?<figure><img src="https://images.theconversation.com/files/223142/original/file-20180614-32313-n2bp35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Let your tea towel dry out after each use to reduce its bacterial load.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/profile-view-young-couple-washing-drying-295734776?src=SoUw9BDl2nbZNp2E-luduQ-1-5">Shutterstock/antoniodiaz</a></span></figcaption></figure><p>Aside from being up to the task of drying our dishes, we don’t usually give the humble tea towel much thought. But this week it’s being blamed for causing food poisoning: </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1005589963403091968"}"></div></p>
<p>But there’s no cause for concern.</p>
<p>Yes, bacteria can accumulate on tea towels, especially when they’re infrequently washed and don’t dry out between use. But most of the bacteria the researchers found on tea towels are not responsible for food poisoning or other gastrointestinal symptoms.</p>
<p>While the media reports focused on the food poisoning risk, the research didn’t actually look at the participants’ gastrointestinal health. </p>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">Explainer: what is gastroenteritis and why can't I get rid of it?</a>
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<h2>How was the research conducted?</h2>
<p>The story came about from a <a href="http://www.abstractsonline.com/pp8/#!/4623/presentation/15470">June 9 poster presentation</a> to the American Society of Microbiology’s 2018 meeting in Atlanta, based on research carried out at the University of Mauritius. </p>
<p>The Mauritian researchers purchased <a href="https://www.medpagetoday.com/meetingcoverage/asmmicrobe/73401">100 tea towels</a> to give to the study participants; 36 were a mixture of cotton and nylon, 33 were pure nylon, and 31 were pure cotton. </p>
<p>After one month of use, the towels were collected to “culture” any bacteria present on them. This means taking bacterial samples and letting them grow in a petri dish to determine the type of organism. </p>
<p>The participants also completed a questionnaire about their tea towel use, diet and family size. </p>
<p>The research did not look at whether the participants had food poisoning or other gastrointestinal illnesses. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/food-safety-are-the-sniff-test-the-five-second-rule-and-rare-burgers-safe-92661">Food safety: are the sniff test, the five-second rule and rare burgers safe?</a>
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<h2>What were the results?</h2>
<p>Bacterial growth was found in 49% of the kitchen towels. Cotton towels had higher levels of bacteria than nylon towels or a mixture of the two. </p>
<p>Bacterial growth increased significantly with increased family size and the presence of children. </p>
<p>Tea towels which were considered “multipurpose” – such as for cleaning table and bench tops in addition to the kitchen – had higher levels of bacteria than towels that were “single purpose”, such as drying hands and dishes in the kitchen.</p>
<p>The researchers found “humid” (or moist) towels had significantly greater concentrations of certain types of bacteria, such as coliforms. <a href="https://www.health.ny.gov/environmental/water/drinking/coliform_bacteria.htm">Coliforms</a> are a broad class of bacteria found in the digestive tract of animals including humans, and are found in their faeces. Although most coliforms are harmless, some rare strains can cause serious illness. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Washing your tea towel after each use is ideal but often not practical.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tea-towels-on-washing-line-blowing-2273449?src=MGp9rFsLGUgTnC3CsNB_7Q-1-79">Sean Nel/Shutterstock</a></span>
</figcaption>
</figure>
<p>They also found that <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/staphylococcus-aureus-golden-staph">Staphylococcus aureus</a> (S. aureus), a common baterium that lives on the skin, was isolated at a significantly higher rate from families of lower socioeconomic status and families with children, as well as bigger families. </p>
<p>They looked at the influence of diet. Coliform and S. aureus were detected on tea towels at a significantly higher rate from families on non-vegetarian diets.</p>
<p>A higher prevalence of enterococcus species was detected on the kitchen towels of vegetarian families. <a href="http://www.stjames.ie/Patients/Infectionpreventioncontrol/VRE.pdf">Enterococci</a> are bacteria which are normally found in a person’s gastrointestinal tract and do not normally cause infections in healthy people, but may in those with a weakened immune system. </p>
<h2>What does it all mean?</h2>
<p>The research is interesting but shouldn’t cause concern. The majority of bacteria identified were enterococcus and pseudomonas species which are not classically involved with <a href="http://www.foodstandards.gov.au/consumer/safety/foodpoison/Pages/default.aspx">food poisoning</a> unlike campylobacter, salmonella, escherichia and listeria species. </p>
<p>But there are some practical points to take away from the research.</p>
<p>For the best protection, <a href="https://www.food.gov.uk/sites/default/files/media/document/cloths.pdf">wash the tea towel after every use</a>. But most of us are unlikely to do this, so waiting until tea towels are dry is okay, as drier tea towels will have a lower bacteria load. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-most-hygienic-way-to-dry-your-hands-54196">What's the most hygienic way to dry your hands?</a>
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<p>It’s best to use tea towels for a single purpose such as drying the dishes, rather than multiple purposes. This will reduce the towel’s bacterial load. </p>
<p>Disposable paper towels are less likely to accumulate bacteria than tea towels that are used multiple times, but the research is yet to establish whether they lessen the risk of gastroenteritis.</p>
<p>Surprisingly, tea towels are not the dirtiest item in the kitchen. <a href="http://www.nsf.org/consumer-resources/studies-surveys-infographics/germ-studies/germiest-items-home">More than 75% of dish sponges/rags</a> contain bacteria. Yet most people who use dish sponges/rags with their hands don’t get gastroenteritis. </p>
<h2>What else do we need to take into account?</h2>
<p>What we don’t know in this research is what the participants were using for kitchen cleaning before being given the tea towels. Were they using tea towels, a rag or disposable wipes? </p>
<p>We also don’t know how frequently participants cleaned their assigned tea towels and what they used to clean them.</p>
<p>The bacterial growth was found to increase significantly with increased family size, extended family and the presence of children. But does that mean the family members and/or children were using the tea towels more or could it be due to other factors such as children playing outdoors in a dirty environment and bringing organisms back to the house? That was not addressed in the poster.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s best to use a different cloth to wipe down benches.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/RjZjYwimO6Y">Nick Karvounis</a></span>
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<p>Generalising the findings to different countries may be a problem. Mauritius is a <a href="https://en.wikipedia.org/wiki/Mauritius">tropical country</a> and the type and quantity of bacteria on tea towels there could very well be different than in a country with a colder, temperate climate.</p>
<p>Finally, this research was a poster presentation at the American Society of Microbiology meeting this year. The process of getting research published in a peer reviewed journal is a more intense and exhaustive process, which helps to iron out any flaws in the methodology or findings that may not be obvious to the investigators at the time. </p>
<p>So it’s helpful to wait for the formal publication which will have gone through the peer review process before we can extrapolate more conclusions. – <strong>Vincent Ho</strong></p>
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<h2>Blind peer review</h2>
<p>This Research Check accurately reflects the abstract. This study is <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/news-flash-world-isnt-sterile/2018/04/01/">one of many</a> that look at bacterial contamination of household items, without reference to more relevant outcomes such as illness rates.
– <strong>Allen Cheng</strong></p><img src="https://counter.theconversation.com/content/98152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Cheng receives funding from the Australian National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, bacteria can accumulate on tea towels. But most of the bacteria the researchers found are not responsible for food poisoning or other gastrointestinal symptoms.Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/869302018-02-01T17:57:00Z2018-02-01T17:57:00ZWhat are school sores and how do you get rid of them?<figure><img src="https://images.theconversation.com/files/203007/original/file-20180123-182965-1180o5w.jpg?ixlib=rb-1.1.0&rect=0%2C1334%2C3538%2C1528&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The usual culprit is the bacterium _Staphylococcus aureus_, better known as “golden staph”.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/698395990?src=5oGzvQ_ZB3yKGJB3Xjhv3g-2-30&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>Impetigo, or “school sores”, is a contagious infection of the very top layer of skin. It’s <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136789">most common</a> in children aged two to six, and ends up spreading from child to child in schools and daycare centres, but can affect children and adults of all ages. </p>
<p>The good news is that it’s unlikely to cause serious harm. It usually clears up within a few weeks, without any scarring. </p>
<p>The usual culprit is the bacterium <em>Staphylococcus aureus</em>, better known as “golden staph”. <em>S. aureus</em> can cause serious infections, and has a fearsome reputation. But the bacteria <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/staphylococcus-aureus-golden-staph">commonly lives on skin</a>, lurking in the groin and nostrils without causing problems.</p>
<p>A second type of bacteria that causes impetigo is <em>Streptococcus pyogenes</em>, commonly known as “strep”. <em>S. pyogenes</em> can cause other infections such as tonsillitis and pharyngitis. In fact, it is often the “strep” responsible for “strep throat”. </p>
<p>Strep impetigo is more prevalent in rural and remote communities. It is also more common in institutional settings such as aged care facilities, boarding schools, and prisons.</p>
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Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
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<p>Impetigo <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/impetigo-school-sores">appears on the skin</a> one to three days after being infected by staph, or four to ten days after catching strep. It can occur on sores from scratches, insect bites and eczema, or on healthy skin. </p>
<p>The sores begin as red areas, or crops of small blisters, most commonly around the nose and mouth, and on the arms and legs. The sores then burst and begin to weep, before drying with a golden-coloured scab, often referred to as a “honey-crust”.</p>
<h2>Treatment</h2>
<p>While impetigo is unlikely to cause problems in healthy people, it’s important to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">see a GP for an accurate diagnosis</a>.</p>
<p>If only a small crop of sores is present, frequent washing with soap and water might be all that is needed. A prescription antibiotic ointment can also be used. </p>
<p>If the sores are more widespread, or there is evidence of infection spreading into the deeper skin (cellulitis), oral antibiotics are often necessary.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/when-should-you-take-antibiotics-42751">When should you take antibiotics?</a>
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<p>Parents can speed up the healing process by removing the crusts two to three times a day. This is done by soaking the skin in a warm bath, then wiping the scabs away gently with a clean face washer and patting dry with a fresh towel. Sores should be completely covered by waterproof bandages.</p>
<p>To prevent other family members catching the infection, don’t share any towels, face washers, clothes and bed linen, and put them on a hot wash. The infected person should use a fresh towel and washer every time they bathe, and keep their nails short. </p>
<p>Kids are generally ready to go back to school once they’ve had 24 hours of antibiotics and if the sores are covered with dressings. For children not taking antibiotics, public health authorities recommend that <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">children only return to school</a> when the sores are completely healed.</p>
<h2>Complications</h2>
<p>Impetigo can occasionally lead to a further, dangerous infection. If children are feverish or lethargic, sores are spreading despite antibiotics, or you’re concerned your child looks unwell, see a doctor. </p>
<p>Newborns and babies are also at higher risk of serious complications due to their immature immune systems, and so get it checked out at the first sign of infection.</p>
<p>One possible reason for sores not improving on standard antibiotics is infection by an antibiotic-resistant bacteria. Infections due to antibiotic-resistant golden staph, MRSA (methicillin-resistant <em>Staphylococcus aureus</em>), are becoming more widespread, largely due to the widespread use of antibiotics. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccine-for-strep-throat-and-rheumatic-fever-to-be-trialled-in-humans-63390">Vaccine for strep throat and rheumatic fever to be trialled in humans</a>
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<hr>
<p>An <a href="https://www.mja.com.au/journal/2017/207/9/increasing-importance-community-acquired-methicillin-resistant-staphylococcus">Australian study</a> in the Hunter area of New South Wales looked at all staph infections diagnosed in the region from 2008 to 2014. Nearly 20% were drug-resistant strains. </p>
<p>For most children, though, the infection is mild and fleeting. Keep an eye on the sores, and see your GP for a diagnosis, but try not to worry if it’s a standard case. </p>
<hr>
<p><em>Dr Kristen Ochs, a GP registrar at the academic General Practice Unit, Fairfield Hospital and Ingham Institute of Applied Medical Research, co-wrote this article.</em></p><img src="https://counter.theconversation.com/content/86930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Tam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>School sores usually clear up within a few weeks, without any scarring. Here’s what to do if you suspect your child has them.Michael Tam, General Practitioner, and Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/871582017-12-13T14:42:41Z2017-12-13T14:42:41ZYou (and most of the millions of holiday travelers you encounter) are washing your hands wrong<figure><img src="https://images.theconversation.com/files/198569/original/file-20171211-27683-1ijbp5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not all bathrooms are clean, which poses a problem for holiday travelers trying to keep their hands clean. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rusty-dirty-sink-655676143?src=2juk6xEtsYn1nsFzmKiExg-1-29">Seroma72/Shutterstock.com </a></span></figcaption></figure><p>For my fourth-grade science fair project, I tested different soaps to see which ones were the most effective at keeping my hands clean. </p>
<p>Now, nearly 20 years later as a microbiology doctoral candidate, I can’t help but think, “Ugh, the fourth-grade me was such an amateur scientist!” </p>
<p>My experiment lacked obvious control groups and ultimately asked the wrong question. Instead of asking which brand of soap was the most “effective” and classifying all bacteria as germs, I should have been investigating how to prevent the growth and spread of specific disease-causing bacteria, or pathogens.</p>
<p>This question is difficult to answer. You can’t tell by eye which bacteria growing within a petri dish are the “good guys” versus ones that cause disease, and some pathogenic microbes, like viruses, can’t be detected within agar petri dishes. </p>
<p>Nevertheless, with the upcoming holiday travels, asking how to prevent the spread of disease-causing pathogens isn’t just for aspiring microbiologists but a great question for everyone.</p>
<p>Do we really stand a chance of keeping our hands clean from germs?</p>
<h2>Two-fisted approach</h2>
<p>There are two main strategies. </p>
<p>The first is to decrease the overall biomass of microbes – that is, decrease the amount of bacteria, viruses and other types of microorganisms. We do this by lathering with soap and rinsing with water. Soap’s chemistry helps remove microorganisms from our hands by accentuating the slippery properties of our own skin.</p>
<p>Studies have shown that effectively <a href="https://www.ncbi.nlm.nih.gov/pubmed/15173145">washing with soap and water</a>significantly reduces the bacterial load of diarrhea-causing bacteria. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198567/original/file-20171211-27686-vibmly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Washing hands with warm soap and water is the best way to keep your hands clean.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hygiene-cleaning-hands-washing-soap-630315251?src=KMSzfDIzHKwmAgJIJze_bw-1-0">r.classen/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>The second strategy is to kill the bacteria. We do this by using products with an <a href="http://emerald.tufts.edu/med/apua/about_issue/agents.shtml">antibacterial agent</a> such as alcohols, chlorine, peroxides, chlorhexidine or triclosan. </p>
<p>Some academic work has shown that <a href="https://www.ncbi.nlm.nih.gov/pubmed/28876132">antibacterial soaps </a> are more effective at reducing certain bacteria on soiled hands than soaps without them. </p>
<p>However, there’s a problem. Some <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Triclocarban#section=Top">bacterial cells</a> on our hands may have genes that enable them to be resistant to a given antibacterial agent. This means that after the antibacterial agent kills some bacteria, the resistant strains remaining on the hands can flourish. </p>
<p>Further, the genes that allowed the bacteria to be resistant could pass along to other bacteria, causing more resistant strains. Together, the “take-over” of resistant strains would render the use of the antibacterial agent essentially ineffective. </p>
<p>Also, the long-term use of some <a href="https://www.ncbi.nlm.nih.gov/pubmed/28504614">antibacterial products</a> may harm your health. </p>
<p>For example, animal studies investigating the antibacterial agent triclosan, which used to be in soaps, toothpastes and deodorant, has been shown to alter the way <a href="https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm">hormones work in the body</a>. The Food and Drug Administration has prohibited the use of over-the-counter antiseptic wash products containing triclosan and many other antibacterial active ingredients. </p>
<p>With this in mind, you may want to stick with plain old soap and water.</p>
<h2>Best practices</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198573/original/file-20171211-27714-1ichuov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Kids traveling during the holidays often have a hard time keeping their hands clean, just as adults do.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/christmas-car-travel-happy-kids-winter-717864226?src=9Obj5yFsFT8Oe_PU0fa7jw-1-37">NadyaEugene/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>To clean our hands, the Centers for Disease Control and Prevention <a href="https://www.cdc.gov/handwashing/when-how-handwashing.html">recommends </a>that we: </p>
<ul>
<li>wet hands with clean water. </li>
<li>apply soap and lather/scrub every nook and cranny of your hands for 20-30 seconds (about the time to sing “Happy Birthday” twice).</li>
<li>rinse well with clean running water.</li>
<li>dry hands with a clean paper towel or air-dry.</li>
</ul>
<p>I was shocked to read a study that indicated that <a href="https://www.ncbi.nlm.nih.gov/pubmed/17577074">93.2 percent</a> of 2,800 survey respondents did not wash their hands after coughing or sneezing. Also, one study showed that across a college-town environment with observations of 3,749 people, the average hand-washing time was approximately <a href="https://www.ncbi.nlm.nih.gov/pubmed/23621052">six seconds</a>! </p>
<p>If soap and water are not unavailable, the CDC recommends using an alcohol-based <a href="https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html">hand sanitizer </a> that contains at least 60 percent ethanol. Alcohols have a broad-spectrum of antimicrobial activity and are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/">less selective for resistance</a> compared to other antibacterial chemicals. </p>
<p>However, alcohol-based hand <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600642/">sanitizers may not work</a> on all classes of germs. </p>
<h2>Not all microbes are germs</h2>
<p>The presence of some bacteria isn’t necessarily a bad thing.</p>
<p>In the lab where I am pursuing my dissertation, our focus is understanding the complex interactions between animal hosts and bacteria. I would be remiss to not mention that the bacteria that live on or within us are essential for us as hosts, especially considering their role in protecting us from pathogens.</p>
<p>We live in a microbial world: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848870/">Trillions of different bacteria </a>colonize our skin, gut, and orifices. Collectively with yeast and viruses, they are called our microbiota. A plethora of exciting research suggests that the associations of animal hosts with their microbiota are not rare occurrences but in fact are fundamentally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848870/">important for the host’s biology</a>. </p>
<p>Our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056765/">microbiota can protect us</a> from germs by training our immune system and by <a href="https://www.ncbi.nlm.nih.gov/pubmed/21036098">colonization resistance</a>): the characteristic of the intestinal microbiota to block colonization of pathogens. </p>
<p>Although more research needs to be done to understand the intricate interactions between microbial communities with host cells, consistent work illustrates that a diverse population of <a href="https://www.ncbi.nlm.nih.gov/pubmed/28292977">microbes</a> and a balance of this community is important for our health. </p>
<p>Poor diet, lack of sleep, stress and antibiotic use can negatively perturb our microbiota communities, which in turn can put us at <a href="https://www.ncbi.nlm.nih.gov/pubmed/23435359">risk for diseases </a>. In fact, it is becoming clear that our microbiota are active participants in preventing and sometimes driving disease, depending on the state of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26638069">microbial communities </a>. </p>
<p>So what is the take-home message? </p>
<p>There is no doubt that <a href="https://www.ncbi.nlm.nih.gov/pubmed/28258814">washing our hands</a> with liquid soap and water is effective in reducing the spread of infectious microorganisms, including those that are resistant to antimicrobial agents.</p>
<p>When you don’t have the opportunity to wash your hands after touching questionable surfaces, use an alcohol-based hand sanitizer. Limit the touching of your hands to your mouth, nose and eyes. </p>
<p>Further, maintain a healthy microbiota by limiting stress, getting enough sleep and “fertilizing” your gut microbes with a diversity of plant-based foods. It’s not only a small world, but a dirty one as well.</p><img src="https://counter.theconversation.com/content/87158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Sconce Massaquoi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With holiday travel in full swing and people packed together in small spaces, it’s important to try to stop the spread of germs. But can we really get our hands clean with a few seconds of cold water?Michelle Sconce Massaquoi, Doctoral candidate, microbiology, University of OregonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/666902016-10-20T15:29:06Z2016-10-20T15:29:06ZEquitable access is key to meeting water, sanitation and hygiene targets<figure><img src="https://images.theconversation.com/files/142318/original/image-20161019-20336-ip8sko.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman carries water she has collected from the Turkwel River near Lodwar in Turkana County, north-west Kenya.</span> <span class="attribution"><span class="source">Rob Hope/REACH</span></span></figcaption></figure><p>The UN’s millennium development goal target of halving the amount of people with access to safe drinking water has been met. The same is sadly not true of the sanitation target. And the transition to the <a href="https://sustainabledevelopment.un.org/sdgs">sustainable development goals</a> for water and sanitation has created even more ambitious targets. These will require real change within this sector to achieve them by the 2030 deadline.</p>
<p><a href="https://sustainabledevelopment.un.org/sdg6">Goal 6</a> of the sustainable development goals, released in 2015, involves ensuring availability and sustainable management of water and sanitation for all. The indicators which will be used to track progress were only <a href="http://unstats.un.org/unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-E.pdf">agreed in March</a> 2016. It’s early days, so changes and shifts might not be visible to those outside the sector. </p>
<p>I’m happy to report that there are shifts towards greater equity in access – which is important because, as research has previously shown, progress in the provision of water and sanitation tends to benefit wealthier populations. The poor are left out in the cold.</p>
<p>The sustainable development goals aim to provide access to all. but to achieve this will take major changes in the sector. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=231&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=231&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=231&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=290&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=290&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=290&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Targets for access to water, sanitation and hygiene: then and now.</span>
</figcaption>
</figure>
<h2>Equality in access</h2>
<p>The millennium development goal focus of halving the number of people without access to water meant that the target could be achieved without helping the poorest. By 2012, <a href="http://www.wssinfo.org/">the Joint Monitoring Programme, or JMP,</a> analysed progress toward the targets by wealth. This highlighted how progress was often greatest for the wealthiest, while there was little change <a href="http://www.wssinfo.org/documents/?tx_displaycontroller%5btype%5d=wealth_quintiles">for the poorest</a>. </p>
<p>Senegal is an example how different progress can be for the richest and poorest in a country which met the MDG target on water. The progress the country made was unequal. In urban areas, access to improved water sources decreased for the poorest between 1995 and 2012. In rural areas, rapid progress for the second wealthiest group still left them 17 years behind that of the wealthiest.</p>
<p>Across the sector there is now a focus on how to extend access to water, sanitation and hygiene services to those who are most marginalised, but also to those who are least able to afford to pay. The target is to make water affordable for all. But this is the one area not currently captured in the SDG indicators. Extending sustainable services to all will require different financing models to address both construction and maintenance, and this remains a key topic under discussion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Senegal met the MDG target for water, but progress was unequal.</span>
<span class="attribution"><span class="source">WHO/UNICEF Joint Monitoring Programme</span></span>
</figcaption>
</figure>
<h2>A better level of access</h2>
<p>There are three key critical areas in which the bar for what is considered access is being raised: safer water quality, integration of hygiene, and safe management of sanitation.</p>
<p>By the end of the MDG period it was clear that <a href="http://www.wssinfo.org/definitions-methods/watsan-categories/">improved water sources</a> did not equate to safe drinking water. A rapid assessment of <a href="http://www.wssinfo.org/water-quality/">drinking-water quality</a> in five countries – Ethiopia, Jordan, Nicaragua, Nigeria and Tajikistan – demonstrated the gap between improved water sources and safe water. Over half of protected dug wells did not provide safe water and nor did around a third of protected <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/report_wash_low.pdf">springs and boreholes</a>. </p>
<p>These results <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000300015&lng=en&nrm=iso&tlng=en">showed</a> that in Nigeria the proportion of the population with access to safe water was <a href="http://www.who.int/bulletin/volumes/90/3/11-094284/en/">15%, or 22 million people</a> lower than estimated based on the MDG indicator. Similar results were found for 4 of the 5 countries included in the study, with a 7-16% decrease in access when water quality was taken into consideration.</p>
<p>Going forward, the SDG indicator for safely managed drinking water services is <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-WASH-Post-2015-Brochure.pdf">defined</a> as:</p>
<blockquote>
<p>a basic drinking water source which is located on premises, available when needed and free of faecal and priority chemical contamination.</p>
</blockquote>
<p>A basic drinking water source is an improved drinking water source with a round trip collection time of no more than 30 minutes including queuing. Where existing data is available, there will be reports against this indicator in the coming year. </p>
<p>But data is not widely available. This will be one of the major outcomes from the SDG for water: millions more people across the globe will have their water sources monitored, with increasing pressure on those that provide water services to ensure water isn’t just available, that it is also safe to drink. The area is already seeing progress with the implementation of water quality testing being expanded in household <a href="http://mics.unicef.org/methodological_work/3/WATER-QUALITY">surveys</a>.</p>
<p>How this data will be made available to water users and decision makers at a local level is not yet clear. But it is essential that this is addressed in the coming years to help deliver safe accessible drinking water for all.</p>
<h2>The hygiene gap</h2>
<p>There is often limited attention given to hygiene. The inclusion of hygiene in target 6.2 is the result of sustained <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000367">advocacy and research work</a> within the sector.</p>
<p>About 28 countries in sub-Saharan Africa have been included in <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Update-report-2015_English.pdf">surveys</a> demonstrating that, on average, only 13% of the population have access to a handwashing facility at home with soap and water. That is around half the population that had access to sanitation in those same countries, and about one fifth of those with access to water. The inclusion of hygiene in the sustainable development goals will ensure the sector continues to build on this important work. </p>
<h2>Safe sanitation</h2>
<p>The emphasis in the millennium development goals was on toilet infrastructure only. This has left what has been described as the <a href="http://www.thedailystar.net/city/untreated-faecal-sludge-huge-threat-health-1225666">second generation sanitation challenge</a>: how to remove excreta building up in pit latrines and septic tanks and how to treat it?</p>
<p>Many toilets aren’t accessible to emptying trucks, or are at risk of collapse if they are emptied. Where equipment is available for desludging, waste is still commonly dumped into waterways as treatment works do not have the capacity. Raising awareness of these issues and communicating them through <a href="http://sfd.susana.org/about/the-sfd">shit flow diagrams</a> is crucial. The sector is changing how it works to address the whole faecal sludge management chain.</p>
<p>The sustainable development goals add new dimensions to evaluating access to drinking water and sanitation, and now hygiene. In the millennium development goals infrastructure was a focus, but with the sustainable development goals it will expand to include management and behaviour change. Progress against the SDG targets for water, sanitation and hygiene may appear slow as these are incorporated into such initiatives.</p><img src="https://counter.theconversation.com/content/66690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrina Charles receives funding from the UK Department of International Development.</span></em></p>Progress in terms of water and sanitation has traditionally favoured those with money. But the hope with the SDG’s is that this gap will be plugged in the future.Katrina Charles, Lecturer and course director in Water Science, Policy and Management, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/620372016-08-01T04:04:53Z2016-08-01T04:04:53ZHealth Check: should we be using alcohol-based hand sanitisers?<figure><img src="https://images.theconversation.com/files/132437/original/image-20160729-12089-1s26yva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol-based hand rubs have their place but aren't usually needed if you're washing your hands with soap and water.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-158005148/stock-photo-female-hands-applying-antibacterial-liquid-soap-close-up.html?src=fYIZ5ZhlfSa7JjWMRZ4QHg-1-2">Boris Bulychev/Shutterstock</a></span></figcaption></figure><p>They’re everywhere in hospitals, travellers’ backpacks and the aisles of pharmacies in winter, but do we really need to use alcohol-based hand sanitisers? And what should we make of the marketing claims they’re needed to kill germs? </p>
<p>Our <a href="http://dx.doi.org/10.1016/j.ajic.2014.10.015">research found</a> we touch our face up to 23 times each hour and, of these, ten touches are to our eyes, nose or mouth. So while touching your face with contaminated hands you could be contaminating your hands or yourself with many infections, including influenza, the common cold and diarrhoeal infections. In fact, contaminated hands can spread most infectious diseases. </p>
<p>In developing countries, diarrhoeal diseases are still the <a href="http://www.who.int/mediacentre/factsheets/fs330/en/">biggest killer</a> of children under five years old. The simplest way to prevent bacteria, viruses and parasites that cause deadly diarrhoeal disease is handwashing with clean water and soap. </p>
<p>In industrial nations like ours, diarrhoeal disease is mostly spread by eating contaminated food – usually from unwashed hands during preparation, serving or eating meals. </p>
<p>There are at least 300,000 germs on our hands at any one time. Most of these have an important role in keeping the outer dermal layer of your skin healthy. There will also be germs that do not normally reside on your hands and these will come and go during the day without causing infections. </p>
<p>For pathogens (germs that cause infection) to actually cause infection, your hands must: (i) pick up sufficient numbers; (ii) these must be alive; (iii) be introduced into your body (through your mouth, nose or eyes); and (iv) you must be susceptible to the infection. </p>
<p>The common pathogens that find their way to your hands during the day could include diarrhoeal viruses and gastrointestinal bacteria, common viral respiratory infections and viruses that cause skin infections. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132443/original/image-20160729-24689-f3i5el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Always wash your hands before preparing and eating food.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-369369200/stock-photo-man-s-hands-cut-tomato-on-the-board-for-a-vegetarian-salad.html?src=U1I8F4PLO-GLVUk1jDYw8A-1-3">Nikolaev Mikhail/Shutterstock</a></span>
</figcaption>
</figure>
<h2>So how often should we remove these pathogens?</h2>
<p>Hygiene has improved since the 19th century, but since the development of vaccinations and antibiotics, handwashing lost its celebrity status. Handwashing is making a welcome comeback, but the message we need to “kill” the germs is inaccurate and confusing.</p>
<p>In a hospital setting, health-care workers use medicated soap and water wash or alcohol-based hand rub to remove germs and kill pathogens. Alcohol-based hand rub has the added bonus of providing an additional 20 minutes of residual action on the surface of the health workers’ hands to keep pathogens from multiplying to a level that can cause infection in vulnerable patients. </p>
<p>But in the general community, soap and water removes pathogens. We don’t need to “kill” them to be safe; removing them keeps us safe. Germs start growing or finding their way back onto your hands immediately after handwashing.</p>
<h2>When should you use alcohol-based hand rub?</h2>
<p>Alcohol-based hand rub cannot penetrate organic material that makes your hands visibly dirty or sticky. So always use a soap and water wash after going to the toilet and when your hands are visibly dirty or sticky. </p>
<p>All other times, when your hands are visibly clean and feel clean, hand rub can be used instead of soap and water washing. But hand rub used after handwashing will increase the penetration of the active ingredients of the rub into the skin and increase the risk of dry and cracked hands. </p>
<p>Hands should be washed before preparing and eating food, and after touching our noses. If you don’t have access to soap and water, alcohol-based rubs are a convenient way of removing pathogens. But again, removing not “killing” germs is what you need to achieve.</p>
<p>Public transport has now become air-conditioned, providing a better environment for keeping respiratory and diarrhoeal viruses on hand rails and seats for longer. If you touch your face (as most of us do), you might like to use a hand rub after leaving the train or bus, as hand hygiene <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/pdf/0981372.pdf">can reduce the spread</a> of respiratory illnesses by 20% and by 30% for gastrointestinal infections.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132441/original/image-20160729-24661-1m8dl1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alcohol-based hand rubs can be useful after using public transport if you’re away from soap and water.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-109789202/stock-photo-stop-button-on-a-london-city-bus.html?src=XvV2A73v-4NSsjhK7pz4KQ-1-80">Bikeworldtravel/Shutterstock</a></span>
</figcaption>
</figure>
<p>Remember, though, inside a closed train or bus flu viruses can spread up to 2.5 metres from a passenger who is in the very early stages of flu, just from breathing or talking. So sometimes there’s no escaping these bugs without vaccination.</p>
<p>Remember, rubbing your hands together for 15 or more seconds while using soap and water effectively removes pathogens. Don’t forget also to focus on your fingertips and around the base of your thumbs. Drying your hands after handwashing removes more pathogens. </p>
<p>While alcohol-based hand rub is necessary for health workers and is convenient for cleaning hands while we travel, it shouldn’t be used on visibly dirty or sticky hands.</p><img src="https://counter.theconversation.com/content/62037/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary-Louise McLaws has been affiliated with several hand sanisters companies examining methods to improve hand hygiene in healthcare workers and cleaning hospital wards, these include: Deb Australia and Deb UK, GoJo, Johnson & Johnson, Whiteley Corporation. Her findings have been published in international peer review journals. She has held advisory positions on the NSW Clinical Excellence Commission and the World Health Organization committees to improve hand hygiene and patient safety including the development of the World Health Organization Guidelines for healthcare workers’ hand hygiene practice and the testing of these guidelines in 6 global test sites. </span></em></p>They’re everywhere in hospitals, travellers’ backpacks and the aisles of pharmacies in winter, but do we really need to use alcohol-based hand sanitisers?Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/533842016-02-07T19:06:05Z2016-02-07T19:06:05ZChildren as young as four can learn how to avoid getting ill, if they understand why<figure><img src="https://images.theconversation.com/files/109636/original/image-20160129-27351-1jc2p1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Asking your child to wash their hands before they eat isn’t useful unless they know why it’s important.
</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Learning about illness is unlike learning about other things: it requires children to reason about objects like “germs” that they can’t see or touch.</p>
<p>Although children have some difficulty of grasping the concept of illness and how illness is transmitted, children begin to learn about it in the preschool years. </p>
<p>At first, they acquire very basic knowledge about illness transmission, and can provide accurate explanations for how someone might have gotten sick. </p>
<p>For example, when <a href="http://www.sciencedirect.com/science/article/pii/S0010028508000467">researchers</a> asked a group of preschool-aged children how another child might have become sick after a sequence of events, even three year olds were able to list accurate explanations for contracting the illness, spontaneously citing germs or contact with a bodily fluid. </p>
<p>But preschoolers’ knowledge isn’t quite complete and they still make mistakes. </p>
<p>For example, the same three year olds had trouble making predictions about who would get sick a day later based on whether they engaged in a risk behavior like eating a contaminated food. </p>
<p>Other studies have shown that five year olds have trouble differentiating between various illnesses, and think that non-contagious illnesses like <a href="jbd.sagepub.com/content/32/5/443.short">cancer</a> and mental illnesses like <a href="http://onlinelibrary.wiley.com/doi/10.1348/026151009X461366/pdf">depression</a> are as contagious as the common cold. </p>
<p>It isn’t until a few years later that children acquire a more sophisticated understanding of illness transmission and can make predictions about how engaging in risky behaviours might make someone sick, and differentiate between illnesses that are contagious and illnesses that are not.</p>
<h2>How children behave when faced with contamination</h2>
<p>Children’s behavior seems to lag a bit behind their verbal understanding of illness transmission, and preschoolers are generally happy to engage with objects — even foods — that have been contaminated. </p>
<p>In one <a href="http://psycnet.apa.org/journals/dev/21/6/1075/">study</a>, researchers presented three- to 12-year-old children with a glass of apple juice and systematically put various objects into the juice. They later asked the children if they wanted to take a drink. It wasn’t until age six that most children rejected the juice when a dead grasshopper was visibly floating inside, and even then, some of the older children still drank it. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0195666314007831">Similarly</a>, another study showed that after watching a video of two actors eating applesauce out of two bowls, two- and four-year-old children ate applesauce from both, including one that had been sneezed in by one of the actors. </p>
<p>It was not until ages five to eight that children ate more applesauce from the clean bowl than from the contaminated bowl; and even then, most of them still ate some of applesauce from the bowl that was sneezed in. </p>
<h2>Teaching children to stay healthy</h2>
<p>Most preschool-aged children don’t necessarily understand illness transmission and how to actively take steps to avoid getting sick until middle childhood–not until children are older than six or seven.</p>
<p>However, my own research suggests that we can teach kids as young as four some healthy habits if we give them the right kind of information. </p>
<p>We <a href="http://www.sciencedirect.com/science/article/pii/S0022096515002593">found</a> that four- to seven-year-old children who knew that touching a sick person might make them sick later avoided touching the toys of an experimenter who they thought might have a cold. </p>
<p>Even the youngest children who happened to know that interacting with a sick person could make them sick avoided contact with a potentially sick experimenter. The implication here is that even children as young as four and five are capable of learning how illnesses spread; most of them just haven’t yet. </p>
<h2>Tips for parents</h2>
<p>Children do not <a href="http://www.sciencedirect.com/science/article/pii/S0010028508000224">learn much</a> if you just teach them a list of dos and don’ts, like “wash your hands before you eat,” or “don’t go outside without a hat”. </p>
<p>The key is to explain why something like washing your hands might be useful. In other words, you can tell a child to wash their hands before they eat, but it might not be effective in promoting healthy behaviour unless you tell them that exactly what they are washing off and how it could make them sick. </p>
<p>In the end, talking to children specifically about germs and how germs spread might be the most effective strategy in promoting healthy behaviours, even in preschoolers.</p><img src="https://counter.theconversation.com/content/53384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vanessa LoBue does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children don’t learn much about how illnesses spread if they are just taught a list of dos and don’ts. They need to know why an action is useful.Vanessa LoBue, Assistant Professor of Psychology, Rutgers University - NewarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/213842014-01-13T03:44:08Z2014-01-13T03:44:08ZHealth Check: should I use antibacterial hand sanitisers?<figure><img src="https://images.theconversation.com/files/38816/original/mpc9vjkb-1389329056.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antibacterial products cost more and might contribute to bacterial resistance. </span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>I should start by saying that an important part of my job is encouraging hospital staff to <a href="http://en.wikipedia.org/wiki/Hand_washing">clean their hands</a>. The World Health Organisation has a global patient safety campaign reminding us that <a href="http://www.who.int/gpsc/5may/EN_PSP_GPSC1_5May_2013/en/index.html">Clean Hands SAVE LIVES</a>, and in-hospital hand hygiene is <a href="http://www.cdc.gov/handhygiene/Basics.html">universally</a> <a href="http://www.hha.org.au/home.aspx">recognised</a> as one of the most important ways of reducing healthcare-associated infection.</p>
<p>Most of you don’t live in a hospital, though. So what about at home? Little bottles of hand gel are appearing in more and more places every day. Is this a good idea or just part of a societal “<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446148/">germ panic</a>”?</p>
<p>There are three groups of products to consider: alcohol-based <a href="http://en.wikipedia.org/wiki/Hand_sanitizer">hand sanitisers</a>, antibacterial soaps and other antibacterial products.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=225&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=225&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=225&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=283&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=283&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38809/original/n4jmzztw-1389326332.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=283&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t panic.</span>
<span class="attribution"><span class="source">xkcd.com</span></span>
</figcaption>
</figure>
<h2>Hand sanitisers</h2>
<p>These are usually alcohol-based and are <a href="http://www.hha.org.au/About/ABHRS.aspx">highly effective</a> at cleaning hands. They are the <em>preferred</em> method in hospital because they are also fast and convenient – and this increases the likelihood they will be used. </p>
<p>Hand sanitisers kill most bacteria and fungi as well as many viruses (norovirus, a common viral gastroenteritis, is a weakness) and work without water. We have a bottle in our nappy bag for that inconvenient pit stop. </p>
<h2>Antibacterial soaps</h2>
<p>Unlike the alcohol gels, these usually contain a <a href="http://en.wikipedia.org/wiki/Disinfectant">disinfectant</a> — such as <a href="http://en.wikipedia.org/wiki/Triclosan">triclosan</a> — or a <a href="http://en.wikipedia.org/wiki/Quaternary_ammonium_compound">quaternary ammonium compound</a>. </p>
<p>Antibacterial soaps have come in for a bit of a bashing in <a href="http://www.smh.com.au/national/health/antibacterial-soaps-arent-more-effective-and-may-be-dangerous-says-us-fda-20131217-2zi7c.html">recent media</a> reports, based on the US <a href="http://www.fda.gov/default.htm">Food and Drug Administration</a> releasing a <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm378542.htm">press statement</a> and <a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm">consumer notice</a> announcing plans to require makers of these products to prove that they work.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=857&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=857&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=857&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1077&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1077&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38813/original/4z52n9xk-1389328721.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1077&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babies are constantly touching surfaces with bacteria, but antibacterial toys aren’t the answer.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>All the rest</h2>
<p>It seems that it’s a great way to market your product by saying it’s “germ resistant”. This is the sales pitch for everything from <a href="https://www.google.com.au/search?q=antibacterial+chopping+board">chopping boards</a> to children’s <a href="http://www.kidsource.com/kidsource/content2/news2/hasbro.antibacterial.html">toys</a> and even <a href="http://www.amazon.co.uk/Croydex-Anti-Bacterial-Toilet-Close-Hinges/dp/B001DYPTGW">toilet seats</a>. </p>
<h2>Are they safe?</h2>
<p>By and large at an individual level, yes, they are. Alcohol-based hand rubs are <a href="http://www.who.int/gpsc/tools/faqs/abhr2/en/index.html">safe to use</a>. They’re obviously not designed to drink and should be kept away from children, but pose no major health risks. Muslim health-care facilities <a href="http://dx.doi.org/10.1016/S0140-6736(06)68431-6">have adopted their use</a>, despite alcohol being <em>haram</em> in Islamic faith.</p>
<p>All hand-hygiene activities take oils from your skin and increase the chance of dry hands or dermatitis, but hand rubs are better from this perspective than soap-and-water hand washing. </p>
<p>Triclosan has received <a href="http://www.huffingtonpost.com/2013/05/02/triclosan-safety-antibacterial-soap-safe-fda_n_3202847.html">media attention</a> because of concerns about thyroid hormone metabolism in animal models, but has not been <a href="http://www.ncbi.nlm.nih.gov/pubmed/22197412">shown to cause</a> these effects in humans. There are concerns about its role as an <a href="http://www.epa.gov/oppsrrd1/REDs/factsheets/triclosan_fs.htm">environmental contaminant</a> as it is found in waste water from sewerage, but also as a residue from industrial processes (the manufacture of those antibacterial plastics). Although, again, there is not conclusive proof of harm. </p>
<p>Of concern to people like me, however, is the risk of <a href="http://theconversation.com/superbugs-human-ecology-and-the-threat-from-within-10765">antimicrobial resistance</a>. If germs in the community are exposed to these products, could we be creating more resistant germs that will cause us problems down the track?</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38818/original/dvvvj23k-1389329391.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Triclosan-based hand washes can reduce rates of hospital infections.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Because hand rubs kill germs by direct action of the alcohol against the germs, there is no risk of resistance. The question is not so clear for the soaps, though.</p>
<p>In the hospital setting, we know triclosan is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/10433670">good antimicrobial hand wash</a> and <a href="http://www.publish.csiro.au/paper/HI04065.htm">can be effective</a> at reducing rates of hospital superbugs. </p>
<p>But hospital-grade triclosan (1%) is a far cry from the concentration in most over-the-counter liquid soaps. A <a href="http://cid.oxfordjournals.org/content/45/Supplement_2/S137.long">review in 2007</a> found no additional benefit to these products and identified risks for resistance. </p>
<p>Any microbiologist will tell you that prolonged exposure of bugs to low concentrations of antimicrobials is the textbook way of breeding resistance.</p>
<h2>Are they necessary?</h2>
<p>So, does the average house and family need to armour up in the war against germs?</p>
<p>I have to say probably not.</p>
<p>Good hygiene is important in preventing disease — and <a href="http://www.biomedcentral.com/1471-2431/12/52">hand washing</a> is part of that (along with <a href="https://theconversation.com/cough-and-sneeze-into-elbows-not-hands-13152">cough etiquette</a>, staying home when sick, and so on). But the benefits of these products over soap and water (apart from the portability of gels) have not been shown outside the hospital setting. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38819/original/h7jmc54m-1389329417.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Soap and water is just as good but doesn’t come with the risks.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Antibacterial chopping boards won’t stop you from getting sick if you don’t practice good <a href="https://theconversation.com/mondays-medical-myth-leave-leftovers-to-cool-before-refrigerating-6114">food-handling</a> <a href="https://theconversation.com/mondays-medical-myth-the-three-second-rule-when-food-falls-on-the-floor-6100">techniques</a> and antibacterial toilet seats do not add to (or replace) washing your hands when you’re done. </p>
<p>And those antibacterial baby toys? Babies put their hand from the toy straight onto the floor, onto the cat or any of a dozen other non-antibacterial surfaces, so any effect is likely to be small (i.e. zero).</p>
<p>We do not – and cannot – live in a germ-free world. Spending money on these products doesn’t guarantee you won’t get sick (of course they can’t) and probably don’t even <em>reduce</em> your risk of getting sick. But they might contribute to bacterial resistance, and they certainly cost more. </p>
<p>Break the marketing cycle of germ panic and reach for the plain old soap.</p><img src="https://counter.theconversation.com/content/21384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trent Yarwood does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations. The opinions in the article are his own and do not necessarily reflect those of his employer.</span></em></p>I should start by saying that an important part of my job is encouraging hospital staff to clean their hands. The World Health Organisation has a global patient safety campaign reminding us that Clean…Trent Yarwood, Infectious Diseases Physician, Associate Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.