Flu season is upon us, and our friends at the Center for Disease Control (CDC) are franticly threatening us with Ebola. The most scientifically sensible advice I’ve heard from the official sources, is that: due to the lack of a proven preventative for this potential scourge, the best defense is “extreme cleanliness.” This approach involves at least three key steps that are within our spheres of control:
1. Minimize unnecessary exposure—avoid picking up the bug!
2. Scrupulous hand washing—don’t get it in your mouth and don’t “hand it off” to others!
3. Keeping a fastidiously clean and sanitary environment at home and the workplace, wherever you can control it, is critical to lowering the risks of perpetual recontamination.
The first part (last month) is an updated course on the critical skill of how to properly wash your hands.
This part reviews the tools, pitfalls, and critical triggers for hand washing.
Hand Washing for All Seasons-part 2
Tools—Proven to Help
Tools—Washing Agents: Soap is the standard washing agent in most westernized industrial cultures. From a worldwide perspective soap is used the least (about 30%). Other than plain water, ash or clay are the top washing agents of choice.
The primary benefit of soap is that it sticks to skin, needs a bit of rubbing to remove it, and improves the effectiveness of the rubbing so people tend to wash hands more completely than with plain water. This is a worthy benefit. People using water only can choose the higher 25 seconds of recommended washing times to reduce bacteria to similar levels as those of soap users at the 20 second mark.
Even “soap-only-for-everyone” advocates admit the effectiveness gained by using soap is that it improves the time spent washing by: requiring removal (soaped hands are not comfortable—they will keep you from licking your fingers.); helping get into the very small skin folds and ridges to dislodge the grease, dirt and germs sheltered there; and providing a visual and tactile signal that “the job is done” when all contact surfaces have received thorough treatment. Please note that “bacteria killer” is not on this list.
Looking past global marketing interests and our Western cultural bias toward soap, these same benefits touted for soap are also attributable to ash or clay which, are as effective as soap in reducing fecal coliform bacteria on contaminated hands when the same washing times and steps are followed.
However, in countries or communities with closed waste-water plumbing (either private septic or municipal collection and treatment systems) plain soap is deservedly the most acceptable hand washing agent.
Beware of harsh agents that can damage skin. Detergents and surfactants, often wrongly called soap, are chemically different and tend to be more aggressive at removing needed skin oils. Meanwhile, other antibacterial agents added to soaps, or straight sanitizers, are designed to kill bacteria. They do not discriminate between the “friendly or not” [more on this later] bacteria and can damage skin either directly or indirectly by distorting the beneficial balance of the resident bacteria (microbiota) on the skin. These agents often leave the skin dry and/or irritated. This unhealthy state leads to rashes, cracking and bleeding, and can render the skin, and ultimately all internal tissues and organs, susceptible to infections.
Plain soap is gentle on both the skin and the skin’s microbiota, as well as on bacterial based septic systems. Clay, ash, or sawdust, though perhaps just as gentle, would surely clog the whole system. So, hi-ho, hi-ho, it’s straight to soap they go.
Ever worry about the slimy, mushy-looking bar of soap swimming in a pool of its own juices so common in the toilet facilities at outback truck stops? Several studies, ranging from dental clinics to public toilet washrooms, found that very dry soap bars were not infected, but in each public facility that left the used bars floating in a surrounding moat, each bar had its own mix of microflora (averaging from two to five different types of microbes) with the bars used most having the most different species. No surprise here! Not so quick, two surprise findings come out of this research: First, bacteria were alive and flourishing. Second, even though all bars languishing in pools of water were infected, none of the bacteria was able to stick to hands. The take-away is also twofold. It reinforces the fact that soap is a poor bactericide. This should be especially reassuring to those folk with normal skin moisture, who are concerned that frequent but brief exposures to soap (not to be equated with detergent based bars or liquids) would be harmful to the skin’s so-called “friendly” microbiota. Finally, don’t worry about soggy soap. Still a bit squeamish about rescuing that slimy bar? Under running water, rub water all over your hands, then rinse-rub it off and towel-rub them dry.
Tools—Hand and Nail Brush: A soft hand and fingernail bush can be a very helpful tool at work or home, where it can reside in the washroom or private space. Long bristles are useful for the whole hand while short ones are especially helpful to get at heavy grime and under the nails. It works best to hold the brush still, pinned against the inside wall of the sink, and move the nails from side to side with short vibration-like movements. Holding the brush low in the sink and perpendicular to the sides will reduce the size of the splatter zone. Be sure to clean the brush regularly. Here are some options to sanitize it: if it won’t melt, boil it for a few minutes or run it through the dish machine (top shelf) heat cycle, or a room temperature soak in an appropriately diluted household sanitizer. Either peroxide or bleach works well for this purpose.
Tools—Deserving False Security Warnings
False Security Warning—Gloves: Wearing gloves can cause further problems by producing a humid environment favoring the growth of microbes and may contain irritants such as latex and talcum powder. They are of limited use, but carry a perceived value far exceeding reality. Gloves are easily abused, which is exacerbated because of a false sense of protection. Gloves add process complexity and can increase cross contamination risk; transferability of germs is higher than that of skin and removal difficulty often propels contaminated sweat droplets great distances. Gloves increase expenses as they must be changed frequently, and increase hand washing need because gloves must be washed by the same rules as bare hands, plus hands must be washed before donning and immediately upon removal. So, use gloves only when a compelling justification exists and manage the glove use process to control the inherent risks.
False Security Warning—Alcohol- Based Hand Rubs (ABHR): Using alcohol lotion-like or gel sanitizers to indiscriminately kill any and all bacteria is proving to be an injurious (potentially deadly) experiment. Survivability of certain bacteria is favored when ABHR use kills off its competition. Typically, spore-forming bacteria have this edge, and the spore phase of Clostridium difficile (or C. dif for short) can survive the ABHR (and/or common antibiotics) and thrive where populations of its competitors are kept low. C. dif has been wreaking havoc in hospitals, but the number of nonhospital related cases is increasing greatly. It is fast becoming our most common gut infection and is growing toward epidemic status. Symptoms include bloody diarrhea, fever, and severe abdominal pain. C. dif produces potent toxins that can cause severe colitis, which often adds to the chronic complications. Even among the patients who seem to have been successfully treated, many will experience multiple relapses, and, with each relapse, antibiotic treatment becomes less successful.
This whole scenario reminds me of an early-school biology teacher’s attempt to twist young minds toward the Darwinian theory of creative evolution using the concept of Natural Selection (a.k.a., survival of the fittest, which is actually related to adaptation not creation). This psychological programming used a visual teaching aid (a lesson kit, still sold to elementary schools today!) about the British Peppered Moth Study. The moth study compares the relative survivability between light and dark colored moths as forest tree trunks (their daytime roosting sites) darken. It’s hard to hide a white moth on a darkly colored tree from a hungry bird, so survivability of dark moths is favored.
There are many who swallow this moth bait and lean towards faith in creative evolution based upon Natural Selection as a cause. I do not know a creation scientist who denies that created living things adapt to changing environmental pressures. But, the logic of using Natural Selection as a creative cause dies on the fact that the existence of an adaptable organism must precede the adaptation. This is a far cry from making some-things from no-things from no-where!
Rather than a cause of creation, adaptation is a built-in tool of a wise Creator to help those things He created “after their kind” survive the rigors of a sin-pressed world. The Moth Study does show that, somewhat akin to us, birds too “eat with their eyes.”
A common causal parallel between the tree-color matching moth’s advantage and that of C Dif. is due to the negative intervention of human entrepreneurial pursuits. An unintend-ed consequence of fueling the needs of industrialization was a soot filled atmosphere that blackened the trees and shifted the natural balance of the two moth color variations. Likewise, the unintended consequence (side effect?) of using alcohol rubs to kill off all possible hand germs wipes out C. Dif’s competition, allowing alcohol resistant pathogenic bacterial strains to gain a deeply seated foothold due to the demise of its balancing competition—both commensal and mutualistic. The deadly unintended consequence in both of these examples of human induced adaptation supports the scriptural wisdom that: “There is a way that seemeth right unto a man, but the end thereof are the ways of death” (Proverbs 14:12; 16:25).
Hand washing with soap and water is significantly better than ABHR at removing C. dif spores from the hands. After ABHR use, a simple handshake can readily transfer 30% of the residual spores to the hands of recipients. So, the good news is that no increase in transferability has been shown related to the use of plain soap and water, nor even plain water without the soap, nor with any other commonly used friction and duration enhancing adjuvant, such as ashes and sanitized clay.
False Security Warning—Antibacterial Soaps: In general, the same principles that can lead to low echelon microbes becoming quasi super bugs due to over use of ABHR can be applied to the use of antibacterial soaps. So avoid them!
False Security Warning—Toilet Paper (TP) in the U.S., was first produced in 1857. Before becoming popular, many other things commonly used in early America included leaves, corncobs, newspaper, mussel shells, and magazine pages.
What looks like a giant chasm in the above micrograph is all relative to the size of the beholder. The head of a common tailor’s pin has a diameter of 2 millimeters (mm) (2000th of a meter) which equals 2,000 micrometers (also called microns). The apparent chasm on the right (fiber circled area with the dot) is 100 micrometers wide. If chasms of this size were linked together like a chain, it would require 20 links to span the head of a pin. That’s a very tiny pore. You think!?
The chasms above are typical pores (holes) in a piece of toilet paper. The dot in the center is the relative size of a red blood cell (RBC) at 8 microns, which is 4 times larger than a hotdog shaped E. coli bacterium is long (about 2 micrometers long but much slimmer). Lengthwise, E. coli are extra-large-sized fecal germs, but, whether entering the pore side-on or head-on, lots of them can easily squish through these TP pores. The bad news is that many common germs are much tinier than an 8 micron RBC. Viruses run in the nanometers (that’s a billionth = 1/1,000,000,000th of a meter), rhinovirus (includes common cold viruses), for example, is 20 nm in diameter, that’s 20 billionths of a meter—thousands of them could ride through the pore on an RBC (the dot). Except for the occasional direct collision with a paper fiber, most organisms of this size would never even “see” that there was something in the way!
It should now be evident why fecal bacteria counts on fingertips zoom up after toilet paper use. We may confidently deduce that if toilet paper fails at blocking germs in any significant manner, in no way does TP use diminish the need to wash up. In fact, it is a good practice to focus on the fingertips twice during your normal choreographed routine.
So we return to the morbid reality that if TP will do nothing to keep feces off the hands, then it won’t keep feces and germs off of the things the hands touch—things that other people might put in their mouths.
I have witnessed unusually bright people come out of the stalls and “wash” only the fingertips on, I assume, the involved hand. Obviously these are among the many who have never ever mindfully considered the contamination sharing opportunities [I call these Ka-ching♫ points] in the many process steps we take for granted in the little tasks of life. For instance, consider the rote and seemingly insignificant process of getting ourselves back together after everything that was undone in the stall is pulled up, tucked in, buttoned, buckled, zipped, smoothed and aligned, sharing the wealth from one hand to the other via everything in between, and now the door. Almost every comma marks at least one direct or indirect Ka-ching♫ opportunity; now comes the valiant act of half-washing the tips of half of their pinkies.
In the United States, a reported fifteen million trees go into the production of the thirty-six billion rolls of toilet paper used each year at an estimated worldwide cost over $20,000,000,000 (20-billion). Seems a dreadful waste for something so lousy at doing the job for which it was bought with hard-earned money. The costs of TP keep adding up even while the rolls are unwinding. TP signifi- cantly increases the disposal burden on community based waste management systems by boosting solid waste and associated costs all along the production to disposal continuum: tree harvest losses and pollution, toxic production and sequestration chemi-cals, clean water diversion, energy use, facilities costly to build, expensive to operate and eyesore ugly to look at. Before we run out of trees and pollute the last drop of water in processing them into thin spider webbing too open to even detain the intended catch, we need to consider better sustainable ways to both prevent and remove fecal contamination of hands and utensils, and to deal with human waste. So put on your thinking caps, and read up on composting toilets.
Critical Hand Washing Times:
Before and after eating.
Before and after food preparation.
Before and after handling meat or fish.
Before switching from raw to ready-to-eat food.
Before moving or switching to other food items or batches.
Before and after wearing gloves for food or medical purposes.
After touching eyes, nose, ears, mouth, pubic, perianal area, wounds or other bacteria friendly areas.
Before and after treating a cut or wound.
Before and after dealing with contact lenses.
Before and after intimacy.
After visiting the washroom and/or toilet.
After cleaning the washroom or toilet facilities.
After changing a diaper.
After touching a pet dog, cat, reptile, or any other animal.
Petting zoos and picnics? Scary thought!
After touching plants or soil.
After visiting a school, hospital, nursing home or church.
After contact with any body fluids or touching items that may have contacted body fluids.
After coughing, sneezing, smoking, eating, drinking or other hand-to-mouth incident.
After handling garbage or trash.
After handling yard or household equipment, laundry, chemicals, used dining ware or utensils.
Personalizing this list by adding and removing items as applicable will help predict the number of daily hand washings needed. This list is long but not exhaustive; to best use this information look for the redundant common principles and use them to plan personal hand washing decisions accordingly. The flu or diarrhea you and yours miss will be the immediate blessing. The bigger blessing is knowing that both near and far down the line, untold numbers of God’s children are not in the wake of sickness and death from your hands.
Personal hygiene, including hand washing, is among those most important lifelong habits to inculcate (train, teach repeatedly) in early childhood and to continually perfect throughout life, for health as well as social moral reasons. Children must be encouraged to mindfully practice good hand washing techniques so they will instinctively know both when and how to get their hands thoroughly clean, dry and safe.
Healthy skin, as a major part of our external epithelium, is the primary defense against bacterial harm. Improper hand washing—excessive use of friction (obsessive rubbing, abra- sive grit or brush bristles), alcohols (ABHR), and/or detergents—can damage skin by scoring or removing the thin film of skin oils that protect the top layers of skin (called the stratum corneum) allowing excessive dehydration. Damaged skin is susceptible to infection by most bacteria residing on the skin, whether categorized as commensal (seemingly just there), mutualistic (often beneficial), or pathogenic (lurking preda- tors). Most bacteria can belong to more than one of these groups, depending on the circumstances. For instance, the same Staphylococcus aureus, which is usually grouped as commensal skin flora, is also the horribly pathogenic “SA” in MRSA—almost correctly described by the news media as the unstoppable skin eating bacteria. The old adage, “roses in a corn field are weeds” fits in this case and can also apply to the germ groupings termed commensal and mutualistic—any germ out of bounds is likely “up to no good.” So keep the dog house in good shape so the roses can’t eat the dog. To be Continued…