This is the time of the year the kids bring back home contagious illnesses they caught who knows where and from. Soon the siblings get sick as well, and we have to take time off from work. Schools and classmates are the usual suspects, but chances are hand hygiene negligence played the most part. To reduce the incidence of pathogens we are stocking antimicrobial products in our home cabinets, a behavior that is not without incidence on health, safety and the environment. In a three part series, I intent to address the issues surrounding this controversial topic, starting with revisiting the roots of poor hand hygiene, then sorting out some “staggering” evidence and finally offering some sound solutions that everyone – including schools and your work place – can easily adopt while keeping toxic products at bay and lowering our carbon footprint.

Part 1 – Is catching a contagious illness an ineluctable outcome of social life?

It’s the hands, doc.

If some contagious microorganisms can spread through air (droplets – pathogen carriers – can travel up to 3ft when you sneeze or cough although it has been showed they can reach 5 rows ahead in an airline economy class), through not properly maintained heat-ventilation-air-conditioning systems (HVAC), or through water, most are passed through hands. 80% of all illnesses find their path to our systems by ways of hand to mouth, nose and eyes experts agree – which is the only number everyone seems to agree upon. Most of bacteria, viruses and fungi can live outside a host (our body but also food and beverage) from hours to days depending on the strain (type) and the surface.

The issue of hand hygiene shook the country in 2002 after the Chicago Tribune published a stunning report on nosocomial (hospital-acquired) infections resulting in over 100,000 deaths. For months, reporters went undercover investigating how so many people would die, each year, from infections secondary to the reasons they were hospitalized in the first place. They found out that no less than 75% of these deaths were preventable (among them 2,600 children). The main finding – not surprising for insiders – was healthcare workers’ lack of compliance with hand-hygiene protocols (in between each patient, after eating, using the restroom, …). The cost? An estimated $6 billion.

A heavy burden

Upper respiratory and gastrointestinal illnesses are less likely to kill – although immuno-compromised people may die from them – but affect millions every year, causing here a school to close, there a cruise line ship to quarantine, an IT department to work double time to compensate for sick co-workers or a sales team to postpone a road show, and at home to reorganize our life to care for our sick love ones. The costs of absenteeism are abysmal: $30 to $60/ day for a student attending a public school (excluding basic aids), half a million (and up) per day for a ship, $100 to $500 per day per employee depending on rank and qualifications, over $1,000 for an executive. Estimating the costs of presenteism (attending school or work while sick) is a bit more difficult – we are definitely not as productive with a headache, sore throat or fever – but the consequences can – and will – lead to the numbers cited above or greater in case of an outbreak. Taken alone, the cost of heath-related absenteeism for businesses can reach $74 billion a year (click her to download the paper), of which an estimated one third is due to contagious illnesses.

Washing hands is so easy

When the nosocomial story broke out, I was heading the sales and marketing activities of a biocide company. We have just launched the first non-toxic surface disinfectant and were about to put on the market a wipe that could be used on hands and surfaces. To some respects, the newspaper story was good news for the industry. In this business, we are many to believe that fear of germs is the main driver to change. Some hope organizations and people will address the issue and correct the problem (re: wash your hands more often), but most wish customers will buy and use antimicrobial products more often. Five years later, antimicrobial products are amongst the fastest growing items in the cleaning and personal care product categories. And we are still terrible at washing our hands. And we are still getting sick as often as before. Robert Jamieson Jr. recently reported accounts of poor hand hygiene in the Seattle Post Intelligence. Many readers followed up with their stories. He feels “This issue of hand hygiene is so frustrating because washing hands is such an easy thing to do”.

And he is right. All you need is a working sink and soap and a dry towel/ paper towel. And if you are in the middle of nowhere, the mall, an airplane or a gas station, you should carry with you a hand sanitizer. And a microfiber clothe. That’s it pretty much. So if all these items are available we have no excuses and are as guilty as the health care workers of hand hygiene negligence.

Playing detectives

I have spent quite a bit of time in health care facilities, following nurses and doctors in their routine, talking with infection control officers (ICOs)– the people in charge of enforcing hygiene procedures – about their challenges and needs. More recently I have run a beta test in schools in the San Francisco bay area testing hand hygiene programs aimed at reducing the incidence of germs causing illnesses. The main object was to study human behavior and to find ways of improving hand hygiene through convenience. And of course, I can’t help but observing everyone in every place I go. And I must admit I became a bit of a germ freak.

When I spoke with k-5 students about the importance of keeping our hands clean – I was amazed how receptive they were and willing to take ownership – I told them to play detectives. We found so many instances one can be at risk of catching a “minor” contagious disease – flu, cold, “stomach flu” – that listing them all would take way too long. But to give you an idea, we found that adults are the main carriers, simply because we interact in different confined environments more often than kids. Here are a couple of easy ones:
- A usual work day. Mom goes to work using public transportation. A tough situation to keep your hands in your pockets, isn’t it? From that point on until the final destination, say the office, she would have touched money, escalator/ bus/ bart/metro hand rail, a door knobs or two, the elevator button, she might have shaken someone’s hand, she would have sit at her desk and checked emails before her first stop to the restrooms. She might even have stopped by the coffee shop for her latte. At the coffee shop, she would have reached to her wallet and handled money again. She might even have used her cellular phone to make sure the kids got to school on time or to talk to a client. And then suddenly her left eye itches and she rubs it with her hand. What a normal reflex. After a hard day at work, she stops by the grocery store, takes a cart and buys diner and a snack for her kids, arrives on time to pick them up at school and hand over the snacks and drinks to her starving kids who might or might not have washed their hands before putting these delicious treats into their mouth. In between all this, she would have found time to eat a sandwich at her desk. Let see if you followed everything: how many times she could have picked a virus and contaminated other surfaces during her day?
- A social event. Dad goes to a Christmas party. Takes his car because you never know when those things end, stops by the gas station, pushes the door, handles money or his credit card, goes back to the fueling machine, handles the gas nozzle, sits in his car, grabs the steering wheel, puts the shift on D and drives away. A co-worker calls on his cellular phone to check about time and directions. He arrives, open a few doors, takes the elevator, and … without having time to wash his hands – well men don’t do that anyway – he is pulled in by his boss who wants to introduce him to a group of folks working at the new office in Boston, MA who flew in today, shaking everyone’s hands. He grabs an amuse-bouche – I love this word – and puts it where it belongs. The evening goes on, time to go. In his car, dad feels tired, sneezes, or even more probable picks his nose first. He arrives a bit late, open the refrigerator, grabs a bottle of water and food – there was not enough, kisses his wife, opens the doors to the kids room, and finally goes for his before bed toilette. Well, what do you think? Plenty of opportunities here as well, right?

In conclusion to this first part, let say that a) thanks to Dr. Gerba – the best germ tracker in this country – we know infectious germs are everywhere, literally EVERYWHERE (I’ll discuss more about this later) b) a contaminated hand can spread pathogens to every other surface it touches c) they (the microscopic monsters looking for a host) can live long enough to find their final destination d) sink, soap and water are not always available or we have plenty of good and bad reasons not to use them, and finally e) in a form of a question, is it we are not aware or is it we are not paying attention?

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