Written by Henry Lin and Edited by Kevin Liu
Every year, the passing of winter is closely followed by its counterpart: the flu season. Leaving behind piles of used tissues in its wake, the flu season is infamous for being the cause of high rates of diseases and infections. Given the unpleasantness of the flu, what can one do to avoid contracting it?
During the flu season, doctors recommend hand-washing as the most effective form of protection against the spread of infectious diseases. Contaminated hands not only transmit infectious agents into one’s own body but also from one environment to another, increasing the risk of others getting infected. According to the Center of Disease Control (CDC), “hand washing can prevent about 30% of diarrhea-related illnesses and about 20% of respiratory infections [1].” Hand washing can also prevent the development of antibiotic-resistant diseases, as the disease-causing agent will not encounter antibiotics in the first place if washed away before infection [1]. Finally, hand-washing is a cost-effective form of disease prevention when compared to the cost of a hospital trip [2].
Given the effectiveness and importance of good hand hygiene, how many people really practice it? In one study, 577 college students had their hygienic practices evaluated by analyzing their knowledge of hand hygiene, the amount of times they washed their hands in one day, and the effectiveness of their hand washing technique [2]. The study revealed that of the participants, 20.1% had poor knowledge of good hand hygiene, 75.2% did not wash their hands frequently enough, and 35.7% did not wash their hands in an effective manner. Of those that did not wash their hands frequently enough, 52.2% claimed they skipped hand washing either because the washroom was too far or because the washrooms were non-functional and dirty.
When no washrooms are nearby, sanitizers can offer an alternative method for practicing good hand hygiene [1]. Most sanitizers are composed of short-chain alcohols like ethanol and work by desiccating, or drying out, microorganisms. However, a major disadvantage for alcohol-based sanitizers is their volatility; the alcohol may evaporate before neutralizing all of the infectious microbes. Currently, new forms of sanitizers are being developed to address the short antimicrobial activity of alcohol sanitizers. One of these sanitizers is based on benzalkonium chloride, which is less volatile and thus has longer antibacterial activity [3]. Instead of desiccating the microbes, benzalkonium chloride disrupts their cell membranes and causes their intracellular components to leak out [3]. Benzalkonium chloride-based sanitizers are available on the market for consumer use mainly as wipes, but they are not widespread due to ongoing research on its safety.
Apart from the direct effectiveness of sanitizers, a study among nurses revealed that a preference for a certain form of sanitizer can also have an indirect impact on their effectiveness. There are three forms of sanitizers: liquids, gels, and foam. Even though liquids have the fastest drying time, they were the least preferred due to the possibility of spilling. Gels and foam take about the same amount of time to dry compared to each other, and both are easier to use. However, foam is preferred over gels because they are less “sticky.” All three types of sanitizers have the same cleansing effect, but replacing current forms of sanitizers with the most preferred form (foam) in a public setting may increase people’s overall use of sanitizers and improve hand hygiene [4].
In addition to improving sanitizer accessibility, hand washing behaviors should also be improved. One method is to provide more clean, functioning, and well-stocked washing facilities so hand washing would be more convenient and appealing for individuals [2]. Washing facilities should also be placed at specific locations where human activity, and thus risks of transmission, is high [5]. In a simulation conducted by the Society of Risk Analysis, good hygienic practices like frequent hand washing at airports can drastically reduce the spread of infectious diseases [5]. This simulation shows that even if only the top 10 major airports had an increase in hygiene, the impact of disease spread would drop by 8% to 37% [5].
Given the fact that many college students disregarded proper hand-hygiene because of poor accessibility, there needs to be more clean washrooms that are better equipped so that a trip to the sink is much more convenient. More studies also need to be conducted on the alternatives to alcohol-based sanitizers and their different forms in order to increase their efficacy. Finally, with distant travel becoming a more common place in the rapidly modernizing world, better hand-hygiene in major areas of human activity, such as airports, needs to be established to combat the rising risks of flu transmission.
References:
- “Show Me the Science – Why Wash Your Hands?” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2018, https://www.cdc.gov /handwashing/why-handwashing.html.
- Mbouthieu, M.G.T., Niba, L.L., Ncheuveu, N.T., Ghumbemsitia, M., Itor, P.O.B., Chongwain, P., Navti, L.K. (2019). An Institution-Based Assessment of Students’ Hand Washing Behavior. Biomed Research International, 2019:1–8.
- Bondurant, S.W., Duley, C.M., Harbell, J.W. (2019). Demonstrating the persistent antibacterial efficacy of a hand sanitizer containing benzalkonium chloride on human skin at 1, 2, and 4 hours after application. American Journal of Infection Control, 47:928–932.
- Greenaway, R.E., Ormandy, K., Fellows, C., Hollowood, T. (2018). Impact of hand sanitizer format (gel/foam/liquid) and dose amount on its sensory properties and acceptability for improving hand hygiene compliance. Journal of Hospital Infection, 100:195–201.
- Nicolaides, C., Avraam, D., Cueto-Felgueroso, L., Gonzalez, M.C., Juanes R. (2019). Hand-Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network. Society for Risk Analysis.