Since our last 'Ask the Experts' article, we've explored a number of topics including hand hygiene in food processing, sun safety for outdoor workers and compared the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to the SARS outbreak in 2003. We also explored the hand hygiene behavior of men compared to women (sorry guys) and had some lively dialogue on the most effective hand wash drying method. What we have learned through reader feedback is that in addition to our hand hygiene experts, many of our readers are experts themselves. Here's a few highlights from our readers questions and feedback.
"It would be interesting to ask dermatologists about any increases in occupational or domestic dermatitis since anti-bacterial soaps were introduced. The NHS in the UK has just about stopped using them, " asked Euan in response to an article by Barry Michaels entitled, "Hand Hygiene in Food Processing and Food Service."
Barry responded, "Indeed the NHS Trust of around 1500 UK hospitals has gone to "simple" soaps as the standard healthcare personnel hand wash product. This was in part because the low level of antimicrobials (AM) in these products were shown not to provide any significant advantage in terms of efficacy while at the same time may carry some possible risks. Because of cost issues associated with AM soaps it became a bit of a no-brainer. Concurrently Triclosan as a common antimicrobial in these soaps as well as consumer AM soap products started being detected in human blood and breast milk surveys, accelerating the phase out. Recently published data also indicates that there seems to be an allergy link in children concerning this AM ingredient.
Of course there are other active ingredients used in AM soaps used as surgical scrubs and in food processing and food service settings. Chlorhexidine Gluconate (CHG) is heavily relied upon in healthcare along with Iodophores (iodine base) and quaternary ammonium compounds (quats) both of which see frequent use in the food industry. Chlorxylenol (PCMX) is also used in food processing and service as an active AM ingredient in hand washes. Added to this are soaps and hand washing agents that utilize newer active ingredients such as activated hydrogen peroxide.
While some of my best friends are dermatologists, I think that I can answer the basic question of allergy increases to these antimicrobials without a consult. While most of these compounds have relatively low allergen potential or they wouldn't end up as being in common use, there are always going to be individuals in any population who are allergic. And as pointed out in the article, skin damage, exposure to much harsher facility sanitizers, food allergens and glove use can drive this low potential over the edge with allergies to all of the above developing. So there is no doubt that since the introduction of antimicrobial ingredients to clean or degerm hands starting with Semmelweis and Lister ,occupational dermatitis to these same agents started to appear.
The secret is to manage all types of exposures to chemicals in the environment including those present in food facility antimicrobial soaps and re-nourish the hands. This is holistic hand hygiene as I describe it in the blog post above. Only the food safety manager is in the position to make the decision as to which type of soap to use and manage skin care as it indeed needs to be managed, if hand hygiene is to be sustainable. If the food safety manager fails in his leadership role, then the process can easily devolve into a whole series of negative endpoints all that are bad for the food business."
Gail asked, "OK so why don't men wash their hands? I can understand people not doing it for 15 seconds since it may seem too long (have they not heard the happy birthday reminder?), but what is the barrier to men not washing their hands?"
Everyone had something to say on this topic and one of the best male responses came from John Scherberger , a healthcare professional. " I can't address why women don't wash their hands after using the toilet facilities. As for men, I have some experience from which to offer the following. Let’s get right down to the crux of the issue: anatomy. It’s a fact of life that women and men eliminate feces in the same manner; but urine, well, that is another process and that is the issue clear and simple. Men urinate more often than they defecate and it would be of importance to the cited study to know what the reason for going into the bathroom was. In general, men are of the mistaken opinion that since their hand or hands contact only intact skin when they urinate they are not exposed to urine as women are since women’s hands are much more likely to come into contact with urine during the wiping/drying process. Men don't use tissue after urinating. But men fail to connect the dots: splash-back from urine hitting the back of urinals can contaminate hands and clothing; hand contact with skin that has been in a warm, dark, and moist surrounding where bacteria such as tinea cruris and tinea corporis thrives; and contact with the flush handle that has been touched by hands that only God knows where they’ve been."
Finally, the question of paper towels versus hot air dryers was explored recently and its seems everyone has an opinion on this depending on their hygienic or green position. At the time of writing this, more than 85% of the readers voted paper towels as the preferred choice in support of effective hand hygiene. Jeanette may have summed it up best when she said, "Hot air dryers are only effective if they dry the hands completely. Paper towels allows the hands to be dryer but are not always sanitary. After a look at both methods in lab testing it shows that there is very little difference in the amount of bacteria removed. Washing process is what makes the difference."
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