Question of the Week
October 4, 2004


We have all heard how important it is to wash our hands. At one time this meant vigorously rubbing your hands together with plenty of soap and water. Now there are anti-bacterial soaps and alcohol rubs. We have more choices for the same job; but do they really all do the same job?

"Improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms (e.g. methicillin resistant staphylococcus aureus) and reduce overall infection rates."

What about the "alcohol-based hand rubs"? How do those work?

"Typically, people carry between 10,000 and 10 million bacteria on each hand. We all know the importance of good hand washing in reducing harmful microorganisms on the skin, but what about those times when there is no access to hand washing facilities or not enough time to wash thoroughly? Can a hand sanitizer (alcohol gel) serve as a suitable alternative to hand washing? ... Alcohol works immediately and effectively to kill bacteria and most viruses. Solutions containing 60-95% alcohol are most effective. Higher concentrations are less potent because proteins are not denatured easily in the absence of water. Alcohol gels work by stripping away the outer layer of oil on the skin, thereby destroying any 'transient' microorganisms present on the surface of the hands...."

How do the "alcohol-based hand rubs" compare to soap and water? While alcohol gels are convenient and popular, they are not meant to replace soap and water. Alcohol gels do not work to remove pieces of dirt and food.

"Food workers often have wet hands and hands contaminated with proteinaceous and/or fatty materials, which can significantly reduce the effectiveness of an alcohol gel. Therefore, soap, friction and running water still remain most effective in removing the types of pathogens food workers might encounter.... For everyone, washing hands with soap and water (whether plain or antimicrobial) is still a must. Hand sanitizers should primarily be used only as an optional follow-up to traditional hand washing with soap and water, except in situations where soap and water are not available. In those instances, use of an alcohol gel is certainly better than nothing at all."

While not the best choice in all settings, the ease and convenience of the hand sanitizers do make them beneficial in some situations.

"Nosocomial infections are a major problem in health care facilities, resulting in extended durations of care and substantial morbidity. Since alcohol gel hand sanitizers combine high immediate antimicrobial efficacy with ease of use, this study was carried out to determine the effect of the use of alcohol gel hand sanitizer by caregivers on infection types and rates in an extended care facility.... Comparison of the infection types and rates for the units where hand sanitizer was used with those for the control units where the hand sanitizer was not used showed a 30.4% decrease in infection rates for the 34-month period in the units where hand sanitizer was used. CONCLUSION: This study indicates that use of an alcohol gel hand sanitizer can decrease infection rates and provide an additional tool for an effective infection control program."
National Center for Biotechnology Information

Washing hands with soap and water is still best, but what kind of soap should you use?

"Seven years ago, only a few dozen products containing antibacterial agents were being marketed for the home. Now more than 700 are available. The public is being bombarded with ads for cleansers, soaps, toothbrushes, dishwashing detergents, and hand lotions, all containing antibacterial agents. Likewise, we hear about 'superbugs' and deadly viruses. Germs have become the buzzword for a danger people want to eliminate from their surroundings. In response to these messages, people are buying antibacterial products because they think these products offer health protection for them and their families. Among the newer products in the antibacterial craze are antibacterial window cleaner and antibacterial chopsticks. Antibacterial agents are now in plastic food storage containers in England. In Italy, antibacterial products are touted in public laundries. In the Boston area, you can purchase a mattress completely impregnated with an antibacterial agent. Whole bathrooms and bedrooms can be outfitted with products containing triclosan (a common antibacterial agent), including pillows, sheets, towels, and slippers."

Antibacterial soaps are not only easier to locate than they were just a few years ago -- in some cases, they are difficult to avoid.

"It's almost impossible to find non-antibacterial products in today's supermarkets and grocery stores. 'Over 70 percent of the liquid soap you can buy now is labeled antibacterial,' Larson says."

While those selling the products would like us to believe that these products will reduce our chances of getting sick, whether or not that is the case is still in question."The households were randomly assigned to use cleaning, laundry and hand washing products that contained antibacterial ingredients, or identical-looking products that did not have antibacterial ingredients.... At the end of 48 weeks, there was essentially no difference between the two groups in the seven infectious disease symptoms surveyed, including runny nose, cough, sore throat, vomiting and diarrhea...."

More specifically:

"Differences between treatment groups in rates of any symptom by household-month were not statistically significant (33.1% and 32.3% in the antibacterial and non-antibacterial groups, respectively). Over the 48 weeks, both unadjusted and adjusted relative risks for each symptom showed no significant effect of antibacterial product use on infectious disease symptoms (Table 2). No interaction of treatment effect with number of months using the products was found in logistic regression analyses for any of the symptoms. Furthermore, differences in number of symptoms reported over the study period (Figure 2) were not significant between the treatment groups."

There was "no significant effect of antibacterial product use on infectious disease symptoms"?

"One explanation for the findings is that the infections that occurred might have been viral and not bacterial, Larson says. Antibacterial products aren't supposed to have an effect on viruses. On the other hand, there may be a popular perception that these products will combat any infection. 'When I buy an antibacterial product, in my mind, I'm thinking this is going to reduce my risk of infections,' Larson says. 'Consumers don't think about the fact that most of the infections healthy people get are cold, flu and diarrhea caused by viruses.'"

Bacteria? Viruses? They both are little things that make us sick, right? How different could they be?

"Bacteria are single-celled microorganisms visible only with a microscope. They are self-sufficient and reproduce by dividing. Not all bacteria are harmful. But when infectious bacteria enter your body, they can make you sick. Bacteria make toxins that can damage specific cells they've invaded. A virus is a capsule of genetic material. Viruses are much smaller than bacteria. Also, unlike bacteria, they're not self-sufficient. A virus needs a suitable host cell in order to reproduce. When a virus enters your body, it invades some of your cells and takes over the cell machinery, instructing these host cells to make the parts it needs to reproduce. The virus may eventually kill these host cells or may become latent -- part of the host cell's genetic material. The distinction between viruses and bacteria is important. This is because drugs that are effective against one type of infection won't work against the other type."

Antibacterial does not mean antiviral, but it's better than nothing... or is it?

"Doctors are particularly concerned that antibacterial soaps could be contributing to the growing problem of drug resistant bacteria. This may be because it is killing the weakest bacteria, leaving the tougher, hard-to-kill strains dominant. Dr Myron Genel, American Medical Association Dr. Myron Genel, chairman of the AMA's council on scientific affairs said he 'suspected' that this might be the case. 'There is no evidence that they do any good and there is reason to suspect that they could contribute to a problem by helping to create antibiotic-resistant bacteria,' he said. Overuse of antibiotics has led to the emergence of new bacterial strains that are largely untreatable because they are resistant to existing drugs."

Questions of the Week:
What are ways to reduce your chances of getting sick from bacteria? How are these the same as (and different from) what you should do to avoid viruses? What role should hand washing play in reducing your chances of getting sick and/or spreading germs? To what extent should you depend upon antibacterial soaps (and other antibacterial products)? In what ways are antibacterial products better and/or worse than similar products without the antibacterial component? What role can alcohol gels play in reducing your chances of getting sick and/or spreading germs? To what extent should you depend on these gels, and when are they not appropriate to use?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

[email protected]
Health Community Coordinator
Access Excellence @ the National Health Museum

Request Question of the Week by email 
QoW Archives: 9/2002 - 8/2003 9/2003 - 8/2004 9/2004 - 8/2005 9/2005 - 8/2006 9/2006 - present

Custom Search on the AE Site