No Water, No Wash, No Problem
The use (and misuse) of hand sanitizers has exploded with the onslaught of Coronavirus. Its convenience factor plus CDC, NIH, and FDA support have driven its application to new heights in away-from-home settings. It may well prove to be the #1 intervention for this virus as two of the four routes of transmission are cut off with a proper application of a 60+% alcohol-based hand sanitizer (ABHS).
The Major Coronavirus Transmission Routes:
- Direct surface contact with an infected person via a handshake, hug or kiss. Virus-contaminated hands can usher the pathogens from the hands or face into the body via contact with the mouth, nose or eyes.
- Hand contact with a contaminated inanimate surface, resulting from expelled deposits of heavy, temporarily airborne, droplets. Hands move the Coronavirus from a no-risk location (on hands) into one’s body by means of touching the mouth, nose or eyes.
- Direct intersection with orally projected droplets being inhaled or entering the mouth or eyes.
- Inhaled aerosolized Coronavirus-containing particles. Wearing a mask is the principal intervention as well as the social distancing with a minimum of six feet.
Eventually, we may get some educated guesses or even some clinical data for the comparative risk of each transmission route. Let us know if you have an estimate for each.
Misuse of the hand sanitizer is common, exacerbated by a variety of inconsistent pumps, bottles, and formulations. The most common error is incomplete coverage. Hand sanitizer can only kill what it contacts. Its vapors do not kill. Following the same procedure as indicated for soap-water washing (Core Handwash™) assures good coverage and germ kill.
SaniTwice® Core Handwash demonstrated:
The Core Handwash Training Poster:
Product formulation matters more than the label claims:
Contact time is also important. Insufficient dosage can dry too quickly and leave active pathogens behind.
An experiential training session is recommended to visually remind staff of these factors, using the application tracer method. Simply add Brevis’ GlitterBug® to your hand sanitizer in a 50-50 proportion. (Use only for training.) Apply this thoroughly mixed blend to hands. Let dry and scan with a UV disclosure lamp or flashlight. Covered areas emit a blue glow while missed areas do not.
Regulatory agencies are rightfully suggesting soap-water handwashing when available as there are some pathogens that are harder to kill than Coronavirus. Please note the word “kill”. What about a protocol that adds cleaning power to the kill factor of the hand sanitizer? Removing germs is every bit as effective as killing them even though combined interventions are not recognized in the Model Food Code due to their inspection and reporting limitations.
Well-formulated hand sanitizer has inherent cleaning potential by virtue of its emulsifiers, emollients, water, alcohol and its undiluted use. This concentrated mixture can be further potentiated in four ways:
- A. Double or triple the application dose. This assures coverage and increases contact time, thus raising effectiveness.
- B. Add friction to “A” by approaching the event as a “handwash” – scrubbing with plenty of muscle.
- C. Add a paper towel to “B”. After an initial scrub, while hands are still wet, wipe vigorously with the disposable towel. (Known as the RubScrub™ method.)
- D. To “C”, add a second application of a single dose as per label directions. Air dry. (Originally created for the military. Described as the SaniTwice® protocol.)
Handwashing For Life recommends matching the risk with the regimen:
Effectiveness of this two-step, clean-kill protocol, was confirmed in two independent research studies. The first was published in the Journal of Food Protection and summarized: “… the SaniTwice regimen with various ABHS is equivalent to or exceeds that of the standard hand washing approach as specified in the U.S. Food and Drug Administration Food Code. Implementation of the SaniTwice regimen in food handling settings with limited water availability should significantly reduce the risk of foodborne infections resulting from inadequate hand hygiene.”
Complete Research Report: https://pubmed.ncbi.nlm.nih.gov/21219752/
This same protocol was subsequently studied by Emory University as a solution for use by farmhands harvesting ready-to-eat produce. Research findings were summarized:
ABHS-based interventions were equally as effective as hand washing with soap at reducing indicator organisms on farmworker hands. Based on these results, ABHS is an efficacious hand hygiene solution for produce handlers, even on soiled hands.”
Complete Research Report: https://pubmed.ncbi.nlm.nih.gov/26555526/
SaniTwice also has applications in nursing homes and acute care where patients are restricted to their beds, well away from the handsink.
SaniTwice has also been adopted by the Clark County school system (Southern Nevada/Las Vegas) for use in their kitchens during water outages.
Coronavirus infectivity routes have highlighted the importance of high-touch surfaces, especially where cleaning is not keeping pace with the rate of contamination. Maintaining surfaces infection-free is all but impossible. Hands are likely to get touch-contaminated but if the Coronavirus is restricted to the hands (not introduced to the mouth, nose, or eyes) there is no problem except to remember to follow such touches with an application of the hand sanitizer. Note: Sanitize hands BEFORE donning Coronavirus masks.
Improve home health by equipping each entry of the house with hand sanitizer and encourage family use as in hospitals – Rub In. Rub Out. Have maintenance, repair and home-health professionals do the same. Making this a family habit will also significantly increase your chances of avoiding the common cold, flu and even Norovirus infections.
Tip. Be careful when changing shoes! Avoid contact with the soles and follow the change with a hand sanitization. Shoes can easily tread on live coronavirus in the cleanest of restaurants, supermarkets, and schools. The floor of even a hospital is their most invisibly-contaminated surface. And how often are purses and bags set on restaurant, bar, and restroom floors?
Relax about the major myth that alcohol hand sanitizers dry and damage the skin. The good ones have emollients. It is soap-water handwashing that does the damage, especially poorly rinsed soaps.
Both handwashing and hand sanitizing significantly reduce the population of any bacteria or virus on the skin. The transient (“bad”) bacteria and virus are eliminated or pushed below an infectious dose, whereas the resident (“good”) bacteria rapidly repopulate the skin after a hand hygiene event. The bottom line: hand hygiene does not impact our normal flora or put us in any risk at all.