Sunday in Brisbane (that’s in Australia) was a perfect chance to discover the local wildlife: kangaroos and koalas at the Lone Pine Koala Sanctuary. Emma and Sorenne were overly excited by the opportunity. When it was their turn to get their photo taken with the koala, however, I noticed the sign on the hand sanitizer station saying, “Out of Order. Sorry for any inconvenience.” As we exited the area into the food court, Emma grabbed some sanitizing wipes that were available (but unmarked and almost not noticeable) on a table and cleaned up Sorenne’s hands the best she could.

After our afternoon “tea” (that’s Australian for “snack”), we headed into the Kangaroo Rescue area. For $2 I bought a rather large bag of kangaroo feed, and we proceeded to shove our hands into the faces of every kangaroo who passed by. Emma was brave and lay down on the ground to pose with one of the big boys. For me the highlight was either seeing a pregnant mommy ‘roo whose joey was wiggling about in her pouch or watching Sorenne’s face light up when the baby kangaroos ate from her hands (right exactly as shown).

Upon exiting the area (which was filled with scrub turkeys, ducks, wombats, emus and feces in addition to the kangaroos), there was a handwashing station with ample running cold water and soap but no paper towel to dry hands. The park prides itself on reusing water, and there was clear signage indicating that all water in use was recycled except for handwashing, food preparation, and drinking water. I didn’t feel confident that they were able to separate distribution so well after realizing that handwashing wasn’t possible in the koala cuddling zone.

Handwashing really isn’t simple, especially when the proper tools are not available.
 

I’m confused with these conflicting handwashing studies.

And, as Les Nessman of WKRP in Cinncinatti said, when I get confused, I watch television. It somehow makes things simple. Television is never confusing.

This morning it was alcohol-based sanitizers didn’t do much to limit the spread of the H1N1 virus, but worked well against cold viruses (the sanitizers also sorta suck against norovirus).

Later today, it was the results of another of those creepy make-grad-students-hang –out-in-public-bathrooms studies, to see if people actually wash their hands, which found that 85 per cent of adults washed their hands in public restrooms, the highest number since the studies began in 1996.

But it's a far cry from the 96% of adults who say they always wash their hands in public restrooms, based on a separate telephone survey conducted at the same time.

Men do a lot worse than women overall — just 77% scrubbed up, compared with 93% of women.

The study was sponsored by the American Society for Microbiology and the American Cleaning Institute (formerly the Soap and Detergent Association). It involved discreetly observing 6,028 adults in public restrooms in August to see whether they washed their hands.

Great. More people are attempting to wash their hands. But are they doing it correctly? Does any attempt count, or only if handwashing is done according to government prescriptions. What is the best way to wash hands? Can’t people with PhDs agree?

No.

A study by researchers at the University of Bradford and published in the current Journal of Applied Microbiology evaluated three kinds of hand drying and their effect on transfer of bacteria from the hands to other surfaces: paper towels, traditional hand dryers, which rely on evaporation, and a new model of hand dryer, which rapidly strips water off the hands using high velocity air jets.



In this study the researchers quantified the effects of hand drying by measuring the number of bacteria on different parts of the hands before and after different drying methods. Volunteers were asked to wash their hands and place them onto contact plates that were then incubated to measure bacterial growth. The volunteers were then asked to dry their hands using either hand towels or one of three hand dryers, with or without rubbing their hands together, and levels of bacteria were re-measured.

The researchers found the most effective way of keeping bacterial counts low, when drying hands, was using paper towels. Amongst the electric dryers, the model that rapidly stripped the moisture off the hands was best for reducing transfer of bacteria to other surfaces.

Yet tomorrow’s N.Y. Times reports it’s a draw, and that “the best available evidence suggests that as far as germs go, the method of drying is less important than the amount of time invested: the longer the better.”

So my pants would be fine as long as I used them enough.

Dr. O. Peter Snyder at the St. Paul-based Hospitality Institute of Technology and Management summarized key aspects of handwashing and drying in a paper available at, http://www.hi-tm.com/Documents/Safehands.html. Snyder says that after hands are washed and rinsed, they must be thoroughly dried.

Blow dryers should not be used because they accumulate microorganisms from toilet aerosols, and can cause contamination of hands as they are dried by the drier (Knights, et al., 1993; Redway,et al., 1994).

Snyder notes that it is also apparent that many individuals do not dry their hands thoroughly when using a blow drier; hence, moisture, which is conducive to microbial growth, remains on hands, or people dry their hands on their clothing.

Proper handwashing requires access to the proper tools – and that means vigorously running water, soap and paper towel.

We’ve reviewed the literature on handwashing and how best to motivate people to wash hands, and conclude in a paper to be published shortly that,

“Although the role of hand hygiene in preventing infectious disease is well recognized, studies repeatedly show that compliance remains low. … Education and training have been cited often as essential to developing and maintaining hand hygiene compliance but, with few exceptions, this approach has not produced sustained improvement. … Hand hygiene was enhanced by provoking emotive sensations of discomfort, unpleasantness and disgust. Evidence suggests handwashing is a ritualized behavior mainly carried out as self-protection from infection and that patterns of handwashing behavior are likely established in childhood. Therefore, interventions that focus on culture, perception and behavior change may prove to be the most successful. How that success is measured must be carefully considered, as there is no standardized method for measuring hand hygiene compliance and current techniques have significant limitations.”
 

Amy, Sorenne and I spent a long last weekend in San Francisco, where Amy conferenced, I had some meetings, but mainly just hung out with the kid (three pirates and a little girl, right).

The washrooms at the San Francisco airport featured the Dysan airblade, billed as the “fastest, most hygienic hand dryer.” Says so right on the machine. And it’s certified by NSF as “tested, certified, hygienic.” Says so right on the machine.

My bowels are in a state of flux when traveling so I had several opportunities to try out the newfangled machinery, that sounds like an airplane is taking off below your fingertips.

We have maintained, based on our reading of the available literature, that proper handwashing, entails:

• wet hands with water;
• use enough soap to build a good lather;
• scrub hands vigorously, creating friction and reaching all areas of the fingers and hands for at least 10 seconds to loosen pathogens on the fingers and hands;
• rinse hands with thorough amounts of water while continuing to rub hands; and,
• dry hands with paper towel.

Water temperature is not a critical factor -- water hot enough to kill dangerous bacteria and viruses would scald hands -- so use whatever is comfortable.

The friction from rubbing hands with paper towels helps remove additional bacteria and viruses.

I did a cursory search to find some data on the Dysan thingy, and found a study comparing paper towel, regular blow dryers, and a Dysan-type jet dryer that was published in 2008.

Those authors state:

“The jet air dryer showed that there were significant differences (although not as great as for the fingerpads) between the towels and both types of dryer. Again, the superior performance of the towels in reducing bacterial numbers was confirmed. As for the fingerpads, the jet air dryer performed better than the warm air dryer in not increasing mean bacterial count on the palms as much but this difference was not significant.

“Therefore, the manufacturer’s claim that the tested JAD is the “most hygienic hand dryer” is confirmed, especially for fingerpads and assuming that the term “hand dryer” refers to electric devices only because its performance in terms of the numbers of all types of bacteria remaining on the hands of users compared to paper towels was significantly worse. …

“It is well known to microbiologists that air movements encourage the dispersal and transmission of microorganisms and increase the chances of the contamination of materials or persons in any situation. This makes paper towels, where little air movement is generated, the most hygienic option tested in this respect followed by the warm air dryer and, lastly, the jet air dryer.”

The friction from rubbing with paper towel is particularly effective at reducing microbial populations; yet many of these public bathrooms have signs proclaiming that electric dryers of whatever kind are better, and save the trees. Oh, and I should hear from someone at Dysan or NSF – public claims need to be backed with public data.

Maybe I’ll just stay at home.
 

At some point while endlessly bitching at Chapman to finish his damn thesis and produce some papers, I realized, I wasn’t so good at closing the deal myself.

I could say I like blogging, being quoted in media, the immediacy of it all, but I also realized I needed the credibility of peer-reviewed publications.

So after grappling with divorce, the angst of children lost, the joy of remarriage and once again the commitment to an ideal, another kid, I decided that while I was bitching at Chapman, I better take care of my own shop.

So, with some pride, I announce the first of about a dozen peer-reviewed papers that are going to appear this year.

Designing effective messages for microbial food safety hazards, which will appear in an upcoming issue of Food Control, by Douglas Powell, Casey Jacob and Lisa Mathiasen, was started by Lisa back in 2003. I told her it was going to be published and she said, “about time.”

Casey did some excellent improvements, and the thing is coming out.

Here’s the abstract; I’ll post the full paper info when it’s published.

Despite numerous food safety information campaigns and educational efforts, microbial foodborne illness remains a significant source of human disease. New food safety messages transmitted using new media are required to enhance food safety from farm-to-fork. A review of the literature reveals that targeting a segment of the population and understanding knowledge, attitudes, and perceptions of the individuals comprising that segment can lead to successful communication of food safety messages. Messages found to be effective are relevant to the target audience, contain reliable information, are rapidly distributed at appropriate times, and are repeated. Those containing information that is easily received and understood have also been found effective. The use of media commonly accessed by today’s consumers is also valuable. Evaluation of the effect of all aspects of food safety messages and media, as measured through observation of recipients’ actions, is required to validate the effectiveness of food safety communications.

And I’m in love with my partner, cause she’s the meanest editor I’ve ever had.

And vice-versa.