Outbreak Control

April 25, 2007
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It turns out that your mother did know best – keeping your hands clean is one of the smartest things you can do to stay safe and healthy. And this advice is not just for kids either. There are many germs (bacteria, viruses and fungi) invisible to the eye that have the potential to make individuals sick and wreak havoc on businesses in the form of employee absenteeism, overtime and healthcare costs, lost revenues and negative publicity.

Tools available to combat the spread of disease and control infectious outbreaks include pharmaceuticals (vaccines, antibiotics, etc.), environmental cleaning /sanitation, and protective equipment, yet one of the most effective means of defense is proper attention to hand hygiene. Leading institutions such as the Centers for Disease Control, World Health Organization and the Association of Professionals in Infection Control all agree that hand hygiene is one of the most important aspects in controlling the spread of germs that cause disease (see references 1,2,3).

As readers of this magazine know, worker health has a real impact on business performance. It is estimated that time missed from colds and flu costs organizations between 20-40 billion dollars each year, and our own poor habits such as “presenteeism” (coming to work sick), combined with common workplace practices, are partially to blame. Consider some sobering facts reported by the Soap and Detergent Association in their annual report on Americans’ hygiene habits:

  • 43% seldom or never wash their hands after coughing or sneezing
  • 32% don’t always wash before eating lunch
  • 54% don’t wash long enough to be effective.(4)


Whether it’s from surfaces such as sinks, handrails, light switches, and doorknobs or shared equipment like telephones, keyboards, and machinery, there are plenty of ways to pick up germs. In the remainder of this article, we will examine some of the threats that exist from failing to follow measures for proper hand hygiene and skin protection and recommend steps that both individuals and workplaces can take to improve their performances in this area.

New emerging threats

While most workplaces experience annual cold and flu outbreaks, there are a number of new pathogens on the rise that can significantly impact any facility or workforce.

MRSAMethicillin Resistant Staphylococcus Aureas is the “super-bug” now making headlines. Once confined to healthcare settings, it has emerged in a new “Community Associated” form, CA-MRSA, that is showing up everywhere from health clubs to schools. This strain of the common Staph bacteria does not respond to conventional antibiotic treatments like penicillin and is often misdiagnosed. MRSA usually manifests itself as a pimple or boil and has been known to be mistaken for a spider bite; patients often end up in the hospital requiring IV antibiotics and/or surgery. In severe cases where it has entered the bloodstream or lungs, it has been fatal.

Norovirus – Nicknamed the “cruise ship virus,” Norovirus has been responsible for numerous outbreaks of extreme gastrointestinal illness – sickening employees, visitors, and customers – and even closing down businesses. This virus is so contagious that one sick individual has the potential to infect dozens of others. The main route of transmission is through touching contaminated surfaces and subsequent ingestion of viruses.

Bloodborne Pathogens (HIV/Hepatitis) – OSHA standard 1910.1030 provides protection guidelines for workers with potential exposure to blood or bodily fluids. Hepatitis C (HCV) is one of the most common bloodborne pathogens, and one of the most dangerous, as there is no vaccine for it. More than 80% of those infected with HCV show no initial symptoms. It is estimated that over half of all liver transplants in the U.S. have hepatitis as a root cause.

Protecting the hands – a multi-layered approach

When it comes to protecting the hands from dangerous pathogens, a layered approach is best. Body substance isolation or barrier methods such as gloves offer excellent protection and should always be worn as required by standards such as OSHA 1910.1030. Yet, gloves are not 100% effective, because they are susceptible to being punctured or torn and may even spread contamination if not removed or disposed of properly.

As a complement to wearing gloves, hand washing with soap and water has also been shown to be very effective in removing visible soil and microscopic contamination, such as bacteria, from the hands. However, proper technique in hand washing is very important. School children are taught to sing the “ABC’s” or “Happy Birthday” twice while washing to ensure adequate time at the sink (approximately 20 seconds). Adults would also do well to heed this advice. It has been reported that many do not wash their hands after using the restroom, and most of those that do spend far less than the optimum time. Properly equipped facilities with plenty of soap (touchless dispensers are far better than bars) and hands-free paper towel dispensers help encourage employees to wash their hands. On the subject of soap, there is little evidence to prove that so-called “antibacterial soaps” are any more effective at removing contamination than traditional products.

Hand sanitizers offer another layer of hand protection. The popularity of these products has grown tremendously in recent years and studies in schools and office settings have reported significant reductions in absenteeism when hand sanitizer programs were implemented (5). Now widely utilized in the healthcare industry, over-the-counter products are also numerous.

Hand sanitizers are available in many forms (gels, foams, sprays, wipes), but users should look for products containing more than 60% alcohol, which is the optimum active ingredient and most effective concentration for broad spectrum efficacy. Most sanitizers contain emollients/conditioners, since the use of pure alcohol can damage the skin. If hands are visibly soiled, workers should first wash with soap and water and then apply sanitizer. For those who wear gloves on a regular basis, sanitizer should be used when gloves are removed or changed. Hand sanitizers should always be used in conjunction with barrier protection and soap and water, not as a replacement. But in jobs where access to sinks is not always immediate, or where multiple washings over a shift can cause skin problems, hand antiseptics are an excellent choice.

If you are choosing a hand sanitizer product for your company, it is important to have one that employees will use repeatedly. The healthcare industry learned early on that the key to a successful hand hygiene program is compliance. Workers only benefit if they use the products. The feel, consistency, odor, and drying/irritation are all factors that impact the use of sanitizers. A user trial with proposed products should be conducted prior to implementation.

Convenience and ease-of-use are also important when it comes to finding the right sanitizer for the workplace. For some, individual sanitizer bottles carried on the person work best. Alternatively, wall mounted dispensers are ideal if appropriately positioned and easy to service/refill. Since alcohol is flammable, it’s important to address potential safety threats by mounting dispensers away from electrical outlets, ensuring locations are not likely to be bumped, limiting the amount of liquid in the dispensers, and properly storing replacement dispensers.

Conclusion

Industrial hygienists and facility managers spend much of their time focused on the safety and well-being of their fellow employees. These concerns typically lead to the procurement of items ranging from pharmaceuticals to PPE, which are unquestionably necessary and important, but it’s sometimes easy to lose sight of the fact that practices such as hand hygiene also have a large impact on the welfare of a workforce.

Whether it is on the assembly-line, eating lunch at one’s desk, using the office copy machine, climbing utility poles, or commuting to work on public transportation, just about every worker needs to be concerned with protecting his/her hands from germs. The overall result from increased attention to hand hygiene will be a healthier and safer employee and a more productive workplace.

References:

  1. www.cdc.gov/handhygiene
  2. www.apic.org
  3. www.who.org
  4. http://cleaning101.com
  5. C. White, Am. J. Infection Control, 13:364-370, 2003.

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