Hand Sanitizer 101

What’s the best way to keep from getting sick and making others sick? Washing your hands! If soap and water aren’t handy, you may reach for the next-best thing: hand sanitizer. These sanitizers contain active ingredients such as ethyl alcohol, ethanol or isopropanol designed to conquer those hard-to-kill bacteria and viruses that love to make you cough and sneeze. 

Goodbye to Germs

When you squirt that hand sanitizer on your hands, rub vigorously. The friction will help get in the nooks and crannies of your hands. In these brief moments, the alcohol is attacking the bacteria’s outer casing or cell membrane. The bacteria cannot survive without its supportive walls, meaning you have cleaner, more germ-free hands. 

Tips for Use

A catch exists for alcohol-based hand sanitizers: The sanitizers must contain enough alcohol to make an impact. Look for a hand sanitizer that has at least 60 percent alcohol. Otherwise, your hand sanitizer is a dud in terms of keeping your hands clean. To make matters worse, using a low-percentage hand sanitizer spreads germs around your hand, making them easier to spread, according to The New York Times. 

You can tell you are using enough hand sanitizer by how fast the sanitizer evaporates. Once you apply the sanitizer to your hands, the product should take at least 15 seconds to evaporate, according to the Centers for Disease Control and Prevention. 

Versus Handwashing

While effective, using hand sanitizers isn’t always the answer. Washing with soap and water is your best bet when your hands are visibly soiled. Hand sanitizers stop germs, but they don’t remove dirt, blood or stool. They also do not kill certain bacteria types, such as E.coli, a common bacteria present in raw or uncooked foods. When you’re cooking or have just gone to the bathroom, go with washing your hands with soap and water for at least 20 seconds over using alcohol-based hand sanitizers. 

Hand sanitizers do have an advantage over handwashing in that they are easier to access. You may not have a sink handy, but you can keep a small bottle of hand sanitizer in your desk, car, pocket or purse. This convenience appeals to healthcare workers and others who are always pressed to save time.

Secondly, frequent warm water and soap usage can dry out and crack your hands. This effect attracts bacteria to your hands. Hand sanitizer manufacturers can incorporate moisturizers to reduce cracking while keeping your hands clean. 

How To See If Your Hands Have Been Properly Sanitized

GBX 1-2-3

One great way to see if you have applied hand sanitizer properly is by using GlitterBug® Gel. This product is formulated to be very similar to popular hand sanitizers but it has a special ingredient that glows when illuminated by black light. Apply the GlitterBug Gel and rub it in as if it were regular hand sanitizer. Then examine your hands under black light from the Brevis GlowBarLED lamp. The GBX molded disclosure center is ideal for viewing the results because it shields out extraneous or ambient light thus enhancing perception. After using the GlitterBug Gel you should see the entirety of your hands glowing. Any dark areas that do not glow are areas that may not have been safely sanitized. Visual feedback to help improve technique and therefore safety.

Best teaching products for hand sanitizer use

You may find these products helpful in your mission to improve hand hygiene:
GBX Disclosure Center with Gel
GlowBar LED Lamp
GlitterBug Gel

The Best Ways to Prevent the Flu

As anyone who has suffered from it knows, catching the flu is a horrible experience. The fever, chills, aches, soreness, muscle pain and extreme fatigue that flu causes will keep the afflicted in bed for days. Besides being in pain and miserable, the sick person will have to miss days or weeks of work – their entire life will be put on hold. Worse, in extreme cases the illness can be fatal. While the vast majority of sufferers survive, every year hundreds of thousands die from the flu worldwide. Clearly, flu prevention is vitally important.

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Luckily, concrete steps can be taken Continue reading The Best Ways to Prevent the Flu

The Science of Handwashing

We all know that keeping hands clean helps keep us from getting sick, but how does handwashing actually work?  Can we really get rid of all the germs on our hands?  Is there a single best technique for handwashing?  Do antibacterial soaps really work?  Scientists have studied these questions, and some of the answers may be surprising.

What exactly are germs?  Can handwashing really get rid of them?

Microbes, microscopic organisms, are everywhere, including on human skin.  Many of the microbes on hands are single-celled bacteria.  Many of the bacteria are always there, living harmless and unnoticed; these are called resident bacteria.  Other bacteria are picked up from the environment; these are called transient bacteria.  Transients can persist on skin for days to months, but can’t live there forever.  They may include pathogens — disease causing organisms, or germs.

Handwashing can never completely remove resident bacteria; there may be 10,000 or more individual bacteria on each hand, and they are adept at sticking to skin and slithering down between the cracks in skin cells to avoid removal.  Transient bacteria are present in fewer numbers and are not adapted to living on skin surfaces; they can be completely removed by handwashing.  Therefore, the purpose of handwashing is not to make hands sterile; it is to get rid of any potential pathogens that have hitched a ride.  However, handwashing technique can vary, and as we will see, some variables are more important than others in making sure pathogens have been removed.     

Does it matter if the water is hot or cold?

Although germs aren’t likely to be destroyed by water temperatures we can tolerate, health experts have long recommended washing hands with warm or hot water.  The reason is that warmer water should help dissolve oils and other substances coating skin, helping to wash away germs with them.  Unfortunately, recent studies comparing the numbers of bacteria on hands washed with cold, warm, and hot water have shown no difference in the results — just as many bacteria remain no matter what water temperature is used.  Since using hot water uses more energy and might irritate the skin if handwashing is frequent, cold water might be a better option.

What does soap actually do?

In general, soap doesn’t kill germs.  In fact, populations of bacteria have been found thriving in liquid soap dispensers in public restrooms.  Instead, the purpose of soap is to help remove contaminants and bacteria from the skin surface.  There is an extra benefit as well; some studies have examined how thoroughly volunteers washed their hands with and without soap; the volunteers using soap did a much more thorough job.  Using water alone will reduce the number of germs on hands, but using soap is more effective.  

Should antibacterial soap be used?  What about other sanitizers?

Although antibacterial soap is everywhere, there is no scientific evidence that it is any better at removing germs from hands than regular soap.  There is also concern that triclosan, a common ingredient in antibacterial soap, could cause bacteria to become resistant to antibiotics.

For how long should hands be washed?

The length of handwashing depends on the circumstances; for example, very dirty hands or hands exposed to more pathogens need a longer period.  In general, studies show that 20-30 seconds of handwashing is all it takes to remove most germs.  To help time handwashing, you can hum the “Happy Birthday” song two times – this should take approximately 20 seconds.

Which areas get missed?

Worldwide, the same areas are missed again and again when hands are washed.  Fingertips, cuticles, between the fingers, and the back of the hand, especially the thumb and ring finger, are areas which get the least attention; therefore, these are the areas where most germs remain.

GlitterBug is designed to disclose where hand washing can improve.

Research-based handwashing technique

In order for handwashing to work, proper technique is a must.  Begin handwashing by wetting hands with warm or cool water.  Apply soap and lather hands; remember commonly-missed areas such as around the nails, between the fingers, and the backs of the hands.  Scrub hands together for at least 20 seconds (or two rounds of the “Happy Birthday” song) before thoroughly rinsing and drying.

As long as the proper technique is used, handwashing is an excellent way to reduce or eliminate transient bacteria, including disease-causing pathogens.  

What Everyone Should Know about Hand Sanitizers

Hand sanitizers have been a popular commodity since the emergence of Covid-19 in the Spring of 2020. There was even a shortage for a while, as everyone rushed to stores to stock up. As sales continue to rise consumers should be aware of the ingredients of the product and the marketing techniques that manufacturers use to increase sales.

Alcohol Content

According to the FDA, in order to be effective, hand sanitizers should contain at least 60% alcohol. The label may list this as ethanol, ethyl alcohol, or isopropyl alcohol. If the label does not show the percentage of alcohol contained in the product, do not buy it. 

Some types of alcohol are extremely dangerous, and it is doubtful that a manufacturer would list these on the label if they are present, but the FDA has found contamination with methyl alcohol or 1-propanol in some hand sanitizers manufactured in Mexico and sold in the U.S. Methyl alcohol, or wood alcohol as it is sometimes called, is used to make antifreeze. 1-propanol is an ingredient of industrial solvents.

False Claims

Claims that hand sanitizers can prevent Covid-19, influenza or other diseases are misleading. Any product making these claims should be avoided. Hand sanitizers, when used properly, can only kill germs that are on your hands, and only lasts until you touch something else.

Misleading Marketing Practices

Some hand sanitizers on the market are scented with appetizing smells such as chocolate or strawberries. If a child smells these, he or she may think they are good to drink. Hand sanitizers packaged in containers that resemble beverage cans, water bottles or food pouches can also mislead young children into thinking that the contents are edible food products.

There have been cases where a person has mistakenly believed that a product that contains alcohol is OK to drink. Since alcoholic beverages contain alcohol, why not drink Nyquil, extract of Vanilla, mouth wash, or hand sanitizer and get a similar “buzz”?  Ingesting any of these products could produce headaches, diarrhea, vomiting, irregular heart rate, seizures and if a very large quantity is consumed, possibly coma or death could result. 

Since hand sanitizers seem to be everywhere these days it is important to understand what the ingredients are. Make sure the contents are clearly labeled and contain a minimum of 60% alcohol. Ignore claims made on labels that the hand sanitizer you are buying will prevent influenza, Covid-19 or anything else. It does not. Never ingest hand sanitizer. It is not safe for human consumption. Small children should be supervised when using hand sanitizers. When shopping for hand sanitizers, avoid packaging that could be mistaken for food products. Steer clear of those with appetizing scents. 

Teach people how to apply hand sanitizer correctly with Glitterbug Gel.

Three Easy Ways to Avoid the Flu

Flu season is no longer coming–it is here. No one wants to stay at home with fever, nausea, and the other unpleasantries that come with being sick. Even if you got the flu shot, with the dismal effective numbers for this year’s vaccine, odds are pretty good you’ll still get sick. It never hurts to do your part when you want something. If good health is high on your list, check out the tips below. Practicing these three tips can help reduce the possibility of becoming a victim of this year’s debilitating strain of influenza.

Wash Your Hands: Everyone hears that handwashing is important but what most people don’t hear frequently enough is how to do it right. To avoid infection, hands must be scrubbed with soap for at least twenty to thirty seconds. Thirty seconds is approximately the time it takes to sing the ABC song. Rinse your hands thoroughly with clean water and dry them well. Regular handwashing is by far the easiest, cheapest, and most convenient protection against contracting the flu.

Avoid Germ-Laden Surfaces: You don’t have to refuse to use your hands to open doors or wear gloves everywhere to protect yourself from germy fixtures. A little knowledge about germ hotspots can help you decide what to touch and what you’d rather not handle. Gas pump dispensers are much dirtier than toilet seats and wiping down shopping carts is definitely a good idea. Carrying a small container of hand sanitizer in your pocket will allow you to instantly zap any germs. However, keep in mind that sanitizers kill good germs that help build your immune system as well as bad germs that make you sick, so use it sparingly.

Flu Posters

Stay Away From Crowds: Chilly winter weather makes indoor activities much more appealing. Unfortunately, it is much easier to pass germs around in close quarters. If at all possible, avoid venues that you know will be crowded. Do your grocery shopping at times that are less busy, such as the middle of the week. Try to stay away from locations such as malls, crowded theaters, or events where a lot of people will be in a confined space.

The tips above do not guarantee you’ll make it through the season illness-free but they can certainly decrease your chances of getting sick. As an added bonus, protecting yourself from the flu also prevents you from spreading it to others. When you consider the loss of time, money, and the terrible feeling of having the flu, a little handwashing or grocery shopping at odd hours seems like no big deal.

How do you know if a surface has been properly cleaned?

Quality control in surface disinfection has always been a challenge. Jim Mann, a Brevis associate, sent us a nifty device to check for surface cleaning. It is called MarX and Brevis is now marketing it as the GlitterBug MarX.This is a stamp device that leaves an invisible circle X mark on stamped surfaces that can be visualized with UV light. It will be simple for quality control personnel to check whether surfaces have been cleaned by shining a UV source, such as the very popular GlitterBug GlowBar LED, on stamped surfaces. In this SARS-CoV-2 pandemic world, knowing that surfaces have been cleaned is more important than ever. And will be in the future when the next pandemic after Covid 19 rears its ugly head, as surely it will.

For decades Brevis has been a world leader in the teaching of hand hygiene with its GlitterBug UV product line and instructional videos. The GlitterBug MarX product is a great addition to this popular family. The MarX device is very portable – and pocketable – at about 1.0 by 2.5 inches (2.5 x 6.3 cm). It is probably capable of at least a thousand stampings if kept covered between uses.

Surface cleaning detection kit with invisible stamper and UVA lamp

Surface cleaning matters even more than ever. Use the MarX to mark surfaces with an invisible mark then use the SpotShooter8 Lamp to see if those marks were properly cleaned off. Easy method to Trust but Verify.

If only the Marx Brothers (Groucho, Harpo, Chico and Zeppo) had known about this, vaudeville may have taken a different turn back in the early 1900s. There is a story, which I can’t verify, that explains why Harpo never talks. Seems that the brothers were on tour and in one particular town, their act was not well received. So as they were walking out of town to get to the train station, Harpo turned around and said something like, “I hope your town burns down.” The next day when they looked at the newspaper, what do they see but an item about how that town had been mostly destroyed by a large fire. Of course, they had nothing to do with starting the fire, but Harpo’s curse was so prescient that the other brothers prevailed on Harpo not to talk any more. And he never did in their acts including when they got into movies. The story may be apocryphal but I like it anyway. If it didn’t happen, it should have.

Buy Now

Meanwhile, GlitterBug MarX has happened and is available now for your consideration and use. Check it out. You will be impressed with its simplicity and effectiveness.

Thank you,

Gordon Short, MD
Brevis Corporation

Epidemic Intelligence Service

EIS, Epidemic Intelligence Service
The most important organization you may never have heard of

Of course if you are an OCD reader of my previous blogs, you have seen my references to the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) and its legendary founder, Dr. Alexander Langmuir. Although I had been assigned to audit the course upon entering active duty in the US Public Health Service in 1957 on my way to becoming a “toxicologist” in the Technical Development Laboratories of the CDC in Savannah, GA, and had an abiding interest in this remarkable organization, I hadn’t a clue as to its amazing reach and influence around the world until I read the book, “Inside the Outbreaks, The Elite Medical Detectives of the Epidemic Intelligence Service” by Mark Pendergrast (Houghton Mifflin Harcourt, 2010).

CDC is remarkable for both its geographic and illness span. Although it started as the Communicable Disease Center, with a major focus on all kinds of infectious disease epidemics, it now embraces subjects such as gun violence and environmental toxins such as lead and mercury in culinary water supplies. EIS officers are mostly MDs but the program also includes veterinarians, dentists, statisticians, nurses, anthropologists, sociologists, microbiologists, epidemiologists, etc.

Thanks to the stellar reputation of Dr. Langmuir and his success in attracting only top students to participate in the EIS course, EIS officers have been in high demand throughout the world. EIS officers only go where they have been invited, but their assistance has been requested around the world. These hardy souls have answered the call to places that bear little resemblance to conditions in the US. That can mean eating what the natives eat (Use your imagination) and sleeping in primitive huts. And traveling by whatever is available: bicycle, dogsled, elephant, camel, boats, you name it. They are hardy adventurers who will go anywhere to do what is necessary even at the risk of their own lives. And there have been a few who paid the ultimate price.

Langmuir stressed the importance of doing “shoe leather” epidemiology by which he meant getting out into the field and talking with those most affected by any outbreak. You can’t learn the essentials by staying in your hotel and watching TV and reading the local newspapers. How is the disease spread? Direct contact with bodily fluids (as in Ebola) or droplet and/or airborne as in influenza. What is the incubation period? What percentage of patients are asymptomatic? What percentage fatal? What age distribution? How do you tell when the peak incidence will occur?

The answers to these and other questions requires people in the field collecting data from all appropriate sources. Who are these people? A surprising number come from the ranks of the Epidemic Intelligence Service. These are the frontline troops who merit more attention than they get.

Gordon Short, MD
Brevis Corporation

COVID19: Show people what they should know to protect themselves from (Coronavirus)

Inform people about how to protect themselves from the acquisition viruses and germs such as Corona Virus. One cannot watch the news lately without being inundated with stories about the latest deadly virus outbreak. Scenes showing the dire situation in China where the outbreak seems to have started are prevalent in the media. Closed borders, sequestered or isolated travelers, cruise-ship customers in lock-down. Investigators are working feverishly to determine the sources of these viruses and the routes of transmission especially from one person to the next.

New Posters: Coronavirus in Public Places

Stay Safe Poster Protect Yourself Poster

The usual routes to infection are the most likely suspects. Touching surfaces in public and then touching our portals of entry (eyes, nose and mouth), breathing in of airborne germs or ingesting contaminated food. Of course we are  concerned with preventing illness amongst the population at large but must also realize that protecting oneself is of primary importance. In that vein Brevis presents new posters to inform people about the basic steps that can help to protect themselves.

What’s Nu with Flu?

I previously wrote about influenza at the end of 1918. But I couldn’t resist adding a bit more to the story based on the December, 2018 book “Influenza” by Jeremy Brown, MD.

So what’s “nu”? Brown tells the well-known story of 1918, the search for the original virus, etc., but then adds to the melodrama. For example, the truth about Tamiflu. Therein hangs a tale. Seems that Tamiflu (or oseltamivir if you prefer generic names) is only marginally effective. Supposedly it can shorten the symptomatic period by only a day and only if it is taken within 48 hours of the onset of symptoms. OK, well something is better than nothing I suppose.

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But the story doesn’t end there. Seems that governments around the world, including the US government, bought into the Hoffman-LaRoche inspired hype that Tamiflu was the best hope the world has to abort any impending influenza pandemic. With that in mind, the Strategic National Stockpile of emergency medicine, maintained by the CDC, added millions of doses of Tamiflu to its warehouses.

But the Cochrane Collaborative, an independent scientific critic, as quoted by Jeremy Brown said that Tamiflu was marginally effective in treating influenza and a little more effective in preventing it, but came with its own list of side effects that could imitate the symptoms of flu itself.

So, what to do? Hand hygiene, barrier protection, avoiding sick people if possible, and, of course, vaccination. Vaccination is only about 50% effective in prevention but may possibly lower the severity of an infection. I get my flu shot every year and don’t forget to cross my fingers. So far, so good.

Keep smiling!

Gordon Short, MD
Brevis Corporation

TB (What, you say?)

As a pathologist I had a visit from TB. Typical story: autopsy on undiagnosed case. The case? A woman about age 60 or 70 who was to be discharged from the hospital the following day, but decided to die first. This was about 50 years ago and I don’t remember too many details about what her organs looked like, but apparently not too alarming. In any event, my exposure was apparently sufficient to change my skin test to positive. (I was lucky and did not medicate or ever have any positive chest X-rays.)

The second case was quite different. A middle-aged lady entered the emergency room and was tentatively diagnosed as a possible carcinoma of the esophagus. Why? Because she was about 5 ft 6 in tall and weighed 60 lbs. At autopsy she looked like those pictures one sees of holocaust survivors who have starved in Nazi concentration camps. Every rib clearly visible. When her chest was opened, her lungs were composed of numerous golf ball size cavities. (And yes, I was wearing a mask.) The clinical story was that for some reason, she refused to see doctors, in spite of the fact that her husband worked in food service at our hospital. She died within 24 hours after admittance. What this case illustrated most clearly was why tuberculosis was called “consumption,” it literally consumes the flesh. Also why the famous Dutch and other artists often portrayed beautiful female subjects as what we would today consider too plump. They were obviously the healthy ones who didn’t have consumption.

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After these experiences with undiagnosed TB, I decided to do a limited chart study of the previous decade in our hospital. One case stands out in my memory. The patient was before my time. He was perhaps in his fifties and was admitted with symptoms of a chest infection. Several features stood out. He was in the hospital, I believe, for 23 days before he expired. During that time he was in a half dozen or so rooms, all semi-private in those days and presumably moved pair him with another male patient. The nurses’ notes all mentioned that he was coughing a lot. But what most caught my attention was that he had two X-rays, one upon admittance and one shortly before he expired. Both were described as showing “a diffuse micronodular infiltrate.” But there was no mention of the possibility of miliary TB, which is, of course, what he had at autopsy. All of which aptly illustrates the old medical axiom that most diagnoses are missed, not because the physician was not capable of making the diagnosis, but just because he didn’t think of it.

Gordon Short, MD
Brevis Corporation

Image by CDC.org

Infection Prevention & Hand Hygiene Resources