Hand washing is not the answer to combat germs

Hand washing is not the answer to combat germs

 Some people go to school thinking they are well, since they do not feel sick anymore. But they can still be carriers of serious infectious agents.

Some people go to school thinking they are well, since they do not feel sick anymore. But they can still be carriers of serious infectious agents.

by Dr. William B. Miller, Jr. — 

Germs are everywhere — on every surface, on our hands, lips and noses, both on us and in us. No crevice, nook or cranny of our bodies is excluded. They will find us, no matter what we do. It is a fact, and it will always be so.

Recent studies concentrating on schools have cataloged how surprisingly fast germs can spread. For example, in one study conducted in a school, an invisible powder was placed on the hands of two children in a fourth grade class. The powder did not have any bacteria. It was a harmless product invisible to the eye but one that could be tracked on any surface with an ultraviolet light scanner.

In the span of a single hour, every child in the classroom had come into contact with it and had it on their hands, faces and noses. The video that accompanies this research is very impressive. Certainly, any virulent pathogen can exhibit the same kind of rapid spread. In fact, that particular school system had previously suffered an outbreak of Norovirus, the same type of virus that afflicts some cruise ships, with 150 children and staff sickened.

What do these experiments teach us? How might we best protect ourselves? Hand washing is important. If done correctly, the risk of the spread of pathogens is diminished. However, many scientific studies indicate that hand washing as a societal solution has significant limitations. Most people do not wash their hands effectively or frequently enough to make any significant difference. The current recommendations for hand rinsing with soap is for a 15- to 20-second scrub. It takes that long before it becomes an effective deterrent.

A 2013 study from Michigan State University, however, found that fewer than 5 percent of all subjects washed their hands according to these guidelines. In fact, many individuals do not wash their hands at all when using the bathroom. Interestingly, the data for alcohol-based hand sanitizers is decidedly mixed.

They are more effective than soap and water in some circumstances for some germs and not for others. For instance, some evidence shows that they are not an effective method to prevent the spread of Norovirus, which leads to significant gastrointestinal illness. It is even possible that hand sanitizers actually hasten the dispersion of that pathogen.

Perhaps the better answer is to take a lesson from the experiments. The spread of any infection begins with a single individual in any specific local setting. So, if that person is not in the classroom, then everyone else has a much better chance of remaining healthy. The spread of pathogens is inevitable at school once the pathogen gains access to that environment. The bottom line: A sick person should not go to school.

Although it might seem obvious, it really is not. Some people go to school thinking they are well, since they do not feel sick anymore. But they can still be carriers of serious infectious agents. More commonly though, students and teachers go to school feeling just a bit under the weather with a sniffle or an early cold. This is a very ingrained aspect of our culture.

For example, when I was in active medical practice as a physician for 30 years, I never took a sick day. It was not that I was never sick. I went to work sick, often much sicker than my patients. It was our practice’s norm at that time. In that era, unless you were absolutely unable to function, you were expected to be at work.

So the single most effective means of improving health, particularly during seasonal illnesses such as the flu, is to create a culture that instructs those who are sick to stay home and only return when they are well. Cultural norms need to be changed and systems need to be put in place to treat this response as a societal duty that does not penalize those who must remain absent.

Sometimes, the answer to a problem in biology is not more technology. In certain circumstances, the best response is an obvious, time-tested, low-tech one. If you are sick and know that you can spread germs to otherwise healthy people, stay home and let it pass.

There is also an underappreciated flip side to these same studies documenting how quickly germs can be transmitted. Although avoiding any active infection is an object to be sought, let us not forget that the continuous exposure to germs is a crucial element of a healthy immune system.

As we more deeply investigate our complex interactions and co-existence with the microbial sphere, we are learning that we are continuously exposed to many good microbes, as well as the bad ones. A germ that does not kill you or permanently harm you makes you stronger on an immunological basis. So, let us learn how to better cope with germs, but not go overboard in doing so.


William B. Miller, Jr., M.D., has been a physician in academic and private practice for more than 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. He currently serves as a scientific advisor to OmniBiome Therapeutics, a pioneering company in discovering and developing solutions to problems in human fertility and health through management of the human microbiome.

Reprinted from AzNetNews, Volume 34, Number 5, October/November 2015.

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