Handen wassen en niet aan je gezicht zitten

[Cees Binkhorst]

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http://www.nytimes.com/2009/09/15/health/15well.html?8dpc
September 15, 2009
Well
With Soap and Water or Sanitizer, a Cleaning That Can Stave Off the Flu
By TARA PARKER-POPE

It sounds so simple as to be innocuous, a throwaway line in public-health
warnings about swine flu. But one of the most powerful weapons against the
new H1N1 virus is summed up in a three-word phrase you first heard from
your mother: wash your hands.

A host of recent studies have highlighted the importance and the
scientific underpinning of this most basic hygiene measure. One of the
most graphic was done at the University of California, Berkeley, where
researchers focused video cameras on 10 college students as they read and
typed on their laptops.

The scientists counted the times the students touched their faces,
documenting every lip scratch, eye rub and nose pick. On average, the
students touched their eyes, noses and lips 47 times during a three-hour
period, once every four minutes.

Hand-to-face contact has a surprising impact on health. Germs can enter
the body through breaks in the skin or through the membranes of the eyes,
mouth and nose.

The eyes appear to be a particularly vulnerable port of entry for viral
infections, said Mark Nicas, a professor of environmental health sciences
at Berkeley. Using mathematical models, Dr. Nicas and colleagues estimated
that in homes, schools and dorms, hand-to-face contact appears to account
for about one-third of the risk of flu infection, according to a report
this month in the journal Risk Analysis.

In one study of four residence halls at the University of Colorado, two of
the dorms had hand sanitizer dispensers installed in every dorm room,
bathroom and dining area, and students were given educational materials
about the importance of hand hygiene. The remaining two dorms were used as
controls, and researchers simply monitored illness rates.

During the eight-week study period, students in the dorms with ready
access to hand sanitizers had a third fewer complaints of coughs, chest
congestion and fever. Over all, the risk of getting sick was 20 percent
lower in the dorms where hand hygiene was emphasized, and those students
missed 43 percent fewer days of school.

Young children benefit, too. In a study of 6,000 elementary school
students in California, Delaware, Ohio and Tennessee, students in
classrooms with hand sanitizers had 20 percent fewer absences due to
illness. Teacher absenteeism in those schools dropped 10 percent.

Better hand hygiene also appears to make a difference in the home,
lowering the risk to other family members when one child is sick. Harvard
researchers studied nearly 300 families who had children 5 or younger in
day care. Half the families were given a supply of hand sanitizer and
educational materials; the other half were left to practice their normal
hand washing habits.

In homes with hand sanitizers, the risk of catching a gastrointestinal
illness from a sick child dropped 60 percent compared with the control
families. The two groups did not differ in rates of respiratory illness
rates, but families with the highest rates of sanitizer use had a 20
percent lower risk of catching such an illness from a sick child.

Regular soap and water and alcohol-based hand sanitizers are both
effective in eliminating the H1N1 virus from the hands. In February,
researchers in Australia coated the hands of 20 volunteers with copious
amounts of a seasonal H1N1 flu virus. The concentration of virus was
equivalent to the amount that would occur when an infected person used a
hand to wipe a runny nose.

When the subjects did not wash their hands, large amounts of live virus
remained even after an hour, said the lead author, Dr. M. Lindsay Grayson,
a professor of medicine at the University of Melbourne. But using soap and
water or a sanitizer virtually eliminated the presence of the virus.

Frequent hand washing will not eliminate risk. When an infected person
coughs or sneezes, a bystander might be splattered by large droplets or
may inhale airborne particles. In a recent Harvard study of hand sanitizer
use in schools, hand hygiene practices lowered risk for gastrointestinal
illness but not upper respiratory infections.

Still, it is a good idea to wash your hands regularly even if you’re not
in contact people who are obviously ill. In a troubling finding, a recent
study of 404 British commuters found that 28 percent had fecal bacteria on
their hands. In one city, 57 percent of the men sampled had contaminated
hands, according to the study, which was published this month in the
journal Epidemiology and Infection.

“We were surprised by the high level of contamination,” said Gaby Judah, a
researcher at the London School of Hygiene and Tropical Medicine. Ms.
Judah added that many of the contaminated commuters reported that they had
washed their hands that morning. They may have been embarrassed to admit
they hadn’t washed, or they may have picked up the bacteria on their hands
during their commute.

For all those reasons, the Centers for Disease Control and Prevention,
with other health organizations around the world, urge frequent hand
washing with soap and water or alcohol-based hand sanitizers. (They also
repeat some advice you may not have heard from your mother: cough or
sneeze into the crook of your elbow, not your bare hands.)

And as hospitals put stricter hand hygiene programs in place, absentee
rates during cold and flu season also drop.

“Statistically, you can’t determine a causal relationship, but it’s very
suggestive,” said Dr. Neil O. Fishman, infectious disease specialist at
the University of Pennsylvania. “Our vaccination rates remained relatively
stable, so what else changed? The only thing different was that hand
hygiene rates increased.”

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