BUSTING THE MYTHS IN INFECTION

CONTROL

Manolito L. Chua, MD, FPCP, FPSMID21st Annual Convention Philippine Hospital Infection Control Society, Inc.

May 29, 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Objective

• To enumerate common misconceptions and

wrong practices in infection control and

discuss the evidence that support / debunk

these practices

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

MYTHS

William Schaffner 1980....

• A belief given uncritical acceptance by a group,

especially in support of traditional practices

• A notion held to be true but without factual basis

• Dirty hospitals have high rates of infection. This

sounds so obvious that it must be true

• Alcohol hand gel kills all dangerous microbes

• Giving too many antibiotics is bad because

people become immune to them

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

References:

1. Healthcare Personnel Attire in Non-Operating-Room

Settings. Gonzalo Bearman, MD, MPH; Kristina Bryant, MD; Surbhi Leekha, MBBS,

MPH; Jeanmarie Mayer, MD; L. Silvia Munoz-Price, MD; Rekha Murthy, MD; Tara Palmore, MD;

Mark E. Rupp, MD; Joshua White, MD. Infect Control Hosp Epidemiol 2014;35(2):107-121

2. Infection prevention myths demystified Laura Hinz (Meds 201

1) and Jennifer N. Bondy (Meds 2012) UWO Medical Journal, Vol 78, Issue 2

3. Infection Control Guidelines for Personal

Appearance Services 2012. Queensland Government

4. Double Gloving: Myth versus Fact . Linda McNeilly

5. Infection Control and Occupational Health. Jacqui

Richmond. B Positive – all you wanted to know about hepatitis B : A guide for primary

care provider p.82-89

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

1. Do long sleeve

shirts and medical

gowns facilitate

transmission of

hospital acquired

pathogens and

subsequent

infections?

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

2. What accessories, jewelries, garment

are not allowed when making rounds?

• e.g. artificial nails, neck ties etc.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Three Components

• a review and interpretation of the medical literature

regarding

• (a) perceptions of HCP attire (from both HCP and patients)

• (b) evidence for contamination of attire and its potential contribution

to cross-transmission

• a review of hospital policies related to HCP attire, as

submitted by members of the Society for Healthcare

Epidemiology of America (SHEA) Guidelines Committee

• a survey of SHEA and SHEA Research Network members

that assessed both institutional HCP attire policies and

perceptions of HCP attire in the cross transmission of

pathogens.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• Specific approaches to practice related to

HCP attire may be considered by individual

facilities;

• however, in institutions that wish to pursue

these practices, measures should be

voluntary and accompanied by a well-

organized communication and education

effort directed at both HCP and patients.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

A. "Bare below the elbows" (BBE)

• HCP's wearing of short sleeves, no

wristwatch, no jewelry, and no ties during

clinical practice.

• Facilities may consider adoption of a BBE

approach to inpatient care as an infection

prevention adjunct, although the optimal choice of

alternate attire, such as scrub uniforms or other

short-sleeved personal attire, remains undefined.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

A. "Bare below the elbows" (BBE)

• Rationale:

• While the incremental infection prevention impact

of a BBE approach to inpatient care is unknown,

this practice is supported by biological plausibility

and studies in laboratory and clinical settings and

is unlikely to cause harm.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

B. White Coats

• Functions of the white

coat

1. Storage

2. Protects clothing

3. Identification

4. Warmth

5. Symbolism

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

B. White coats

• Facilities that mandate or strongly recommend use of a

white coat for professional appearance should institute

one or more of the following measures:

• 1. HCP engaged in direct patient care (including house

staff and students) should possess 2 or more white coats

and have access to a convenient and economical means

to launder white coats (eg, institution-provided on-site

laundering at no cost or low cost).

• Rationale: These practical considerations may help achieve the desired professional

appearance yet allow for HCP to maintain a higher frequency of laundering of white

coats.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

B. White coats

• Facilities that mandate or strongly recommend use of a white

coat for professional appearance should institute one or more

of the following measures:

• 1. HCP engaged in direct patient care (including house staff

and students) should possess 2 or more white coats and have

access to a convenient and economical means to launder

white coats (eg, institution-provided on-site laundering at no

cost or low cost).

• Rationale: These practical

considerations may help achieve

the desired professional

appearance yet allow for HCP to

maintain a higher frequency of

laundering of white coats.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

White coats

• 2. Institutions should provide coat hooks that would

allow HCP to remove their white coat (or other

longsleeved outerwear) prior to contact with patients

or the patient's immediate environment.

• Rationale: This practical consideration may help achieve the desired professional appearance yet limit

patients' direct contact with potentially contaminated attire and avoid potential contamination of white

coats that may otherwise be hung on inappropriate objects in the hospital environment.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

White coats

• 2. Institutions should provide coat hooks that would allow HCP to

remove their white coat (or other longsleeved outerwear) prior to

contact with patients or the patient's immediate environment.

• Rationale: This practical consideration may help

achieve the desired professional appearance yet

limit patients' direct contact with potentially

contaminated attire and avoid potential

contamination of white coats that may otherwise be

hung on inappropriate objects in the hospital

environment.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

C. Other HCP apparel

• On the basis of the current evidence, we cannot

recommend limiting the use of other specific items of HCP

apparel (such as neckties).

• Rationale: The role played by neckties and other specific

items of HCP apparel in the horizontal transmission of

pathogens remains undetermined.

• If neckties are worn, they should be secured by a white

coat or other means to prevent them from coming into

direct contact with the patient or near-patient

environment.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

D. Laundering - Frequency

• Optimally, any apparel worn at the bedside that

comes into contact with the patient or patient

environment should be laundered after daily use.

• In our opinion, white coats worn during patient

care should be laundered no less frequently than

once a week and when visibly soiled,

• .

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

D. Laundering - Frequency

• Optimally, any apparel worn at the bedside that comes into contact with the

patient or patient environment should be laundered after daily use.

• In our opinion, white coats worn during patient care should be laundered no

less frequently than once a week and when visibly soiled,

• Rationale: White coats worn by HCP who care for very

few patients or by HCP who are infrequently involved in

direct patient care activities may need to be laundered

less frequently than white coats worn by HCP involved

with more frequent patient care. At least weekly

laundering may help achieve a balance between

microbial burden, visible cleanliness, professional

appearance, and resource utilization.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

D. Laundering - Home laundering

• Whether HCP attire for nonsurgical settings

should be laundered at home or professionally

remains unclear. If laundered at home, a hot-

water wash cycle (ideally with bleach) followed by

a cycle in the dryer is preferable,

• Rationale: A combination of washing at higher

temperatures and tumble drying or ironing has

been associated with elimination of both

pathogenic gram-positive and gram-negative

bacteria.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

E. HCP footwear

• All footwear should have closed toes, low

heels, and nonskid soles.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

E. HCP footwear

• All footwear should have closed toes, low heels, and

nonskid soles.

• Rationale: The choice of HCP footwear

should be driven by a concern for HCP

safety and should decrease the risk of

exposure to blood or other potentially

infectious material, sharps injuries, and

slipping

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

F. Identification

• Name tags or identification badges should be

clearly visible on all HCP attire for identification

purposes.

• Rationale: Name tags have consistently been

identified as a preferred component of HCP attire

by patients in several studies, are associated with

professional appearance, and are an important

component of a hospital's security system.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• Shared equipment, including stethoscopes,

should be cleaned between patients.

• No guidance can be offered in general regarding

prohibiting items like lanyards, identification tags

and sleeves, cell phones, pagers, and jewelry, but

those items that come into direct contact with the

patient or environment should be disinfected,

replaced, or eliminated

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

3. Are Hand dryers more hygienic

than paper towels ?

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Hand towels vs. air dryers

The Myth

• Are paper towels or air dryers more effective?

• Proponents of towels argue that you may as

well not wash your hands if you insist on using air

dryers as they just blow the germs back on.

• Proponents of air dryers lament the

environmental impact of towels.

• Unfortunately, the literature is similarly divided on

the issue.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Evidence

• Uncertainty began to mount in 1991 when a study in

the American Journal of Infection Control reported

that air dryers were more effective in reducing the

numbers of Escherichia coli and rotavirus from

hands.

• The argument was levelled when a randomized

control trial conducted in 2000 failed to find a

significant difference in bacterial numbers when the

use of rotary dispenser towels, stacked paper towels,

air dryers, and spontaneous evaporation were

compared.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Evidence

• It is interesting to note that in a separate study, it was

found that hands that were held stationary under the dryer

retained fewer bacteria than rubbed hands.

• This difference was explained by the fact that rubbing

allows bacteria to migrate from the hair follicle to the skin

surface, thus the finding may simply be a measurement

bias.

• Nonetheless, they concluded that stationary hands under

an air dryer was the best method, followed by a tie

between paper towels and rubbed hands.

•

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Evidence

• Taylor et al concluded that in bathrooms equipped

with paper towels, the germs were transferred from

the hands to the towels, which were then disposed of

in open receptacles where they acted as reservoirs of

bacteria.

• In contrast, while the air dryers killed a sizable

proportion of microorganisms by virtue of the heater,

the splattering of water droplets onto the wall behind

the dryer made this one area of the bathroom to

avoid.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Verdict

• Despite the controversy, all studies were in agreement about the importance of hand washing.

• Proponents of towels can argue using evidence from early literature, the finding that paper towels were more effective in removing bacteria from the fingertips in particular and the CDC recommendation that one use a paper towel to turn off the tap.

• They may also argue that air dryers are not recommended in critical care environments due to the possibility of air dispersal of bacteria-laden droplets.

• Air dryer enthusiasts can cite findings from more recent studies, environmental considerations, and the capacity to remove bacteria from the air.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• The important takeaway points are to wash

your hands well;

• if you choose a towel, dispose of it in a

closed receptacle;

• if you choose an air dryer, try to use an

automatic model and don’t rub your hands.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Show Me the Science -

How to Wash Your Hands• Dry your hands using a clean towel or air dry them.

•

Why? Germs can be transferred more easily to and from

wet hands; therefore, hands should be dried after

washing. 1,2 However, the best way to dry hands remains

unclear because few studies about hand drying exist, and

the results of these studies conflict. Additionally, most of

these studies compare overall concentrations of

microbes, not just disease-causing germs, on hands

following different hand-drying methods. It has not been

shown that removing microbes from hands is linked to

better health 3. Nonetheless, studies suggest that using a

clean towel or air drying hands are best 4-6.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

References

1. Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch-

contact-associated bacterial transfer following hand washing. Epidemiol Infect. 1997

Dec;119(3):319-25.

2. Todd EC, Michaels BS, Smith D, Greig JD, Bartleson CA. Outbreaks where food

workers have been implicated in the spread of foodborne disease. Part 9. Washing

and drying of hands to reduce microbial contamination. J Food Prot. 2010

Oct;73(10):1937-55.

3. Luby SP, Agboatwalla M, Billhimer W, Hoekstra RM. Field trial of a low cost method to

evaluate hand cleanliness.Trop Med Int Health. 2007 Jun;12(6):765-71

4. Gustafson DR, Vetter EA, Larson DR, Ilstrup DM, Maker MD, Thompson RL,

Cockerill FR 3rd. Effects of 4 hand-drying methods for removing bacteria from

washed hands: a randomized trial. Mayo Clin Proc. 2000 Jul;75(7):705-8.

5. Huang C, Ma W, Stack S. The hygienic efficacy of different hand-drying methods: a

review of the evidence. Mayo Clin Proc. 2012 Aug;87(8):791-8.

6. Jensen D, Schaffner D, Danyluk M, Harris L. Efficacy of handwashing duration and

drying methods. Int Assn Food Prot Annual Meeting. 2012 July 22-25.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

4. What is the role of hand

sanitizer in preventing

influenza?

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• A randomized intervention trial involving 1437 young adults living in university residence halls during the 2006–2007 influenza season was designed.

• Residence halls were randomly assigned to 1 of 3 groups—1. face mask use

2. face masks with hand hygiene

3. control— for 6 weeks.

• Generalized models estimated rate ratios for clinically diagnosed or survey-reported ILI weekly and cumulatively

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Mask Use, Hand Hygiene, and Seasonal Influenza-

Like Illness among Young Adults: A Randomized

Intervention Trial

• The study by Aiello et al did not

demonstrate that hand hygiene prevented

transmission of influenza.

• First of all, the authors make clear that

most of their influenza- like illness (ILI)

cases were likely not associated with

influenza infection.

• Second, their study showed no benefit for

hand hygiene.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Mask Use, Hand Hygiene, and Seasonal Influenza-

Like Illness among Young Adults: A Randomized

Intervention Trial

• Aiello et al conclude,

• “ILI incidence between the face mask and hand hygiene

group and the face mask-only group were not

substantially different, suggesting that the addition of a

hand sanitizer component did not appreciably decrease

the rate of ILI in this study population.”

• They further state, “It is important to note that

handwashing habits were the same in both the face

mask—only and control groups at baseline and over the

study period, which suggests that mask use alone may

provide a reduction in respiratory illness regardless of

handwashing practices.”

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

What is the role of hand sanitizer in

preventing influenza?• The efficacy of hand hygiene in reducing

transmission of influenza likely hinges on a

fundamental, unresolved issue:

• Is influenza virus spread primarily by large

droplets or by small-particle aerosols?

• The greater the importance of large droplets, the

more likely that hand hygiene will reduce

transmission.

• If small-particle aerosols predominate, hand

hygiene may provide little benefit.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

What is the role of hand sanitizer in

preventing influenza?• Evidence exists that 100-fold greater quantities of

virus are required for infection by intranasal drops

than with aerosols

• illness after intranasal inoculation is milder than

naturally acquired disease, has shorter duration

of cough

• lacks the abnormalities in small airway function

and transient increase in airway reactivity that

characterize naturally acquired disease.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

What is the role of hand sanitizer in

preventing influenza?• One study showed no detectable influenza

virus on hands 5 minutes after transfer from

environmental surfaces .

• Another study showed no detectable virus on

the hands of 6 of 20 volunteers 2 minutes after

inoculation with a high concentration of H1N1

virus .

• Volunteers with detectable virus at 2 minutes

showed a 3–4 log reduction compared with the

initial inoculum.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

What is the role of hand sanitizer in

preventing influenza?

• In the absence of data demonstrating

that hand hygiene reduces

transmission of influenza, it has been

argued that recommending it is

prudent.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

What is the role of hand sanitizer in

preventing influenza?• However, the incremental cost of following this

recommendation — certainly if alcohol based

hand sanitizer is widely employed — would be

considerable when extended to the large at-risk

population around the world.

• Also, if hand hygiene is ineffective and individuals

behave inadvisably, increased cases of influenza

would result.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Show Me the Science -

When to Use Hand Sanitizer• Washing hands with soap and water is the best way to reduce

the number of microbes on them in most situations. If soap and

water are not available, use an alcohol-based hand sanitizer that

contains at least 60% alcohol.

•

Why? Many studies have found that sanitizers with an alcohol

concentration between 60–95% are more effective at killing

germs than those with a lower alcohol concentration or non-

alcohol-based hand sanitizers . Non-alcohol-based hand sanitizers

may 1) not work equally well for all classes of germs (for example,

Gram-positive vs. Gram-negative bacteria, Cryptosporidium,

Norovirus); 2) cause germs to develop resistance to the sanitizing

agent; 3) merely reduce the growth of germs rather than kill them

outright, or 4) be more likely to irritate skin than alcohol-based hand

sanitizers .

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Show Me the Science -

When to Use Hand Sanitizer• Alcohol-based hand sanitizers can quickly reduce the number of

microbes on hands in some situations, but sanitizers

do not eliminate all types of germs.

•

Why? Although alcohol-based hand sanitizers can inactivate many

types of microbes very effectively when used correctly, people may

not use a large enough volume of the sanitizers or may wipe it off

before it has dried . Furthermore, soap and water are more

effective than hand sanitizers at removing or inactivating certain

kinds of germs, like Cryptosporidium , Norovirus ,

and Clostridium difficile

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Show Me the Science -

When to Use Hand Sanitizer• Hand sanitizers may not be as effective when hands are visibly

dirty or greasy.

•

Why? Many studies show that hand sanitizers work well in clinical

settings like hospitals, where hands come into contact with germs but

generally are not heavily soiled or greasy . Some data also show that

hand sanitizers may work well against certain types of germs on

slightly soiled hands. However, hands may become very greasy or

soiled in community settings, such as after people handle food, play

sports, work in the garden, or go camping or fishing. When hands are

heavily soiled or greasy, hand sanitizers may not work

well Handwashing with soap and water is recommended in such

circumstances.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

5. Does Reverse Isolation Work ?

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

REVERSE ISOLATION

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

REVERSE ISOLATION

• Reverse isolation is when there is positive

pressure in the room. Filtered, clean air is

brought into the room and allowed to vent out of

the room to the surrounding corridors. Usually

visitors must wear protective garb to protect the

patient from the visitors (masks, etc), if visitors

are allowed at all.

Isolation is when the patient can infect others.

Reverse isolation is when others can infect the

patient (if the patient is immuno-compromised,

like with leukemia, etc).

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Reverse Isolation Work ?

• Evidence does not support the use of reverse

isolation in hospitals…the use of reverse isolation

procedures should be discouraged as they are

unlikely to be of benefit, and commonly cause anxiety

and confusion for patients, families, and healthcare

workers”

Sheshadri, S. and Baumann, M.Reverse isolation for Neutropenic

Patients. Comunity Oncology. November 2008

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• Reverse isolation was eliminated as an isolation

category by the Centers for Disease Control (CDC) in

the mid 1980’s.

• There are three types of isolation: Transmission-

Based (Contact), Airborne, and Droplet.

• Reverse Isolation was eliminated as it was not found

to improve outcomes for neutropenic patients, and

isolation is a negative experience for the patient.

• Debunking Reverse Isolation. Beth Hawkes. December 7, 2014

• http://nursecode.com/2014/12/debunking-reverse-isolation

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

6. The hotter the water you use

for handwashing, the better

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

How hot does water need to be when

you wash your hands?• In a 2005 study documented in the Journal of Occupational and

Environmental Medicine, participants were instructed to wash

their hands in water ranging from 40 degrees all the way up to

120 degrees. What the study found is that the temperature of

the water doesn’t really matter when it comes to getting your

hands truly clean.

•

• The FDA recommends washing dishes at an uncomfortable

110 degrees as one of the steps to get rid of harmful bacteria.

Interestingly, even though the FDA recommends washing your

dishes at 110 degrees as one of its bacteria-killing steps,

studies have shown that washing dishes in colder water can

kill bacteria too. The difference may be in how quickly the

grease comes off.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Claim: Always Wash Your Hands With

Hot Water, Not Cold Anahad O ‘Connor

• Scientists with the Joint Bank Group/Fund Health Services Department pointed out that in studies in which subjects had their hands contaminated, and then were instructed to wash and rinse with soap for 25 seconds using water with temperatures ranging from 40 degrees Fahrenheit to 120 degrees, the various temperatures had “no effect on transient or resident bacterial reduction.”

• no evidence that hot water had any benefit, and noted that it might increase the “irritant capacity” of some soaps, causing contact dermatitis

• Hot water for hand washing has not been proved to remove germs better than cold water

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Truth Behind the Myths: Hot Water Hand Washing and

The Five Second Rule (Infographic) by Unity Point Clinic -

December 18, 2014

• Myth One: Using hot water to wash your hands kills

more germs.

• The researchers discovered that the average water

temperature people used while washing their hands was

between 104° and 131°. While this amount of heat has

the possibility of killing germs, the amount of time required

in constant contact with the hot water would damage the

first layer of the skin. The damage, in turn, would make us

more susceptible to bacteria as we would have decreased

our defense system.

• The group says that water as cold as 40° still reduces the

amount of bacteria on the skin when hands are washed

properly.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• Wet your hands with clean, running water (warm or cold), turn off

the tap, and apply soap.

•

Why? Because hands could become recontaminated if placed in a

basin of standing water that has been contaminated through previous

use, clean running water should be used . However, washing with

non-potable water when necessary may still improve health . The

temperature of the water does not appear to affect microbe removal;

however, warmer water may cause more skin irritation and is more

environmentally costly .

• Turning off the faucet after wetting hands saves water, and there are

few data to prove whether significant numbers of germs are

transferred between hands and the faucet.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Truth Behind the Myths: Hot Water Hand Washing and

The Five Second Rule (Infographic) by Unity Point Clinic -

December 18, 2014

• Myth Two: As long as you pick up food that

was dropped on the floor in 5 seconds or less,

there won’t be any germs on it.

• National Public Radio reported on a study done

by biology students at Aston University in

Birmingham, UK.

• The students completed an experiment on how

much bacteria was found on food dropped on

tiles, linoleum and carpet for various amounts of

time.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Truth Behind the Myths: Hot Water Hand Washing and

The Five Second Rule (Infographic) by Unity Point Clinic -

December 18, 2014

• They found that …

• sticky foods picked up bacteria faster than dry

foods

• food dropped on the carpet was contaminated

with the least amount of germs

• The team also surveyed 500 people and discovered that

87% of them ate food off of the floor. Of that 87%, three-

quarters used the five second rule.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Truth Behind the Myths: Hot Water Hand Washing and

The Five Second Rule (Infographic) by Unity Point Clinic -

December 18, 2014

• Microbiologist Eric Schulze expressed a warning about

the five second rule.

• He stated that it could take less than five seconds for

hundreds of bacteria to attach themselves to food on

the floor.

• After one minute, that number increases to ten times

more bacteria.

• His advice is simple: People track things like fecal

matter on the bottoms of their shoes.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

The Truth Behind the Myths: Hot Water Hand Washing and

The Five Second Rule (Infographic) by Unity Point Clinic -

December 18, 2014

• While not all of the bacteria on the floor is

harmful to people, it’s an issue of risk each

time you decide to eat it.

• Eating food off of the floor means that you

are taking the chance that your food did not

fall in the area of harmful bacteria.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

7. Does wearing a mask by

patients decrease the risk of

transmitting airborne / droplet

infection?

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• When the Unites States experienced an outbreak of the swine flu in

2009, everyone was talking about how to reduce the spread of the

infection.

• Health organizations reminded people of the importance of regular

handwashing with warm water and soap.

• People who developed the flu were advised to stay home to recover

and avoid spreading the virus to others.

• Then, some people started doing something most of us hadn't seen

before: wearing surgical masks.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• First, a 2008 study published in the international Journal

of Infectious Diseases concluded that when used

correctly, (The First Randomized, Controlled Clinical Trial of Mask Use in

Households to Prevent Respiratory Virus Transmission C.R. MacIntyre 13th

International Congress on Infectious Diseases Abstracts)

• masks are highly effective in preventing the spread of

viral infections.

• Family members of children with flu-like illnesses who

used the masks properly were 80 percent less likely to

be diagnosed with the illness.

• Surprisingly, the difference between types of masks

used was insignificant.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Another study published in the Annals of Internal

Medicine reported similar results.• (Facemasks and Hand Hygiene to Prevent Influenza Transmission in

Households: A Cluster Randomized Trial . Benjamin J. Cowling, Ann Intern

Med. 2009;151(7):437-446)

• 407 people who had the flu

• They found that family members reduced their risk of getting the flu by

70 percent when they washed their hands often and wore surgical

masks.

• In 154 households in which interventions were implemented within 36

hours of symptom onset in the index patient, transmission of RT-PCR

confirmed infection seemed reduced, an effect attributable to fewer

infections among participants using facemasks plus hand hygiene

(adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87])

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Other studies found promising results

outside of the household. Facemasks, Hand Hygiene,

and Influenza among Young Adults: A Randomized Intervention Trial.

Allison E. Aiello. January 25, 2012

• Researchers from University of Michigan conducted on

more than 1,000 students living in residence halls.

• They assigned the student to groups: those who wore

masks, those who wore masks and practiced hand

hygiene, and those who did neither.

• The results showed that those who wore masks in

residence halls and practiced good handwashing

reduced their risk of flu-like illness by an astonishing 75

percent.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Still, the study found no reduction in

symptoms for mask use alone.

• This finding suggests that the use of masks

should always be paired with regular

handwashing.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Different Types of Masks

• Facemasks• Facemasks are fairly loosely fitting, disposable masks approved by

the U.S. Food and Drug Administration for use as medical devices.

• These masks prevent large droplets of bodily fluids that may

contain viruses from escaping via the nose and mouth.

• Facemasks also protect against splashes and sprays from others,

such as those from sneezes and coughs.

• The downside is that these masks don’t prevent the inhalation of

small, airborne contaminants.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Different Types of Masks

• Respirators• Respirators, also called N95 respirator masks, are designed to

protect the wearer from small particles in the air that may contain

viruses.

• They are certified by the CDC and the National Institute for

Occupational Safety and Health.

• The name comes from the fact that they can filter 95 percent of

airborne particles, according to the CDC.

• N95 masks are also often used when painting or handling

potentially toxic materials.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Does Wearing a Mask Prevent the Flu?Kristeen Cherney , May 7, 2015

• Respirators are selected to fit your face. They must form a

perfect seal so that no gaps allow airborne viruses in.

Healthcare workers use them to protect against airborne

infectious diseases such as tuberculosis and anthrax.

Unlike regular facemasks, respirators protect against both

large and small particles.

• Overall, respirators are considered much more effective at

preventing the flu virus than regular facemasks. Still,

studies have found benefits to both types of masks.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

CAN “FACEMASKS” PREVENT

DISEASE?• Infectious diseases such as influenza (the “flu”) can be

• spread by several methods, including:

• Airborne droplets or sprays,

• Hand to mouth/nose/eye contact,

• Direct surface contact, or

• Combinations of these methods.

• Because recent evidence suggests that inhalation of

microscopic airborne particles may also transmit some

diseases, it has been suggested that “masks” might

reduce disease transmission.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

Surgical Masks (SM)

• A surgical mask can:

• Protect patients from bacteria and other particles exhaled by health care workers.

• Protect health care workers from contact with sprays or splashes that may contain infectious organisms.

• SM ARE NOT designed to reduce the inhalation of small airborne particles that may contain infectious organisms.

• DO NOT expect a SM to protect you from inhaling

• infectious organisms.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

N95 Filtering Facepiece Respirators FFR

CAN ONLY PROTECT WHEN WORN

• The benefit of using any respirator, including a properly fitting N95 FFR, is quickly lost if it is not worn at ALL times the hazard is present.

• Most of the benefit of wearing a respirator is lost unless it is worn at least 90% of the time.

• Infectious aerosols are invisible, so there is no indication when they are present. Also, some sick people may produce particles that can infect others before they show any symptoms themselves. Therefore, it is very easy to receive a significant exposure without knowing.

• Even taking the respirator off to talk or eat in an area where infectious particles are present might allow enough exposure to cause infection.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

N95 Filtering Facepiece Respirators FFR

CAN ONLY PROTECT WHEN WORN

• Unfortunately, there may be little benefit from wearing an

N95 FFR that has not been fit‐tested on the wearer.

• Effective fit‐tests may be difficult to obtain for members of

the general public. Contact the organizations listed at the

end of this fact sheet for more information about fittesting

and infectious aerosols.

RESPIRATORS ALONE

WILL NOT PREVENT

DISEASE

TRANSMISSION

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• While wearing a properly fit N95 FFR can

reduce inhalation exposures, frequent hand

washing with soap and water can help

minimize transmission through other

exposure routes.

• An annual seasonal flu vaccination is

the best way to reduce the chances that

you will get seasonal flu

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

•OTHER MYTHS

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• MYTH – Wearing gloves means you do

not need to wash your hands.

• FACT – Gloves are not a substitute for

effective hand-washing..

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• MYTH – Health care workers should use

additional precautions when caring for a

patient with HBV to prevent

transmission.

• FACT – The implementation of standard

precautions ensures a high level of

protection against the transmission of HBV

in the health care setting.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• MYTH – Health care workers need to have

booster doses of hepatitis B vaccine every

five years.

• FACT – Booster doses are no longer

recommended in immunocompetent individuals

after a primary course of HBV vaccine, as

evidence suggests that a completed course of

HBV vaccination provides long-lasting protection.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

• MYTH – Health care workers with HBV

must not have contact with patients

because of the risk of transmission.

• FACT – Health care workers with HBV are

generally advised to avoid performing

exposure prone procedures, however, they

can still have non-invasive contact with

patients.

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015

BUSTING THE MYTHS IN INFECTION

CONTROL

by Dr. ML Chua presented during the 21st PHICS Annual

Convention, 27-28 May 2015