Hand Soap Drama

I often feel like I'm the only one that hasn't bought into the anti-bacterial soap and hand sanitizer frenzy that has gripped us since the SAR's outbreak in 2003. We have been incredibly phobic about bugs ever since. Little kids have their cute themed mini-antibacterial hand sanitizer bottles hanging from their school bags along with their kookie pens and other gadgets. The pharmaceutical industry is laughing all the way to the bank and wants us to continue to live in fear of the latest outbreak of something fatal. But realistically, what is the cost to us?

My Healthy Home

As my seven year old daughter enters her gymnastics class the gym teacher's assistant stands dutifully squirting hand sanitizer in every direction. On this day entry is denied to those unwilling to partake of the sanitizing process. My daughter is the only non-conforming child. I'm compelled to step in to negotiate and then demand a free non-sanitized pass. Hand sanitizer and antibacterial soap is banned in my house, reserved only for use when there is a sick person around, in healthcare settings and when someone is at risk of getting an infection because they are immuno-compromised. No exceptions. Triclosan is a swear word that triggers a hostile reaction. I'm apologetic to my daughter for my strong opposition and she tells me that she understands and doesn't mind.

My home is cleaned once a week, has two cats and a dog each of which leave drool and other body fluids in manageable amounts in places that I don't really want to dwell on. In my mind I know, this is how it should be and my seven year olds immune system is developing with little exposures to "things I know are there, but don't want to think about". Her immune system functions so well in fact, she is rarely sick and thankfully our like-minded pediatrician, the wonderful Dr. Larry Rosen of the Whole Child Center in Oradell rarely gets to see her. This too is as it should be; healthy living and a healthy child.

The family joke; "you have to be dying to get medical attention" around here. What can I say? I'm a hospice and palliative care specialist. I'm focused on quality of life, alleviating symptoms and don't have time for the routine non-life threatening aches, pains, cuts and bruises of everyday life. Thankfully, no-one in the family is terminal yet, except maybe one of the cats might have some ominous tell tale signs.

When sickness knocks at the door, we treat the symptoms; Tylenol for the fever, rest, fluids, little treats, elevated pillows to alleviate the cough, throat lozenges and warm salty gargles for the sore throat. If they are not better in a couple of days, Dr. Larry Rosen comes to the rescue with similar recommendations and needed reassurance. And life is not filled with drama. I don't think my daughter has had a course of antibiotics in her little life yet. Why? I'm not afraid of bugs.

We know from research that children that grow up in households with two or more animals have better health outcomes and stronger immune systems. Why is that? It's simple. Bugs. Animals carry them, their fur is full of dirt, dust, dander and mites and we develop antibodies over time to everything that they carry around, leave in our homes and jettison into the air.

Common Sense about Bugs

So, back to the gym experience: I'm told that they don't want any bugs in the gym. I'm floored! Misperceptions about bugs are rife. They are everywhere, all over you, all the time, creeping and crawling. You can't get away from them, so why even try to kill them. Most of them cause no harm. Let's face it, how often do you get sick when you consider how many bugs you are exposed to on a daily basis. Billions of them: Clostridium, Staphylococcus, Cryptosporidium, Escherichia Coli, Streptococcus to name a few. Between 10,000 and 10 million bacteria on each hand at any given time. Can you feel the fear rising? Most won't make you sick, some actually help you and all of them in small doses help you build a healthy immune system. Do you ever wonder why so many people have allergies these days? Bug wars are to blame. Our immune system mounts a massive defense in the form of an allergic reaction to the littlest exposures because we have been busy killing off the bugs we see as threats to our lives and our immune system is not used to routine exposures.

I remember seeing my first advertisement for anti-bacterial spray and watching a lady joyfully spray chemical droplets into the air all over her house. I remember thinking how misinformed people are who would want to kill all the bugs in the air and how impossible that would be. I wonder what the spray tastes like as the droplets land on your taste buds or what it does to your lungs as you breathe it in deeply and it sets about killing things and irritating things in your alveolar sacs? I remember thinking that someone needs to ban these types of products and everyone who believes in them should think about the concept and the flaws in thinking that go with the product and its goals.

I worked on an AIDS unit in New York City in the early nineties. It was ravaged by young people dying from weird and awful infections and diseases. We had many patients with PCP pneumonia which really only responded effectively to treatment with an antibiotic called Septra. Unfortunately, many people are allergic to Septra, so we often started the desensitizing process hoping that one day, they would be able to take a full dose to treat their pneumonia. One drop, on day one. Two drops on day two and so on. Some had reactions, some were hovering on the verge of a reaction, some did very well. And the premise of desensitization?  Little exposures to the antibiotic for the immune system without causing a major allergic reaction. Our treatment was often successful.

The same applies to exposure to bugs. Our immune system exposed in small doses, is desensitized, develops antibodies and the bugs don't pose a threat. All achieved without slathering ourselves in chemicals and buying a Maserati for some pharmaceutical executive.

So what am I suggesting? If your child is rolling around in the mud or covered in dirt, let it be! If they forgot to wash their hands before dinner once in a while, no big deal. The dog is licking your face? That's OK. Dirt under your fingernails? You can deal with it later. The shopping cart has not been cleaned since it went into service at the supermarket. Should you really be worried about that? Forgot to mop the floor with bleach today? No one knows, it's not necessary. To achieve this level of comfort without having an anxiety disorder, we have to change how we think about cleanliness, bugs, chemicals, our immune system and our environment. We have to manage our fear and not let fear decide how we live our lives. Bugs are everywhere & it's not necessary to kill them.

Paradoxical Thinking

It's paradoxical that we take the trip to Trader Joes or Whole Foods to buy organic foods and non-hormone and antibiotic laden meats. We even buy house cleaners and laundry detergents that are kinder to the environment. Yet we are vigilant about applying antibacterial soaps and hand sanitizers on our skin, a huge chemical exposure with every activity we engage in. What is the thinking process behind that? Our skin is a very effective sponge that absorbs everything we put on it and rub into it. These products are so effective; guess where else you might find them? In your toothpaste, in your deodorant, and in your shaving cream. Most shockingly, added to fillers in your burger from your local fast food restaurant so they can control the numbers and growth of food borne bacteria.

Way back at the turn of the millennium, I had the pleasure of attending Columbia University's nurse practitioner program. Back then I was taught by Elaine Larson, RN, PhD, who talked extensively about her research in hand washing in healthcare settings. A National Institute of Health funded study noted that the use of antibacterial soap is no better than regular soap at cleaning your hands. Some studies suggest that antibacterial products cause resistance to oral antibiotics and some others see no differences in resistance in the short term. Triclosan, the chemical commonly used in sanitizers and anti-bacterial soaps has been linked to many negative health effects. It interferes with the endocrine system, which plays a hand in growth and development, causes skin irritation and allergies. Dr Larson suggests that if antimicrobial products are no better, why use them? Why expose yourself to these extra chemicals known to cause harm? Why take the risk if antibiotic resistance is a possibility in the future?

Hand Sanitizer Mania

Hand sanitizer use is everywhere. Alcohol based gels are easy and convenient to use and very effective at killing bugs. They also cause terrible skin irritation; they strip the natural oils from our skin and are recommended by the center for disease control and prevention for use by healthcare personnel in healthcare settings only. Dr. Rosen tells me that a study of alcohol-based hand santizer use in long term care facilities showed that increased the risk of norovirus outbreaks in the nursing home. Another study proved that handwashing with soap and water was more effective at removing C. difficile, a bacteria that grows in our gut and present in feces, than alcohol rub. So why am I seeing hand sanitizers at the supermarket? At the gym? As I board an airplane? Attached to school kids book bags? Why do I smell it in the air after my Yoga class or forced on my child as an entry fee to her gymnastics class. Mania, fear, peer pressure and effective alarmist commercialism. I'm glad to be non-conformist. How about you? I get the same results; "health" without any of the effort. Case studies in child health show that ingestion of alcohol based sanitizers cause ethanol poisoning and may result in extreme health measures to save the childs life. That risk outweigh the risk of a transient illness in my mind.

Healthy Alternative

A healthy alternative is to use essential oils with antibacterial properties instead. Essential oils contain natural aldehydes and phenols that compared to conventional antibacterial soaps showed the highest antimicrobial activity even with resistant strains of microbes. Have I convinced you yet?

Recommendations

• Follow the CDC hand washing guidelines
• Teach your family how to wash their hands effectively.
• Use regular soap and water.
• Consider using essential oils with antibacterial properties: Tea Tree, Eucalyptus, Lavendar, Lemon, Lemongrass, Cinnemon, Grapefruit, Clove Bud, Sandlewood, Peppermint, Kunzea and Sage oil all have proven anti-bacterial properties.
• If you tend to wash your hands multiple times during the day, set limitations: only when visibly soiled, after using the bathroom, before handling food etc.
• Replace anti-bacterial soap with regular soap and read the ingredients.
• Throw out hand sanitizers
• Turn a blind eye to minor cleanliness infractions
• Increase vigilance if there are sick and immuno-compromised people in your home.
• Manage your fear
• Enjoy a healthy life

References:

• Lett Appl Microbiol. 2008 Sep;47(3):167-73
• J Craniomaxillofac Surg. 2009 May 25
• Pediatr Emerg Care. 2010 Jul;26(7):508-9
• Infect Control Hosp Epidemiol. 2009 Oct;30(10):939-44
• Am J Infect Control. 2011 Mar 14
• Center for Disease Control and Prevention