09/03/2009 - 09:58

Reduce the spread of flu with good hand hygiene

Laura H. Kahn

Laura H. Kahn

A general internist who began her career in health care as a registered nurse, Kahn works on the research staff of Princeton University's ...

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A recent report by the President's Council of Advisors on Science and Technology estimates that a resurgence of the H1N1 influenza virus during the 2009-2010 flu season could lead to 30,000-90,000 deaths, mostly in children and young adults. What's worse, the flu season could begin as early as September, just as school is starting.

The report discusses the importance of early vaccine availability, disease surveillance, antiviral drugs, and decisions on school closures. Unfortunately, it only mentions hand hygiene briefly and suggests it as a mitigation strategy rather than recommending an extensive national hand hygiene program. While hand hygiene (especially hand washing) should be a critical issue during a potentially deadly flu pandemic, this simple approach is often ignored as part of disease prevention strategy. While I've examined this topic in a previous column, this simple act deserves renewed attention.

Hand washing and sanitizing might seem like too simple an act to do much good, but reducing the spread of influenza must be taken seriously at all levels--from local school districts to the federal government."

Influenza viruses can persist on nonporous surfaces such as door handles, desks, and chairs for 24 to 48 hours. So when a contaminated hand touches a nonporous surface, it serves as a primary source of disease transmission. In classrooms, these surfaces abound, and the potential for transmission is high.

A number of studies have shown that improving hand hygiene in school settings can reduce rates of absenteeism due to infectious illnesses. In fact, the use of hand-sanitizing gel reduces absenteeism rates by 33-50 percent. (See the numerous studies released in the last decade.) While there is some evidence that children prefer using hand-sanitizing gel rather than washing their hands with soap and water, both methods were equally effective in reducing illness. These were all relatively small studies, but they did show significant benefits from improving hand hygiene. (A note to parents and educators: The gels must contain at least 60 percent alcohol to be effective.)

What these reports suggest is that proper hand hygiene should be a basic component of student education. Hand-sanitizing gel dispensers (for example, mounted on classroom and cafeteria walls), in conjunction with rigorous education and enforcement campaigns, could improve hand hygiene and reduce illness rates. They are easy to use; students (and teachers) need only to be educated and encouraged to use them.

Of course, many people who are familiar with U.S. school systems will ask whether the schools can even afford this simple system of hand washing or sanitizing. It's a fair question, but easily answered. Hand-sanitizing gels are inexpensive. At retail, a dispenser could cost as little as $23.50. A case of hand sanitizer that provides 4,000 uses costs $57.95. If each child sanitizes his or her hands twice a day, the annual cost of gel and dispensers is approximately $6 per child per year. In addition to improved student health and academic attendance, hand-sanitizing gels would have the added benefit of reducing health care costs and parental job absenteeism. Entire communities would benefit.

Schools should consider the potential influenza pandemic as a teachable moment. Students have the opportunity to learn about disease transmission and, most importantly, learn how to protect themselves and others from getting sick. Improved hand hygiene should be a life-long habit.

Hand washing and sanitizing might seem like too simple an act to do much good, but reducing the spread of influenza must be taken seriously at all levels--from local school districts to the federal government. A national hand hygiene campaign that would include the use of hand-sanitizing gels in elementary schools could be one of the most sound and cost effective ways of minimizing the spread of influenza.