Thursday, August 27, 2015

Healthy Habits: Handwashing is Not the Answer to Combat Germs

Hand Washing Not the Answer to Combat Germs
William B. Miller, Jr., M. D.

They are everywhere. On every surface; on our hands, our lips and noses and everywhere on us and in us. There is no crevice, nook or cranny of our bodies that is excluded. They will find us, no matter what we do. It's just fact. Germs are everywhere, all around us, and it will always be so.  

Recent studies concentrating on schools have cataloged how surprisingly fast germs can spread.  For example in ones 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. Instead, it was a harmless product that remains invisible to the eye but can 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, and 150 children and staff were sickened.

What do these experiments teach us then? How might we best protect ourselves? Certainly, hand washing is important. If done correctly, 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 don't wash their hands effectively or frequently enough to make any important difference. The current recommendations for hand rinsing with soap is for a 15-20 second scrub. It takes that long before it becomes an effective deterrent. However, a 2013 study from Michigan State found that fewer than 5% of all subjects washed their hands according to these guidelines. In fact, many individuals don't wash their hands at all when using the bathroom. Interestingly, the data for alcohol based hand sanitizers is decidedly mixed. It is more effective than soap and water in some circumstances for certain germs and not for others. For instance, there is some evidence that this is not an effective method to prevent the spread of Norovirus that leads to significant gastrointestinal illness. It is even possible that it actually hastens 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 index person is not in the classroom, then obviously everyone else had a much better chance of remaining healthy. The spread of pathogens is inevitable at school once the pathogen gains access to that environment. Therefore, a sick person shouldn't come to school. Although it might seem obvious, it really isn't. Some people come to school thinking that they are well, don't feel sick, but can still be carriers of a serious infectious agent. More commonly though, students and teachers come to school feeling 'just a bit under the weather' with a sniffle or an early cold. They (or their parents) are making a . 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 came to work sick, often much sicker than my patients. That was our practice norm at that time. In that era, unless you were absolutely unable to function, you were  expected to come to 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 that are sick that they are expected to stay away and only return when they are better. Cultural norms need to be changed and systems need to be put in place that regard this response as a societal duty that does not penalize those that 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 and 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 a little appreciated 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's 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 there is continuous exposure to many good microbes as well as some bad ones.  A germ that doesn't kill you or permanently harm you makes you stronger on an immunological basis. So, let's learn how to better cope with germs, but let's not go crazy in doing so.

Dr. Bill Miller has been a physician in academic and private practice for over 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. For more information,

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