Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene

Facilitating the transportation of fecal hitchhikers from your exhaust pipe orifice to your fuel filler neck orifice is one of the biggest backcountry threats. Stop these illegal immigrants en route, because we all know you can't close the border!

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by Ryan Jordan | 2010-08-31 00:00:00-06

Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene

Introduction

Backcountry travelers have a long list of things to fear. Here are my ten favorites:

  1. Animal attacks by mosquitoes, bears, snakes, ticks, wolves, or locusts.
  2. Drinking water poisoned with giardia, crypto, amoeba, typhoid, or the bird flu.
  3. Running out of toilet paper and having to wipe with snow, rocks, pine cones, or spruce sprigs.
  4. Having to build a fire when it really counts.
  5. Having to push the 911 button on their SPOT because they failed to build a fire when it really counted.
  6. Getting their feet wet, and then having them fall off after a progression of suprahydration, maceration, epidermal separation, fissurization, staphylococcal infestation, gangrene, and rot.
  7. Accidentally leaving something behind, or having to justify to everyone on the Internet (in the lightweight backpacking community, at least) why they can't leave something behind, like their Sling-light, Crocs, Frisbee, iPod, Newcons, or box of E&J.
  8. Hiking with other people.
  9. Hiking solo.
  10. Running out of coffee.

Of course, only #10 is a justified fear.

For the rest of you, you may be fearing the wrong things.

What you should be fearing is facilitating the transportation of fecal hitchhikers from your exhaust pipe orifice to your fuel filler neck orifice.

This article discusses how to stop these illegal immigrants en route, because we all know you can't close the border.

The Relationship Between Hand Sanitation and GI Illnesses

The problem is an age old one: minimize gastrointestinal (GI) illness that results from backcountry activities.

The two most commonly perceived GI illnesses are (1) those acquired by drinking contaminated water, and (2) those acquired as a result of poor hygiene. This article addresses the hygiene issue, and specifically, hand sanitation.

Tod Schimelpfenig, Curriculum Director at the Wilderness Medicine Institute of the National Outdoor Leadership School (NOLS), believes that hand sanitation may play a more important role in illness transmission than drinking untreated water. "Hand washing is very important but poorly and infrequently done," says Schimelpfenig. "It's inconvenient and must be a disciplined habit." Over a period of several years, NOLS made intentional changes to their hand sanitation practices and curriculum which resulted in significant reductions in GI illnesses (Leemon and Schimelpfenig, 2003). Currently, NOLS uses alcohol gel hand sanitizers because they are readily available and inexpensive - key decision factors for sizable programs like NOLS.

My own personal experiences are deeply rooted in a desire to keep my hands clean in the wilderness.

When I was an institutional wilderness guide in the 1980s, we cared very little about and had no policies regarding wilderness hygiene. Some of our practices included:

  1. Everyone eating out of the same pot, with the same spoon (to save weight, increase simplicity, and... to improve camaraderie perhaps?!)
  2. Leaving soap out of our kits and believing that simply washing hands and scrubbing vigorously with water was enough.
  3. Never washing cookware, and believing the probable lie propagated by some "lightweight backpacking enthusiasts" that it will sterilize itself the next time you boil water in it.

If these are some of your practices, a careful read of Boulware (2006) might be a wise investment of your time.

What I thought I learned during my years of institutional guiding was that we really needed better water treatment technologies, because almost all of the guides, and many of the students, experienced GI illnesses at some point during or shortly after their treks.

What I really learned, looking back, is that our poor hygiene was probably a far greater contributor to our GI distress than contaminated water, and that specifically, I can look back and be genuinely horrified at our hand sanitation practices.

Upon reviewing much of the research that began to emerge about this topic in the late 1990s and early 2000s, I realized that especially with groups of people sharing cooking and other gear, hand sanitation would be an important part of staying healthy in the wilderness.

Alcohol-Based Hand Sanitizers

I've been an aficionado of using alcohol-based (EtOH) sanitizers for years, for the same reason that Tod Schimelpfenig stated above: they are cheap and easy to find. However, I've also discovered the nasty unspoken risk of using them: the dehydration of hand skin that leads to cracking. Some companies add moisturizers into these mixes, but I've found them to be marginally effective and to leave greasy residues.

Some ultralight backpackers like EtOH-based sanitizers because they can serve double duty (by disinfecting the skin around wounds for first aid treatment, or as a firestarting aid). However, I never found the weight savings to be worth it, and I've always preferred the more robust disinfecting potential of a sterile alcohol wipe, and more efficacious methods of firestarting using dedicated supplies.

In response to skin cracking, I've tried a number of reactive measures to control it, including hand lotions, Hydropel, those thin fingerless "sun gloves" that saltwater fly fishermen wear, using less sanitizer, and rubbing oils from my own forehead into the skin! I wasn't happy with any of these solutions and instead found myself caught in the vicious downward spiral of pain and discomfort by successively applying stinging alcohol gels to my cracked hands.

In addition, while I was working in the area of biofilm research in the 1990s, we discovered that cracks in the skin served as protective environments for bacterial growth, with the resulting colonies of pathogens remaining more resistant to disinfection than bacteria attached to the outside surfaces of the skin. Dyer et al. (1998) also suggest that the organic-solvent properties of EtOH strip away skin chemicals (e.g., sebum and lipids) that play a role in impeding bacterial infection.

My solution in 2008, after one particularly cold and windy spring trek with bleeding cracks on my hands, was to finally bag alcohol hand sanitizers altogether and simply use soap and water, even if it had to come from my water bottle if I wasn't near a water source.

Alternatives to Alcohol Based Hand Sanitizers

After reviewing a variety of research discussing various hand washing methods, I've reverted back to the time honored practice of good old soap and water. I carry a MiniVial containing highly concentrated castile soap (my favorite is Dr. Bronner's), and always wash my hands after bowel movements and upon arrival into camp prior to preparing the evening meal.

The efficacy of vigorous handwashing with soap relative to other methods cannot be underestimated (Simonne, 2008).

However, sometimes, washing hands with soap and water is simply inconvenient, so I do carry a benzalkonium (BAK) chloride-based hand sanitizer that is easy on the hands and has shown good efficacy in sanitization relative to alcohol-based products (Dyer et al., 1998).

A number of companies market BAK hand sanitizers, but finding them in a form useful for the ultralight backpacker has been problematic, until Adventure Medical Kits' recent introduction of a 0.5 fl. oz. pump bottle. The form factor is small (pocketable), simple to use (just pump to spray, no lids or caps to fiddle with), and lightweight (a full bottle weighs an ounce). The manufacturer claims that the bottle holds "150 Sprays" and that it should be "applied liberally". This latter point is important with any hand sanitizer, be it soap, EtOH, or BAK: if you don't coat and scrub the entire surface of your hands, it's not going to be effective.

In practice, I find that six sprays deliver enough liquid for me to wash the entire surfaces of both hands, which suggests that I can get 150 / 6 = 25 full hand washings out of the bottle. If I wash with soap and water twice a day, and use hand sanitizer 3X / day (my normal routine), then the Adventure Medical Kits 0.5 fl. oz. pump bottle is enough for an eight-day trek for me. Plus, and my wife will agree, my hands aren't "all scratchy" when I come home.

Conclusion

Washing with soap and water is still my preferred method of hand sanitization. It leaves my hands feeling cleaner than with any other method, and science has shown repeatedly that it remains the most effective method. I'd be awfully nervous if I saw my surgeon grab a scalpel after only a quick application of a dollop of EtOH onto the palm of his hand!

While a variety of non-soap (waterless) methods of hand sanitization exist, few of them are accessible or easy to use by wilderness backpackers. EtOH and BAK are the two primary methods available in small, light, and simple to dispense form factors. Between the two, I prefer BAK for its ability to preserve the health of my skin when used over a long period of time, and of the BAK products, I've found the Adventure Medical Kits 0.5 fl. oz. pump spray bottle to be an ideal product that fits in with my own philosophy of "simple, light, and effective."

References

  • Wilderness Injury, Illness, and Evacuation: National Outdoor Leadership School’s Incident Profiles, 1999–2002, by Drew Leemon and Tod Schimelpfenig, Wilderness and Environmental Medicine, 14, (pp. 174-182), 2003.
  • Influence of Hygiene on Gastrointestinal Illness among Wilderness Backpackers, by David R. Boulware. Journal of Travel Medicine, 11:1 (pp. 27-33), 2006.
  • Hand Hygiene and Hand Sanitizers, by Amy Simonne, University of Florida IFAS Extension, http://edis.ifas.ufl.edu/pdffiles/FY/FY73200.pdf.
  • Testing a New Alcohol-Free Hand Sanitizer to Combat Infection, by David L. Dyer, Kenneth B. Gerenraich, and Peter S. Wadhams, AORN Journal, 68:2 (pp. 239-251), 1998.


Citation

"Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene," by Ryan Jordan. BackpackingLight.com (ISSN 1537-0364).
http://backpackinglight.com/cgi-bin/backpackinglight/hand_sanitizers_best_practices_wilderness_hygiene.html, 2010-08-31 00:00:00-06.

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Forum Index » Editor's Roundtable » Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene


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Addie Bedford
(addiebedford) - MLife

Locale: Montana
Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene on 08/31/2010 15:54:06 MDT Print View

Companion forum thread to:

Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene

David Chenault
(DaveC) - BPL Staff - F

Locale: Crown of the Continent
ahhhh.... on 08/31/2010 16:41:59 MDT Print View

A satisfying nerdy treatise.

While doing a WFR recert years ago, the instructor was of the opinion that alcohol hand sanitizer's benefits were almost totally psychosomatic. Now it's ubiquitous and I have to go about the world smelling it. Ick.

John S.
(jshann) - F
Re: Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene on 08/31/2010 19:59:58 MDT Print View

Boulware article
http://onlinelibrary.wiley.com/doi/10.2310/7060.2004.13621/abstract

CDC on handwashing
http://www.cdc.gov/Features/HandWashing/

John Brown
(johnbrown2005) - F

Locale: Portland, OR
Poor choice of words on 09/01/2010 00:24:15 MDT Print View

Illegal immigrants as metaphor for fecal matter and bacteria? Really? Thoughtless at best, mean-spirited at worst. Not what I want to see when I am checking in w/ a website about a favorite pastime.

-edited with a better choice of words.

Edited by johnbrown2005 on 09/02/2010 00:32:34 MDT.

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Soap and water on 09/01/2010 01:30:36 MDT Print View

> I've reverted back to the time honored practice of good old soap and water.

Absolutely 100+%.
If I go to the loo in the bush (happens sometimes ...), I am met on my return by Sue with soap and water waiting. ALWAYS. Never have any problems.

Cheers

Kathy Hoffman
(basecampbound)

Locale: Foothills of San Gabriel Mtns.
Been There....Done That on 09/01/2010 02:57:22 MDT Print View

Aaaahhhh....I fell prey to the whole "hand sanitizers kill every germ known to man" fallacy. I used to use it routinely, until I ended up with a horrific rash, cracks, bleeding, and peeling skin that looked like leprosy. The doctor took one look at my hands and without me saying a word, exclaimed, "Use a lot of hand sanitizer, huh?" He then gave me the sage advice that only a seasoned medical professional could give. "Stop doing that."

David Goodyear
(dmgoody) - MLife

Locale: mid-west
Grammy was right on 09/01/2010 05:52:13 MDT Print View

The older I get, the more this becomes true. It seems that we find scientific studies and reasons why Grammy was right... eating your veggies, eat the skin of the fruit, wash your hands with soap and water.

Good article. I have often tried to convince my hiking buddies that you are at more of a risk of a GI infection from not washing your hands than debating the efficacies of the many water treatment options.

Dave

Steven McAllister
(brooklynkayak) - MLife

Locale: Atlantic North East
The Smell on 09/01/2010 06:42:29 MDT Print View

Is there such a thing as a good unscented hand sanitizers?
I'm tired of getting bombarded with flying insects soon after application.

Also, I use Kirks Castile soap, it has very little scent, super concentrated and is a lot cheaper than Dr. Bronners?

Greg Mihalik
(greg23) - M

Locale: Colorado
Re: The Smell: Unscented on 09/01/2010 08:49:14 MDT Print View

Dr. Bronners does have an unscented version, but it is hard to find.

Edited by greg23 on 09/01/2010 08:53:13 MDT.

David Corbin
(wildyorkie) - M

Locale: New York
"Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene" on 09/01/2010 08:56:20 MDT Print View

There is no single means of cleaning hands which is a "magic bullet." Efficacy varies depending upon the pathogen and user technique and the sanitizing agent used.

See the references which correspond to the following findings:

1) Compared to rubbing with an antibacterial liquid with a water rinse only, an alcohol-based hand sanitizer was relatively ineffective against norovirus.

2) 62% alcohol foams were only somewhat more effective than water against E. coli, because the time required for dryness often exceeds the recommended 30 seconds resulted in a small amount being used.

3) Alcohol based hand sanitizer was significantly better than soap and water with respect to reduction in levels of fecal streptococci.

4) An alcohol-based hand sanitizer with polyquaternium polymer and organic acid was superior to alcohol sanitzer against enteric viruses.

5) Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

REFERENCES

1) Appl Environ Microbiol. 2010 Jan;76(2):394-9. Epub 2009 Nov 20.

Effectiveness of liquid soap and hand sanitizer against Norwalk virus on contaminated hands.

Liu P, Yuen Y, Hsiao HM, Jaykus LA, Moe C

Center for Global Safe Water, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322

Abstract

Disinfection is an essential measure for interrupting human norovirus (HuNoV) transmission, but it is difficult to evaluate the efficacy of disinfectants due to the absence of a practicable cell culture system for these viruses. The purpose of this study was to screen sodium hypochlorite and ethanol for efficacy against Norwalk virus (NV) and expand the studies to evaluate the efficacy of antibacterial liquid soap and alcohol-based hand sanitizer for the inactivation of NV on human finger pads. Samples were tested by real-time reverse transcription-quantitative PCR (RT-qPCR) both with and without a prior RNase treatment. In suspension assay, sodium hypochlorite concentrations of >or=160 ppm effectively eliminated RT-qPCR detection signal, while ethanol, regardless of concentration, was relatively ineffective, giving at most a 0.5 log(10) reduction in genomic copies of NV cDNA. Using the American Society for Testing and Materials (ASTM) standard finger pad method and a modification thereof (with rubbing), we observed the greatest reduction in genomic copies of NV cDNA with the antibacterial liquid soap treatment (0.67 to 1.20 log(10) reduction) and water rinse only (0.58 to 1.58 log(10) reduction). The alcohol-based hand sanitizer was relatively ineffective, reducing the genomic copies of NV cDNA by only 0.14 to 0.34 log(10) compared to baseline. Although the concentrations of genomic copies of NV cDNA were consistently lower on finger pad eluates pretreated with RNase compared to those without prior RNase treatment, these differences were not statistically significant. Despite the promise of alcohol-based sanitizers for the control of pathogen transmission, they may be relatively ineffective against the HuNoV, reinforcing the need to develop and evaluate new products against this important group of viruses.

Free full text @
http://aem.asm.org/cgi/content/full/76/2/394
- - - -

2) BMC Infect Dis. 2010 Mar 26;10:78.

Efficacy of ethanol-based hand foams using clinically relevant amounts: a cross-over controlled study among healthy volunteers.

Kampf G, Marschall S, Eggerstedt S, Ostermeyer C.

BODE Chemie GmbH, Scientific Affairs, Melanchthonstr, 27, 22525 Hamburg, Germany. guenter.kampf@bode-chemie.de

Abstract

BACKGROUND: Foams containing 62% ethanol are used for hand decontamination in many countries. A long drying time may reduce the compliance of healthcare workers in applying the recommended amount of foam. Therefore, we have investigated the correlation between the applied amount and drying time, and the bactericidal efficacy of ethanol foams.

METHODS: In a first part of tests, four foams (Alcare plus, Avagard Foam, Bode test foam, Purell Instant Hand Sanitizer) containing 62% ethanol, which is commonly used in U.S. hospitals, were applied to 14 volunteers in a total of seven variations, to measure drying times. In a second part of tests, the efficacy of the established amount of foam for a 30 s application time of two foams (Alcare plus, Purell Instant Hand Sanitizer) and water was compared to the EN 1500 standard of 2 x 3 mL applications of 2-propanol 60% (v/v), on hands artificially contaminated with Escherichia coli. Each application used a cross-over design against the reference alcohol with 15 volunteers.

RESULTS: The mean weight of the applied foam varied between 1.78 and 3.09 g, and the mean duration to dryness was between 37 s and 103 s. The correlation between the amount of foam applied and time until hands felt dry was highly significant (p < 0.001; Pearson's correlation coefficient: 0.724; 95% confidence interval: 0.52-0.93). By linear correlation, 1.6 g gave an intercept of a 30 s application time. Application of 1.6 g of Purell Instant Hand Sanitizer (mean log10-reduction: 3.05 +/- 0.45) and Alcare plus (3.58 +/- 0.71) was significantly less effective than the reference disinfection (4.83 +/- 0.89 and 4.60 +/- 0.59, respectively; p < 0.001). Application of 1.6 g of water gave a mean log10-reduction of 2.39 +/- 0.57.

CONCLUSIONS: When using 62% ethanol foams, the time required for dryness often exceeds the recommended 30 s. Therefore, only a small volume is likely to be applied in clinical practice. Small amounts, however, failed to meet the efficacy requirements of EN 1500 and were only somewhat more effective than water.

Free full text @
http://www.biomedcentral.com/1471-2334/10/78
- - - -

3) Am J Trop Med Hyg. 2010 Feb;82(2):270-8.

Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania

Pickering AJ, Boehm AB, Mwanjali M, Davis J

Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, CA 94305, USA. amyjanel@stanford.edu

Abstract

Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.

Free full text @
http://bwc.berkeley.edu/home/safewwater/14%20Pickering.pdf
- - - -

4) Appl Environ Microbiol. 2008 Aug;74(16):5047-52. Epub 2008 Jun 27.

Improved inactivation of nonenveloped enteric viruses and their surrogates by a novel alcohol-based hand sanitizer.

Macinga DR, Sattar SA, Jaykus LA, Arbogast JW

GOJO Industries, Inc., One GOJO Plaza, Suite 500, Akron, OH 44311 macingad@gojo.com

Abstract

Norovirus is the leading cause of food-related illness in the United States, and contamination of ready-to-eat items by food handlers poses a high risk for disease. This study reports the in vitro (suspension test) and in vivo (fingerpad protocol) assessments of a new ethanol-based hand sanitizer containing a synergistic blend of polyquaternium polymer and organic acid, which is active against viruses of public health importance, including norovirus. When tested in suspension, the test product reduced the infectivity of the nonenveloped viruses human rotavirus (HRV), poliovirus type 1 (PV-1), and the human norovirus (HNV) surrogates feline calicivirus (FCV) F-9 and murine norovirus type 1 (MNV-1) by greater than 3 log(10) after a 30-s exposure. In contrast, a benchmark alcohol-based hand sanitizer reduced only HRV by greater than 3 log(10) and none of the additional viruses by greater than 1.2 log(10) after the same exposure. In fingerpad experiments, the test product produced a 2.48 log(10) reduction of MNV-1 after a 30-s exposure, whereas a 75% ethanol control produced a 0.91 log(10) reduction. Additionally, the test product reduced the infectivity titers of adenovirus type 5 (ADV-5) and HRV by > or =3.16 log(10) and > or =4.32 log(10), respectively, by the fingerpad assay within 15 s; and PV-1 was reduced by 2.98 log(10) in 30 s by the same method. Based on these results, we conclude that this new ethanol-based hand sanitizer is a promising option for reducing the transmission of enteric viruses, including norovirus, by food handlers and care providers.

Free full text @
http://aem.asm.org/cgi/content/full/74/16/5047
- - - -

5) Am J Infect Control. 2005 Mar;33(2):67-77

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses.

Sickbert-Bennett EE, Weber DJ, Gergen-Teague MF, Sobsey MD, Samsa GP, Rutala WA.

Department of Hospital Epidemiology, University of North Carolina Health Care System, North Carolina, USA. esickber@unch.unc.edu

Abstract

BACKGROUND: Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers.

METHODS: We studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method.

RESULTS: The highest log 10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2.

CONCLUSIONS: Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

Abstract and link for full text purchase:
http://www.ajicjournal.org/article/S0196-6553(04)00587-5

Also see comments on this paper in:

Am J Infect Control. 2005 Sep;33(7):431-4; author reply 436-7.
Am J Infect Control. 2005 Sep;33(7):435-6; author reply 436-7.
Am J Infect Control. 2005 Nov;33(9):558-60.

Am J Infect Control. 2005 Sep;33(7):429-31; author reply 436-7.

Greg Mihalik
(greg23) - M

Locale: Colorado
Re: "Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene" on 09/01/2010 09:27:25 MDT Print View

David,
I didn't wade through your post so maybe I missed a point or two...

But... most of this stuff is for clinical settings were crud, dirt, etc. on the hands is not typical. When hands are "soiled", "sanitizers" are of little use until scrubbed clean with soap and water.

Even in clinical settings alcohols are selective, and do not kill things like Clostridium Difficile - but scrubbing with soap and water does.

Daniel Goldenberg
(dag4643) - M

Locale: Pacific Northwet
Re: Hand Sanitizers and TP on 09/01/2010 09:29:10 MDT Print View

Regardless of what cleaning media is used, I contend that the use of toilet paper will result in a much higher efficacy than if no toilet paper is used.

Wayne de jong
(wdj) - MLife
Hand Sanitizers for Trekking on 09/01/2010 09:50:52 MDT Print View

Our outfitter for a Kilimanjaro climb carried bleach (a brand used locally to sterilize infant formula bottles) and prepared a dilute solution before meals for the cooking staff and guests to use prior to meal prep and eating. Though it leaves a slight chlorine smell until thoroughly dried, it seems to be an effective and readily available antimicrobial treatment.

JASON CUZZETTO
(cuzzettj) - MLife

Locale: NorCal - South Bay
RE: "Hand Sanitizers: My Journey..." on 09/01/2010 09:52:02 MDT Print View

Ryan - great article. Funny lead in. I once read the introduction of soap saved more children from infection and childhood death in third world countries than any other thing. Then as a paramedic I was taught that hand sanitizers were only good if nothing else was available and to wash your hands as soon as possible after application. So I use Dr. Bronner's when backpacking and when traveling internationally. I even wash my clothes in it when I have to do them by hand.

Again, I love how straight to the point you get.

Marco A. Sánchez
(marcoasn) - M

Locale: The fabulous Pyrenees
Re: Hand Sanitizers on 09/01/2010 10:23:00 MDT Print View

Interesting article. As noted, most stomach illnesses are caused by poor hand hygiene.

Oh! and just in time to boost sales of the Adventure Medical Kits hand sanitizer featured in the Shop :-)

Arthur Forbes
(FNF) - F
Re: Poor choice of words on 09/01/2010 10:27:41 MDT Print View

If you lived on the Mexican border and dealt with the massive problems these people cause you might find that description quite accurate.

Hans Conser
(nucleus) - F
Re: Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene on 09/01/2010 10:35:10 MDT Print View

Ryan, skin that is prone to cracking can be a sign of Vitamin A deficiency, and I wonder if that is a factor for you? Due to my work, I use EtOH sanitizer on my hands 25+ times a day on my hands and I notice no drying or cracking effects at all.

Dr. Hans Conser D.C.
www.bozemanchiropractic.com

Unknown abc
(edude) - F
"Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene" on 09/01/2010 11:16:26 MDT Print View

OK, that's it. Out with the stupid alcohol sanitizer... I've been waiting for this justification. I'll go get some castile bar soaps at Walgreens or something. I'm also sick of liquid soaps which are somewhat expensive considering how fast they run out when you let others in the group use it too. I always liked bar soaps in the shower and on the bathroom sink anyways.

"Illegal immigrants as metaphor for fecal matter and bacteria? Really? Thought Ryan was smarter than that."

I thought it was pretty funny! :D

Edited by edude on 09/01/2010 11:17:54 MDT.

Nathaniel McCartney
(theleafman) - MLife

Locale: Central PA
Mud or Sand as a substitute for soap? on 09/01/2010 13:11:56 MDT Print View

Thanks Ryan for being a voice of reason in the current trend of (over) use of alcohol-based sanitizers. If I've just touched something that is likely to make me ill, I want to remove this contamination from my skin, not just spread it all over both hands and hope that I used enough alcohol to really sterilize everything. While I do carry and use soap, more often than not I instead choose to use a technique my dad taught me when I was a kid- to use mud, sand, clay, or even just dirt with a bit of water to scrub my hands, then rinse them off with a bit of water. I find this technique works really well no matter what kind of crud you're trying to remove. Just how "sterile" a mud scrub can make your hands is up for debate, but my hands definitely feel cleaner using this method vs. using just soap & water. Anyone else out there use the mud scrub method?

Mitchell Keil
(mitchellkeil) - F

Locale: Deep in the OC
Alternative Disinfectant on 09/01/2010 15:06:03 MDT Print View

Thanks Ryan for this timely posting. I have used the alcohol gels in my potty kit for years with little of the effects you discuss. I think largely because I use my kit perhaps once a day.
However, hand sanitizing is an important issue and I have found a method which work for me. I use the granulated chlorine used for pool disinfection which can be found in any pool supply store, Target or Walmart for regular hand sanitation around camp. Here is what I do:
When I get to camp I haul up about 40oz of water and empty it into a camp bowl I have constructed from a Sea to Summit kitchen sink. The bowl weighs about 3.5oz. I then sprinkle about 1/8 teaspoon of granulated chlorine into the water and swish it around until dissolved. Then I rinse my hands in the strong solution and set about my camp chores. Before preparing meals I again rinse my hands in the solution and wash with camp soap. After dinner I add more camp soap to the solution and wash my dishes. Then a refill of the bowl with fresh water and more chlorine and a final rinse. The chlorine removes any and all food odors completely and the now clean dishes are bandana dried and set out for the morning. I also use this same water if I have to use my potty kit while in camp. I have been doing this for many years and it has worked to keep me healthy. Incidentally, a stronger solution can be made which is useful in disinfecting medical implements if necessary. I have also used the clean solution to wash my underarms to remove the stink. Works wonders for this application.

Edited by mitchellkeil on 09/02/2010 11:54:38 MDT.