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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Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene
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Dave T
(DaveT) - F
poor taste. on 09/04/2010 06:25:01 MDT Print View

"Stop these illegal immigrants en route, because we all know you can't close the border!"


Ryan,

Maybe you should have followed up with:

"Keep your dirty hands and your trail GORP apart, just like white women and colored men!"

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Re: "Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene" on 09/04/2010 14:59:13 MDT Print View

> I'll go get some castile bar soaps at Walgreens or something.

We collect those little packaged soaps you find in motels etc. Much lighter than a full-sized bar, far more convenient than a dropper bottle, and one tiny bar lasts for a year or two in the bush.

Cheers

Edited by rcaffin on 09/04/2010 16:24:07 MDT.

Eric Fredricksen
(efredricksen) - MLife

Locale: Silicon Valley
Yours vs. others' on 09/04/2010 16:27:47 MDT Print View

I'm wondering if clean hands are less important when hiking solo. It seems very possible that your own GI fauna would be less harmful to you that that of others'.

John Davis
(Bukidnon) - F
Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene on 09/05/2010 00:54:22 MDT Print View

Agreed, Eric. Your system ought to be used to them, although care should be taken as to what gets touched after a visit to the ablutions office. VSO's doctor told a bunch of us new recruits that diarrhoea means you have ingested someone else's faeces.

I also wonder if this and the issue of contaminated water come into sharper focus in hot, dry environments. My suspicion is that British backpackers have traditionally not been too concerned with hygiene and have suffered very little as a result. The Scottish Highlands have been particularly well supplied with cold, clear water this August.

Water near the summit of an excellent Munro

The glens were sodden and even summits such as that of Mullach Fraoch Choire had excellent water sources. I wish its pool hadn't been freshened up quite so frequently during my holiday.

Edited by Bukidnon on 09/05/2010 01:03:38 MDT.

Tohru Ohnuki
(erdferkel) - F

Locale: S. California
Re: Yours vs. others' on 09/05/2010 08:03:30 MDT Print View

I would agree. Good sources of water harbor few pathogens and probably quite a few of the "I've never gotten anything in the backcountry" reports are from soloists. Hell is other people (or their commensal bacteria)...

John Davis
(Bukidnon) - F
Re: Yours vs. others' on 09/05/2010 09:12:54 MDT Print View

Couldn't help chuckling, Tohru

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: Hand Sanitizers on 09/05/2010 17:46:35 MDT Print View

"Never use the stuff at home."

Mud and sand? Or hand sanitizer?

Simon Wurster
(Einstein) - F

Locale: Big Apple
Re: Hand Sanitizers: My Journey Towards Discovering Best Practices for Wilderness Hygiene on 09/07/2010 12:46:08 MDT Print View

"just like our grandparents did" Ever watch your grandparents wash their hands? It was if they were scrubbing in on surgery. The 21st century quick wet-soap-lather-rinse ain't gonna do nothin' no-how. But if you scrub well like they did...

The BAK-based cleaners have an advantage for me as a contact lens wearer: no alcohol residue (and thus eye burn). No rinsing needed, just rub (scrub?), air dry, then continue as if at home. (I don't have to use any treated water prior to hand-meets-eye, removing that possible source of contamination as well.)

I use the Adventure Medical Kits hand sanitizer, and found that the dispenser can be refilled: take a suitable pair of pliers (I use needle-nose vise-grips) and carefully grasp the bottom plate and rock it off. It'll be scratched a bit, but it'll snap back on without any fuss (and many times too). I use either Soapopular (for backcountry as it's odorless but more expensive), or the Office Max Smart & Silky brand (the one for kids) for day-to-day use (dirt cheap). Even though these brands vary in concentration of BAK from 0.13% (Soapopular) to 0.10% (Smart & Silky), I can tell no difference in efficacy.

Richard DeLong
(Legkohod) - MLife

Locale: Eastern Europe / Caucasus
washing hands solo on 09/09/2010 05:27:34 MDT Print View

My trick for washing hands in the backcountry was developed while solo-hiking the PCT. I suck water into my mouth from my Platypus or water bottle and immediately dribble it out of my mouth onto my hands while rubbing vigorously. No soap. It may sound remarkably anti-hygienic, but it allows for much better rubbing of the hands than if you pour water with one hand onto the other and try to rub and rinse the hands with each hand subsequently pouring water onto the other.

With this method I could cleanse my hands as many times a day as I wished (3-8 times) to keep them feeling clean. I used hand sanitizer only after bowel movements.

I had no GI problems then or since.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Can you infect yourself from fecal matter? on 09/09/2010 10:09:32 MDT Print View

If you're solo then you won't be infecting others

Walter Underwood
(wunder) - M

Locale: San Francisco Bay Area
BAK for first aid on 09/12/2010 10:59:04 MDT Print View

You don't need alcohol sanitizer for a first aid sterilizer, BAK works fine. That is the active ingredient in Bactine.

If you need lots of sterile wash, overdose some water with purification chemicals (tablets or Aqua Mira) so there is excess sterilizer available.

Also, don't eat with your hands. Be really careful about touching food -- use a clean spoon or knife whenever you can.

FInally, learn to keep your fingers clean. For example, spread on sunscreen and insect repellent with the back of your hand, not your fingers. Don't drop your gear in the dirt so you won't be handling dirty gear. And so on.

Oh, and Dr. Bronners turns into gel in the cold. Not my favorite. I'm a Biosuds guy.

Edited by wunder on 09/12/2010 10:59:51 MDT.

John Murtiashaw
(murda) - F

Locale: Ashvegas and beyond
Where the lab tests at on 09/14/2010 14:15:58 MDT Print View

When I interned at Baxter State Park, I remember the rangers telling us that hand sani only "piXXed off" the bacteria. I use it all the time in tha woods tho, and at music festivals where there's no running water (at least until I can spring for the VIP tix). When I did wilderness therapy, we gave out sani all day but did a solid hand washing every night, but for that you need at least two people and some kind of water jug, a cook pot would work. When the little kids would really screw up at the wag bag I'd make d--- sure soap and water was in play, a bleached nail brush too. Nothing like a chemical reaction to get ya clean n godly.
PS no profanity on the message boards? wtf are we like, 6? if you're old enough to pay with a credit card I don't think you will be offended by some strong words.

Mitchell Keil
(mitchellkeil) - F

Locale: Deep in the OC
Profanity on 09/14/2010 14:41:51 MDT Print View

No, we are not 6. One would expect "potty mouth" behavior from 6 year olds. We are adults, most of us, and as such don't feel the need to sprinkle profanity liberally throughout a post. One can communicate clearly, effectively and with respect for each other without it. When we disagree, which happens often enough on BPL issues, we find a way to do so without making the "other" feel badly. The object here on this site is to learn from each other, teach each other and have fun sharing good times and bad times on the trail with our gear. When we are on the trail I would assume most of us find profanity useful at times. When we are sitting at our computers in our homes or offices writing a post, we exercise a certain level of consideration for the rest of the BPL community not knowing who enjoys a little profanity and who does not.

John Murtiashaw
(murda) - F

Locale: Ashvegas and beyond
slow yo roll on 09/14/2010 16:14:15 MDT Print View

Mitchell!!! Cool down my eloquent homeboy, I wasn't advocating that you cuss up a storm, I just think if I fork over 20 bones for ninety down jacket articles I should be able to say what I please. Now go get your bedford handbook and post a reply.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: slow yo roll on 09/14/2010 16:21:03 MDT Print View

John, you didn't read the terms and conditions that you agreed to when you subscribed here.

--B.G.--

Mary D
(hikinggranny) - MLife

Locale: Gateway to Columbia River Gorge
Hand Sanitizers: on 09/14/2010 16:37:55 MDT Print View

And there are youngsters reading on these boards. Need to keep it family-friendly!

Mitchell Keil
(mitchellkeil) - F

Locale: Deep in the OC
Profanity on 09/14/2010 16:42:22 MDT Print View

Last Comment on the subject.

I don't need a Bedford Handbook to reply. I value and treasure the English language and make a practice of using it with skill and style every day -- even in a post.

We get members like you ocassionally. They last a while then drift off to some other interests they may have, or they adjust to our community and get into the spirit of things. I hope you do -- adjust that is. Meanwhile, Bob's comment that you may need to go back and read what you agreed to when you signed up for this site with your "20 bones" is a good suggestion.

mark wuethrich
(mwuethri)
Cracked hands solution on 01/04/2011 21:11:57 MST Print View

I've had to deal with the cracked hands a lot from crack climbing at T Wall in the winter. Solution: chapstick, blistex worked best for me, just rub it over the cracks and you're good to go

Craig Price
(skeets) - MLife

Locale: Melbourne, Australia
soap vs alcohol hand gel on 07/16/2011 02:22:10 MDT Print View

er, back on topic.

I gather this means that a good soap and water wash is often better. Beauty!

I've often wondered why any of us gram watchers (aren't we all on this site) would even contemplate taking gel instead of just plain simple soap leaves that are readily available at any outdoor shop. As long as you have water to use, it is lighter to take leaves. You get about 50 in a packet, and re-pack, say 10-20 in an XXS snap lock bag for any trip (overnight needs even less) and they weigh almost nothing (the biggest weight is the small pill sized snap lock bag itself, at about 1g)! Now it seems the tech data supports it also, so I can feel relaxed about it at the same time.

Craig

Edited by skeets on 07/16/2011 02:25:08 MDT.

Greg Mihalik
(greg23) - M

Locale: Colorado
Re: Soap "leaves" - No thanks on 07/16/2011 09:24:02 MDT Print View

"...plain simple soap leaves that are readily available at any outdoor shop.."

I tried them. I didn't like them.

Getting the first one out is easy. Getting the second one out with wet fingers can result in one drop of water saturating the rest of the "leaves" and solidifying them.

And if you get out several before hand, they are light enough to waft away on a breeze.

If you are doing more than just a hand wash you will go through them fast.

Liquid soap, although heavier, is much easier to dispense, spread, and use.

IMHO.

Edited by greg23 on 07/16/2011 09:42:21 MDT.