…and don’t forget to dry them!

I went to Alexandra Street Junior School way back when Goole was still in the West Riding of Yorkshire and we were still force-fed warm bottles of milk and cod liver oil on a daily basis. The school isn’t there any more, which is a pity. I believe it closed in 1976. The red brick building was far more attractive than those that now inhabit its space.

I didn’t spend a lot of time at that school. Actually some might argue that I didn’t spend much time at any of the schools I went to for one reason or another. I got by though. The reason for my absence from Alexandra Street between the ages of 5 and 7 was because I developed a nasty infection in my bone marrow called href=”http://www.bjj.boneandjoint.org.uk/content/89-B/5/667.full”>Osteomyelitis. Cause? Probably S. aureus in the first instance but the subsequent chronic infection may have been caused by a number of organisms, including S. epidermidis, Pseudomonas aeruginosa or Serratia marcescans. I was hospitalised for long periods of time and went through some painful surgery and aftercare. Antibiotics were few and far between at the time and the emerging resistance of S. aureus to what was available was perhaps one of the reasons my recovery was so slow. About three years as I recall. Although I wasn’t at Alexandra Street that much, there are lots of things I remember about it. One thing in particular is the toilets!

The toilets were situated across the playground from the school main building. It was a brick-built block with girls toilets on one side and boys on the other. The inner walls were brick as far as I remember and there was no heating in there. The toilet seats were wooden and if one of them had a crack in it you avoided it because it could give you a vicious nip when you got up! The whole place smelled of disinfectant; a little bit like hospitals at the time. The toilet paper was ‘Izal’…and each piece was printed with the message

‘now wash your hands’.izalmessage

It was fascinating stuff; smooth and slippery on one side and a bit more absorbent on the reverse. If you didn’t rub it together to soften it up a bit, it wasn’t very efficient, in fact, it made much better tracing paper than toilet paper. It was great for doing ‘rubbings’ to reproduce coins etc. It was absolutely no good for blowing your nose. The toilet paper was described by the makers as ‘medicated’ and it did smell of disinfectant, contributing to the overall smell in the room and your hands!

Having to walk across the playground to get to the toilet was no problem in the warmth of Spring and Summer but an absolute nightmare in the wet and cold months. Hat, coat, scarf and gloves were required for a visit at this time. You had to be very quick to do the business and I would guess that despite the message on the toilet paper, we were less likely to wash our hands in the Winter months than in the Summer. This remains a factor today.

The sinks (or hand wash basins) were in a row on the right as you entered the building, or left as you came out of the toilet. There was cold water only and the pipes would constantly freeze in the winter. We used to get some excellent icicles from the guttering. I can’t really remember how we dried our hands but I think it was a roller towel; constantly wet and hopelessly ineffective.

Drying your hands, as I have mentioned in previous blogs, is an important part of the hand-washing process. Any item used (outside of the home) for drying the hands that is communal, i.e. roller towel, cotton towels is inappropriate and only serves to redistribute micro-organisms. Either paper towels or jet stream dryers are preferable in these areas. Hot air dryers have been criticised for not being efficient in drying hands because they take too long,  using too much energy and redistributing dust, skin scales and microorganisms into the environment thus posing a cross contamination and infection risk.

How many times have you been into a toilet in a restaurant or motorway services for example and had the opportunity to observe other people’s hand hygiene habits? I can’t help but take note when someone comes straight out of the loo and through the exit, or washes their hands and shakes them a bit before wiping them on the back of their trousers and walking through the door. Very few large public places like railway stations or airports provide paper towels nowadays, although arguably they are the most efficient way of drying your hands and removing bacteria from the skin surface. Rather they, like many other places, opt for the new generation of hot air jet stream hand dryers that, if used as directed dry your hands thoroughly in 10-12 seconds. The Dyson Airblade was the first but it is way too noisy, particularly if there is more than one in use. This has now evolved and the dryers are more compact and 50% quieter. Arguably this system is still not appropriate for clinical areas but certainly ideal for high traffic areas such as motorway services.

The arguments about how efficient hot air hand dryers are is ongoing. I was in a motorway service station the other day and used a hot air dryer with an added beam of UV light that shone onto parts of my hands whilst I was drying them. I had come across UV light as an antibacterial agent before in water purification but thought I would investigate it in relation to hand dryers.The broad aim with the new hand dryers (and I am sure there are variations) is to filter the air that dries your hands so that 99.9% of any harmful organisms present are removed.I really don’t think that’s too important in a motorway service station, is it? I would like to see everyone washing their hands using a reasonable technique and then drying them thoroughly, by whatever means. Let’s face it, as soon as you walk out the door, you’re recontaminating those hands again. BUT, that’s not an excuse for not washing them. We have to remember it’s often the germs that you pick up in the toilet that have the potential for causing infection, for example, E.coliE. coli. Anyway, the jet stream dryers are great; fast and efficient. But what about that UV light?  I think the general consensus of opinion is that it really has no effect on your hands via the hand dryer; they aren’t exposed to it long enough in the time it takes to dry them. Great in theory maybe…but not convincing to me.

Now, the use of UVC in e.g. Asda toilets may be a different thing. The air in the toilets is pretty static so it may be that the constant UV light can effectively kill organisms in the air created by the aerosols from flushing the loo…IF it’s the right concentration. But that’s another story.

Basically, UV kills cells because of the cumulative DNA damage. UV radiation disrupts the chemical bonds that hold the atoms of DNA together in the microorganism. If the damage is severe enough, the damage cannot be repaired and the cell will die. Longer exposure to UV light is necessary to ensure complete kill off of all micro-organisms. Unlike chemical treatments, UV treated air or water does not resist re-contamination.

Inevitably, drying your hands is an important final step in the hand-washing process and should be carried out thoroughly, ensuring no moisture remains on the hand surface, between the fingers or underneath jewellery. I think the arguments can continue in health care as to which is the best method to achieve this but for me the most important thing is to get the public on board and make sure when they wash their hands, they understand how to complete the process.

We have come a long way since I was at Alexandra Street School but the message given out on that toilet paper remains relevant. After using the loo, ‘please wash your hands’. Perhaps we should then write on the mirrors above the sinks…’and don’t forget to dry them!’

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cats, coffee and cash

How clean is your kitchen? If it looks clean, is that good enough? Whatever you do to clean in your kitchen, there are a few simple things that can help. Kitchens, like anywhere else are easier to keep clean if they are actually cleanable. Does that sound daft? It’s not really.

Firstly, it’s important to avoid clutter. A place for everything and everything in its place is a great goal to have. Don’t use worktops as storage areas if it can be avoided. If they are covered in equipment such as toasters, mixers, storage coontainers, kettles and coffee makers, the potential for contamination and the need for regular cleaning are increased.

Do you need to wipe down the surfaces with disinfectant? Well, that depends. Surfaces shuld be kept clean and free from dust and other contaminants. Wipe them down regularly with a cloth rinsed in hot soapy water. I have cats and I don’t know if at night they investigate my kitchen surfaces. The likelihood is that they do, so I use a hypochlorite solution (e.g. Milton or Domestos)to disinfect, or an antibacterial spray and wipe surfaces down before I prepare food in a morning.

my hands are clean!
Look, they’re clean!

 

 

Apparently, there are some ways to discourage your cats from getting up on to those kitchen worktops…they can’t walk on kitchen (tin foil), they can’t stand bubble wrap and they can’t stand the smell of oranges, so if you get an orange kitchen cleaner they won’t get up there ! If you’re really concerned about them jumping up there (and it’s only natural) try one of the above  and let us know what happens.

The cloth that I use may be a disposable one but I don’t change it on a daily basis, rather at the end of the day I soak it in bleach for ten minutes, rinse and then leave to dry overnight. I dispose of it at the end of the week, or sooner if it becomes grossly contaminated or the fabric begins to deteriorate. If it’s a cotton cloth I treat it the same way on a daily basis but wash it in the machine once a week. Research has identified dish cloths as being harbours of potential pathogens but I like to take a common sense view when dealing with them.One thing you can be sure of, if your dish cloth begins to smell, the bacteria levels are…disturbing. Soak it in a bleach solution first, then wash in the machine and leave to dry (preferably on a line outside where the UV rays help to kill any bacteria left) or, throw it out and buy a new one!

Your sink in the kitchen is also a potential reservoir of infection, Sinks should be kept clean and free from limescale. Rinse debris away and then use a disposable coth and hot soapy water to remove grease. A descaler may be needed periodically to remove limescale but not bleach, this just takes colour out of the problem. Limescale presents a nice uneven surface in which germs can breed and it can’t be guaranteed that bleach gets in to all those little crevices, so don’t bother. Use a descaler, leave for the allotted time, rinse with hot soapy water, then dry. You should be left with a nice even surface that is cleanable

Germs…

FAT TOM…need warmth, moisture, food and time to reproduce (they may or may not require oxygen, and some do prefer a slightly acidic environment but not all) so if you remove one or more of those factors then they can’t.Drying is very important in breaking the chain of infection, not only in surface cleaning but handwashing also.Similar attention should be paid to taps and the drainer. Never put bleach down the sink , for all sorts of reasons.It won’t help unblock sinks, it won’t get rid of smells but it will interfere with the environmental bacteria down there which helps to keep unwanted organisms in low numbers and the drain smell free. If you have a septic tank, bleach should only be used in small amounts so as not to interfere with the bacteria levels necessary for breaking down organic waste.

More often than not, it’s not your kitchen you should be worried about but those of places where you and many others go to eat, drink, socialise. One of my biggest complaints is the failure of these big franchises to monitor hygiene standards in their establishments. I went for a coffee and snack with my sister the other day. It was to a coffee shop in Hull, near the Ice Arena. It was quite busy and we had to wait a while to be served because everyone seemed to be having food. I counted three staff on duty. Two serving and one clearing and cleaning. Coffee was prepared by ‘the Barista’ and food was served by another girl. Both took turns in taking money. Neither at any stage washed their hands. The Barista had a disposable cloth in front of the coffee machine which had obviously been in use for a while because it was covered in coffee grounds. Each time a coffee or other drink was made, coffee grounds, milk, foam, ice or syrup potentially were spilled in front of the coffee machine. I saw the surface wiped a couple of times with the same cloth which was then tucked under the coffee machine.I accept, there was no cleaning going on there, it was just physical removal of debris but the cloth should at least have been rinsed out and importantly, hands washed!

Now, I have mentioned how dirty dish cloths are. How do you think they compare to the money we have in our purses and pockets? Money is handled by potentially thousands of people without ever being laundered (well, not by being washed anyway).So, should people who handle money be handling food?

Dirty money.

Some studies have involved swabbing the  hands, currency and credit cards of people in various locations in the UK, and then testing for the presence of faecal bacteria (bacteria from the gut) which can cause nasty tummy upsets if ingested. As you might expect, the subjects’ hands were pretty disgusting, but also, some of the cards and the paper money had as much fecal bacteria on them as you would find in a dirty toilet bowl.No reason to believe that coins, with their uneven surfaces and in many cases, visible dirt, are any different.

So the message is Costa, Starbucks, Nero and others: If your staff prepare drinks and food and then take money, they MUST wash their hands before going on to the next customer. AND, perhaps you should take a leaf out of the NHS book and give them badges stating ‘it’s OK to ask’ so that we can make sure the hands that deliver us the sandwich, cake or coffee are clean by asking “have you washed your hands?”

If you need further advice…get in touch!