Hand Sanitizer: The Good, the Bad, and the Ugly

Staying health may be as simple as keeping your hands clean. In fact, experts say remembering to wash your hands frequently and thoroughly is the single most important way to stay health.Researchers estimate that routine hand washing is so effective it could prevent a million deaths per year since about 80 percent of infections are spread through hand contact.

Harmful germs are ubiquitous and prevalent in kitchens and bathrooms, on floors, faucets (especially school drinking fountains), keyboards, ATM machines, cell phones, and doorknobs.  Antibiotic-resistant staphylococcus (a common cause of skin infections) has been found on yoga mats, wrestling mats, and cardio resistance machines. Cramped and heavily trafficked airplane bathrooms are one of the best places to get contaminated.

The importance of hand washing can't be overstated. To reduce your risk of picking up unwanted micro organisms, the Centers for Disease Control and Prevention (CDC) recommends hand washing—preferably using soap and water—in the following circumstances:

• Before, during, and after food preparation
• Before eating food
• Before and after caring for someone who is sick
• Before and after treating a cut
• After using the toilet
• After changing diapers
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal waste, or handling pet food and treats
• After touching garbage

Soap or Sanitizer?

Soap and clean water is best but if they aren't available (for example, during car travel), an alcohol-based hand sanitizer—containing at least 60 percent alcohol—is an acceptable alternative. Health officials have found that hand sanitizers containing less than 60 percent alcohol is not enough to kill most harmful bacteria and viruses.

However, buyers beware! Don't assume all hand sanitizers are created equal. Read labels and look for products with between 60 and 95 percent alcohol listed as ethyl alcohol, ethanol, or isopropanol.

One of the problems with hand sanitizers is that they don't cut through grime well. The alcohol in the gels kills bacteria and viruses, but health officials say soap—any soap—used properly removes them. High-tech soap (a.k.a hand sanitizers) is not recommended for use on visible dirt and is not an effective agent for bacteria associated blood, feces, bodily fluid, and animal fat (attention food service workers) unless they are wiped off first.

The U.S. Food and Drug Administration (FDA) and other health agencies have also expressed concerns that the overuse of sanitizers may cause germs to develop resistance. In addition, be wary of false and unproven product claims. Hand sanitizer and antiseptics cannot prevent infection from MRSA (methicillin-resistant Staphylococcus aureus)—a deadly strain of bacteria—according to the FDA. Any claims that a product kills MRSA, staph, and strep should be disregarded and the agency strongly urges consumers not to buy over-the-counter hand sanitizers or other products that allegedly prevent infection from MRSA, E. coli, Salmonella, flu, other bacteria, or viruses. On the plus side, hand sanitizers are quick and easy to use and cause less skin irritation than soap and water.

One caveat: the alcohol in hand sanitizers will shorten the life of your manicure. Alcohol dries out nails and cuticles and causes nail polish to chip and peel. Switching from polish to a gel or shellac costs more but will last longer.

Germ Busting Basics

To wash hands properly, the CDC recommends lathering up with soap and washing for at least 20 seconds—the time it takes to sing "Happy Birthday" twice. In the agency's video, "Put Your Hands Together," CDC epidemiologist Michael Beach, PhD offers the following instructions:

"Focus on washing the front of your hands, the back, in between the fingers, and around the nails and so on. Then rinse everything off," says Beach in the video. "Use something to wipe your hands after that—preferably something disposable, like a paper towel and then use that to turn off the tap as well."

When soap and water are not available, squeeze a dime-size amount of hand sanitizer—containing at least 60 percent alcohol—into your hands and rub until solution is completely absorbed. Safeguard yourself in the gym or at work by wiping workout mats, machines, desktops, and computer keyboards with an antiseptic wipe.

Dr. Rafael Pajaro reviewed this article.

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Sources:

U.S. Food and Drug Administration

The New York Times

The Centers for Disease Control and Prevention

Teen Health: Top Issues That Are Overlooked

Adolescence is a time of great personal change.

Teens may get a bad rap for being rebellious, moody, and self-conscious, but that's actually not the case for the majority of youngsters. However, their sometimes erratic behavior can be difficult to interpret.

Since parents are the gatekeepers of their children's health, recognizing a problem and being vigilant about getting it addressed is important. The sooner a health issue is treated, the better the chances are of a full recovery.

To help make parents aware of under-diagnosed health problems, QualityHealth recently spoke with two adolescent medicine experts, Susan Yussman, MD, MPH, and Arik Marcell, MD, MPH. If you recognize any of these symptoms, it's wise to bring your concerns to the attention of your pediatrician as soon as possible.

Depression

According to the National Adolescent and Young Adult Information Center (NAHIC), the third most common form of death among teenagers is suicide. (Note: Unintentional injuries such as motor vehicle and other accidents are the most common form of death in this age group.) Susan Yussman, MD, MPH, believes many of these tragic deaths could be prevented if depression is spotted earlier and treatment is administered.

"Parents and physicians tend to be more focused on normal growth and development," says the adolescent medicine expert at the University of Rochester Medical Center. Mental health is often overlooked because so many of the common symptoms—such as social isolation and sullenness—can be attributed to what might be considered "typical" teenage moodiness. "It may surprise you to know that depression can also cause teens to act out aggressively."

Arik V. Marcell, MD, MPH, assistant professor at the Johns Hopkins Children's Hospital and director of adolescent services at the Harriet Lane Clinic concurs and says it's vital for parents to understand the risk factors and recognize the symptoms of depression.

The New York Times reported in April 2012 that depression risk factors for adolescents include having parents with depression—in particular a depressed mother and early exposure to stress and other negative experiences such as neglect or abuse. Hormonal factors associated with puberty and menstruation may also contribute to depression.

Other symptoms include:

• Trouble making/keeping friends
• Declining grades/truancy
• Loss of interest in normal activities
• Anger/irritability/hostility
• Weepiness/sadness
• Restlessness/agitation
• Excessive sexual behavior
• Acting-out behavior such as stealing, violence, and self-injury
• Lack of hygiene or a decline in self-care
• Negative self-talk or low self-esteem
• Change in appetite or abnormal eating behavior
• Frequent headaches and stomachaches
• Difficulty concentrating or making decisions
• Substance abuse

Adolescents with depression are at significantly higher risk for substance abuse, recurring bouts of depression, and other emotional health problems in adulthood. Both doctors point out that in medical school today there is more emphasis on mental health. "Pediatricians are taught to screen for mental health issues in adolescents, but if you don't get the answer you want from your child's physician, consult a mental health professional," advises Yussman.

Eating Disorders

During middle childhood, it's not unusual for teens to become more aware of their bodies and as a natural consequence, their diet. But eating disorders such as anorexia and bulimia are much more complicated than picky eating and can quickly spiral out of control.

Both may stem from depression (though clinical depression is more common) and affect adolescent girls and boys. "Recent studies report that anorexia is higher in boys than previously thought," says Dr. Marcell. "Today, 3 in 10 patients diagnosed with anorexia are boys—that's up from 1 in 10." Anorexics restrict certain types of food and often engage in more activity than eating which results in weight loss," says the Baltimore-based expert. Yussman adds that the average recovery time for anorexia is six years.

Though the typical anorexic is a white female from middle to upper socio-economic status, many overweight teens suffer from eating disorders as well. "Unhealthy eating behaviors include binging on certain foods then purging it," Dr. Yussman explains. "Some of these teens are also known for using diuretics and weight-loss pills in damaging ways."

Sexually-Transmitted Diseases (STDs)

During the teen years, many young people become sexually active for the first time. According to the Centers for Disease Control and Prevention, chlamydia is the most commonly reported STD in the United States. Like other STDs, chlamydia often has no symptoms, so many people with the disease don't know they have it. Although it's easy to cure, chlamydia can affect future fertility if left untreated which is why the CDC currently recommends that all sexually active females 25 years old and younger be tested annually.

"Teens and young adults account for a quarter of the sexually active population but are responsible for half of all STDs in this country," says Yussman. Aside from the lack of symptoms, many STDs go untreated because teens are inexperienced and don't recognize abnormalities in themselves and aren't aware of places to go for confidential services. "STD screening today is minimally invasive," says Marcell, explaining that chlamydia and gonorrhea can be detected with a urine test for a boy or a self-administered vaginal swab or a urine test for a girl.

The doctors advise parents to explain to their sons and daughters that anyone who is sexually active can get an STD. "Be sure males understand that using a condom offers protection from unwanted pregnancies but also protects against STDs," Marcell explains. "Young males should understand that even if his partner is using birth control, he could get a sexually-transmitted disease. Condoms protect against pregnancy and STDs. Using other forms of birth control alone such as the pill, the patch, or the IUD will not protect against STDs."

Concussions

A concussion is a type of traumatic brain injury that can be caused by a bump, blow, or jolt to the head. A fall or seemingly mild bump on the head can also cause a concussion. Car accidents also put young, inexperienced drivers at increased risk of concussion.

Though more attention is currently being paid to head injuries—especially at the high school level where students play competitive sports—many concussions are overlooked. According to Dr. Marcell, collisions in football and soccer pose the greatest risk to the head.

"Regulations differ from state to state, of course, but all student athletes should have a baseline evaluation at school or through their pediatrician's office," he says. "If your child participates in sports, find out how concussions are monitored. If he plays on multiple teams with different trainers and coaches, make sure each one is aware of any head injuries that have occurred in other sports. You can't assume trainers and coaches necessarily talk to each other."

Concussions can have a more serious effect on a young, developing brain. Be sure your school has a concussion plan. If they don't, the CDC can help.

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Sources:

Interview with Susan Yussman, MD, MPH
Golisano Children's Hospital at the University of Rochester Medical Center

Interview with ArikV.  Marcell, MD, MPH
Assistant professor at the Johns Hopkins Children's Hospital and director of adolescent services

Morning Exercise Without Stress or Strain

There are countless reasons why exercising first thing in the morning is a great idea. You start your day off with an energizing, positive activity that revs up your metabolism. You knock something important off your to-do list and it boosts your mood for the entire day. But early morning exercise presents a few challenges.

Health Tips

1. Eat light. After a long night with no calories, it's important to eat something before you head out for a run, hike, or to the gym. Even if all you eat is a little yogurt, a piece of whole wheat toast and peanut butter or a handful of nuts and a glass of milk, having a light snack on board will make the difference between running the distance and hitting the wall. Don't wolf down a big meal though or you'll feel weighed down and may even experience bloating and cramping.

2. Hydrate. Have a glass of water before you exercise to rehydrate your body after a long, dry night. Drinking coffee is fine and may even give you the energy boost you need to finish your workout, but coffee is a diuretic and no substitute for water. Worried you'll have to pee while exercising? Go to the bathroom before you leave the house. If you're headed to the gym, no problem—use their bathroom. If you're exercising outdoors, plan a route with bathrooms or port-a-potties along the way.

3. Warm up and stretch. Your muscles have to wake up just like the rest of you. Start exercising by walking at a slow to moderate pace for five minutes or more. Once you're fully warmed up, stretch gently to loosen your joints, ligaments, and tendons. Don't forget to do a cool-off walk and post-workout stretch too.

Safety Tips

4. Lighten up. If you exercise before the sun is up, make sure cars, bikes, and other early birds can see you. Wear bright colored reflective clothing, and carry a light.

5. Follow the rules. Bike with traffic and run against traffic. In most parts of the country, it's the law that bike riders must go with the flow of traffic. Stay alert for sleepy drivers who don't see you and your bike and give yourself plenty of room between traffic and parked cars. Whenever possible, use bike lanes and bike-only routes. When you run, run on the sidewalk, a track, or if you must run in the road, towards oncoming traffic. That way, if a car doesn't see you, you'll be sure to see the car and be able to get out of the way.

6. Don't be a victim. If your early morning workout leaves you in the dark, walking through unlighted parking lots to get to your gym, or running along trails or roads with plenty of areas for bad guys to lurk, take precautions to protect yourself. Exercise with a partner whenever possible. Carry a walking stick, pepper spray, an alarm or air horn, and an attitude that says, "don't mess with me." If a stranger approaches you, don't hesitate to scream. Yell, "Help!  Police" and run away as fast as you can. Vary your route and avoid areas where your instincts tell you you're not safe or consider changing your workout time to an hour that feels safer.