The God's own people are once again braving the perils of floods and incessant rains in many areas with unmatched willpower and unity. The waters are receding slowly, yet much caution needs to be exercised to ward off new breakout of diseases and related issues that may occur after a natural disaster.
An H1N1 alert has been issued in the state following the floods and ongoing relief work. According to reports, the health department has issued the warning after 38 people have been confirmed to have contracted the disease and three people died of H1N1 in the last month alone.
As we already know this pandemic is caused by a strain of the swine influenza virus (H1N1), which normally causes disease in pigs, hence the name Swine Flu. It spreads from person to person mostly by the normal transmission routes associated with colds and seasonal influenza.
Viral particles enter the body through the respiratory tract, but the air is not the only means by which the virus spreads. It can survive for certain periods on different surfaces and also on the skin. It is recognised that hands can play an important role in spreading the virus between people and also in contaminating objects around.
Swine flu has proved to be a highly contagious disease. Though for the vast majority of people the symptoms are relatively mild, a number of people are at risk of becoming more seriously ill due to various factors.
It is highly recommended that people in high-risk groups be vaccinated against H1N1 (swine flu), and also get medical assistance at the earliest if symptoms are detected, to avoid further complications.
Preventing the spread of swine flu
Soap and water hand washing and alcohol-based rubs are effective in reducing the presence of influenza A virus on human hands, according to the results of a study published in the February 1 issue of 'Clinical Infectious Diseases.'
Guidelines have also been issued by the department of health indicating that preventing the spread of germs is the single most effective way to slow down the spread of diseases like swine flu. The guidance also emphasises the importance of preventive hygiene. This can be attained by
• ensuring washing of hands regularly with soap and water,
• cleaning the surfaces regularly.
• always carrying disposable paper tissue or cloth.
• using paper tissues to cover the mouth and nose while coughing and sneezing,
• disposing the used tissue papers or cloth as soon as possible effectively, with caution (don't throw it around carelessly)
The importance of good hand hygiene
Although person-to-person transmission of influenza virus is primarily due to aerosol spread, transmission on the hands of patients and their caregivers is also potentially important," warns M. Lindsay Grayson, MBBS, MD, MSC, FRACP, FAFPHM and colleagues, from the Infectious Diseases Department, Austin Health, the Department of Epidemiology and Preventive Medicine, Monash University, and the Department of Medicine, University of Melbourne, Australia.
If a person with swine flu coughs or sneezes without covering their nose and mouth, droplets containing the virus will be dispersed in the air and would typically spread at least a metre. A person close by might inhale this and the droplets could also fall onto surrounding surfaces. The infected person’s hands can easily become contaminated by the droplets during coughing and sneezing which in turn will result in the transfer of germs to the surfaces that he touches, such as door handles, hand rails, telephones and keyboards.
The flu virus can live on a hard surface for up to 24 hours and on a soft surface for about 20 minutes. The viral particles will pass onto the hands of any person who touches these surfaces within the said period. When touching their eyes, nose or mouth they may also become infected as the virus enters their body. An even more direct means of transmitting the virus is through skin-to-skin contact, such as when shaking the hands of an infected person whose hands are contaminated.
Efficient hand hygiene by thorough washing and drying of the hands will reduce hand contamination and help prevent the spread of the disease. It would be better to minimise touching the mouth, eyes or nose unless the hands have been recently cleaned.
Appropriate timings to wash the hands
To help reduce the spread of influenza, it makes good sense to wash the hands frequently throughout the day. It is particularly important to wash them after coughing, sneezing or disposal of the used paper tissues, before and after taking food.
In addition, one should also continue to wash hands at times when required normally as part of personal hygiene, to reduce the potential spread of harmful organisms such as after using the toilet and before preparing food. However, there should also be increased vigilance if someone is ill and suspected of having an infection such as swine flu. Essentially, the sick person and the carer must wash their hands frequently than others.
The proper technique of washing hands
Good hand hygiene involves more than just washing at the appropriate times. According to WHO, the actual way in which hands are washed is absolutely important, to get rid of germs.
The whole process of washing and rinsing the hands takes only less than 10 seconds for most people. This is not long enough as hands should be washed for at least 20-30 seconds in normal circumstances. If they are particularly dirty, the period needs to be extended.
• The correct procedure of hand washing would be wetting the hands first and applying sufficient soap to cover the whole surface of the skin.
• The soap lather needs to be well distributed till the wrist area by rubbing the palms together and scrubbing the back of the hand as well as the space between the fingers.
• After this, hands should be rinsed thoroughly under running water, so that any contamination and soap residue is readily washed away with the stream of water.
• Attention must be given to washing the areas around ornaments worn, like rings or bangles if these cannot be removed.
• Long nails can harbour more germs than short ones hence care must be taken with washing the underside of them.
• Cleaning under the fingernails with a nail brush may be considered if hands are heavily soiled.
• Finally, dry the hands thoroughly using paper towels, a clean cloth towel or an electric hand dryer.
Importance of drying the hands
This step of drying the hands is very important. Some bacteria may remain on hands even after washing, and these bacteria are more easily spread via wet hands than dry ones. New independent research has found that single-use paper towels are the most effective way to dry one's hands and to reduce the risk of the transmission of viruses
The relatively dry environment of the human skin helps to limit the types and numbers of micro-organisms that can survive on it. Micro-organisms present within droplets of moisture can live for much longer periods. Therefore, if the hands remain damp, there is a greater chance of infections while touching the eyes, nose and mouth, or by transferring the microbes to other surfaces that would be eventually touched.
It can also lead to a deterioration in the skin’s condition and integrity, if the hands constantly remain damp due to ineffective hand drying. This again can lead to either an increase in the number of micro-organisms on the skin or a change in their types from the normally harmless ones which we all carry on our hands.
A cloth towel may also be used to dry the hands if disposable products are not available but if not cleaned carefully that itself could turn out to be a carrier of the virus. In situations where a person is ill with suspected influenza, it would be better to have a separate towel of his own which is not shared by others to help reduce the possibility of infecting others.
Alternate sanitising aid
Frequent use of hand sanitizer, instead of soap and water, may lead to fewer respiratory infections, fewer sick days, and less antibiotic use at least in toddlers, writes John Ross MD FIDSA, Harvard Health Publishing based on a Spanish study that enrolled 911 children who attended day care, from newborns up to three-year-olds.
The most preferred method of hand cleansing is washing the hands with soap and water, followed by thorough drying. Droplets and visible dirt which could trap micro-organisms are washed away by this process.
In situations where soap and water is not available and when the hands are not visibly soiled, then hand sanitisers which have proven anti-microbial performance are also an aid to hygiene.
Hand sanitizers are easily available in small bottles or dispensers that can be conveniently carried in a pocket or handbag. It comes normally in a liquid or gel form and should be rubbed thoroughly over the hands and fingers and allowed to dry.
(Author is the Director TGL Foundation, Chairperson CSA, Editor- The Intl Journal, Senior Director FWO)