No flu shot mandate for doctors

Dcotors no being mandated to take H1N1 vaccine.  A good move, but not sure I agree with the reliance on hand sanitizer.  Soap and Water washing frequently is vital.

AMA meeting: No flu shot mandate for doctors; hand sanitizer pushed


The AMA will study if there's any benefit from requiring all health professionals to receive influenza vaccine.

By KEVIN B. O'REILLY AND DAMON ADAMS, amednews staff. Posted Nov. 23, 2009.
Houston -- The AMA House of Delegates rejected a proposal to mandate vaccinations for health care professionals but approved other policy to prevent the spread of seasonal flu and influenza A(H1N1).

A resolution by the Infectious Diseases Society of America said the AMA should back universal seasonal and H1N1 flu immunizations unless health professionals have medical contraindications or religious objections. In October, New York state announced that it was requiring all health professionals to get the H1N1 immunization, but the mandate was suspended later that month due to vaccine shortages.

"It is our ethical duty to do no harm and prevent transmission of disease to patients," said Michael L. Butera, MD, an alternate delegate who spoke on behalf of IDSA. "Despite educational efforts, we have 40% to 70% immunization rates that are woefully inadequate." Mandates may be "the only way to achieve" the goal of universal vaccination, he said.

But delegates balked at the idea of a vaccination mandate, saying that requirements should be a last resort and can be counterproductive if implemented poorly. The house directed the AMA to study the ethical and scientific intricacies of the issue further.

Delegates said hand sanitizer dispensers should be available in well-trafficked areas and urged large gathering places to develop plans in line with Centers for Disease Control and Prevention recommendations.

Physicians briefed on H1N1

During a session at the Interim Meeting, two CDC officials briefed delegates on the latest epidemiological data on H1N1 and how best to manage the disease. They addressed hospitalization rates, vaccine availability, dosing and vaccine testing.
Most cases of H1N1 have not required hospital care. But the highest hospitalization rates have been for children through age 4, said Anthony E. Fiore, MD, MPH, a medical epidemiologist in the CDC Influenza Division. Among hospitalized adults, 70% have an underlying medical condition. If a patient appears to have the virus, treatment should be started as soon as possible. "We encourage people not to delay treatment awaiting laboratory confirmation."

Physicians and other health care professionals need to take precautions to make sure they don't get sick, said Michael Bell, MD, associate director for infection control at the CDC Division of Healthcare Quality Promotion. Most exposure risk in hospitals is from sick workers, not patients. He cited an example of a resident at an Ohio hospital who infected 166 people with the virus.
To prevent the spread of H1N1 in physician practices, sick workers should stay home, and ill patients should be kept away from noninfected patients. Dr. Bell recommended vaccination for doctors and their staffs, saying it doesn't make sense to put patients at risk by skipping shots.

Health care personnel who develop a fever and respiratory symptoms should be excluded from work for at least 24 hours after the fever subsides, the CDC said. Workers who develop acute respiratory symptoms without fever should be allowed to work unless assigned to areas with severely immunocompromised patients. In those cases, workers should be reassigned temporarily or excluded from work for seven days from the onset of symptoms.

Meanwhile, CDC officials on Nov. 12 said about 22 million Americans had been sickened by H1N1 and about 4,000 had died, including 540 children. About 42 million doses of vaccine have been created.
"The amount coming out will increase rapidly in the next few weeks," Dr. Fiore said.

In a Nov. 10 letter to doctors, Food and Drug Administration Commissioner Margaret A. Hamburg, MD, said no serious adverse events attributed to the vaccine had emerged in clinical trials on more than 3,600 patients. She encouraged physicians to report any vaccine-related problems to the Vaccine Adverse Event Reporting System.

Colette R. Willins, MD, a family physician in Westlake, Ohio, and a delegate for the American Academy of Family Physicians, was among the physicians at the AMA Interim Meeting who voiced frustration about not receiving H1N1 vaccines yet.

"They keep telling us to watch for it," she said. "I can't even get my staff vaccinated."

The print version of this content appeared in the Nov 30, 2009 issue of American Medical News.

Hand Sanitizers: UPDATE

NEW: Compilation of antimicrobial posts

Here are two articles about alcohol based hand sanitizers.  Please note that you can make your own with pure essential oils and aloe vera in order to avoid some of the reported side effects of the alcohol containing products.  Pure essential oils are well known to kill bacteria, fungi and viruses.

Alcohol will dry your skin so just as with mild soap and water washing, use a high quality natural skin lubricant to prevent problems from dry skin such as chapping and cracking where viruses and bacteria can find thier way into your body.

Some alcohol based sanitizers have been known to cause headache, dizziness, nausea and other complaints because in order to be effective they must be 60% alcohol.

If the product contains Triclosan, also be cautious: Researchers who added triclosan to water and exposed it to ultra-violet light found that a significant portion of the triclosan was converted to dioxin. Triclosan reacts with chlorine molecules in tap water to form chlorinated dioxins, highly toxic forms of dioxin. The same study found that the combination of water and triclosan produces significant quantities of chloroform, which is a probable human carcinogen. Many recent studies have raised serious concerns that triclosan may promote the emergence of bacteria that are resistant to antibiotics. So while alcohol based sanitizers may not cause super bacteria. Research indcates that hand sanitizers containing triclosan can.

Triclosan has been found to kill off the protective bacteria on your skin and lead to a greater rate of infection and risk of MRSA.

The best method to reduce risk of disease is hand washing with natural, non-triclosan containing soap.

Hand Sanitizers: What You Don't Know

By Stephanie Tweito Jacob

We all know that having clean hands is one way to prevent seasonal cold and flu viruses, including H1N1 swine flu. But should you wash with soap and water, or coat your hands with disinfecting gel from one of those dispensers that seem to be appearing in more and more restrooms, offices, hallways and stores?

If your hands aren't actually grimy, the best way to clean them is to use hand sanitizer, James Scott, a microbiologist at the University of Toronto's Dalla Lana School of Public Health told "Best Health Magazine." "It reduces the bacterial burden to a greater extent than soap and water," he said. "And your hands stay cleaner longer than if you were to use soap and water."

The waterless gels and foams have also been found to be effective in preventing the spread of viral and bacterial-based diseases like seasonal colds and flus. One study found that college students with hand-sanitizer dispensers in their dorms had fewer complaints of coughs, chest congestion and fever. Plus their risk of getting sick was 20 percent lower than students whose dorms did not have the dispensers.

But the hand sanitzers must contain 60 percent or more alcohol, according to the FDA. Skim past the "kills 99.9% of bacteria" claim on the package and instead be certain that the active ingredient listed is either ethanol or isopropanol, at a percentage over 60.

They also must be used correctly. Make sure hands are free of visible grime and dirt and then apply a palm-full of product and rub vigorously for 20 to 30 seconds, making sure to distribute the sanitizer between your fingers, under your nails and jewelry, on your wrists and on the backs of each hand.

Never rinse your hands with water or wipe them with a towel after using a hand sanitizer -- this will counteract the effect of the product.

Another gold star for hand sanitizers: They tend to be gentler on skin than soap and water. Despite their high alcohol content, which is often thought to make creams and gels drying, one study found alcohol-based hand sanitizers left skin in better condition than antibacterial soap. "Most of the modern hand sanitizers have emollients in them that will actually improve skin condition," Scott said.

But, don't toss your soap dispenser just yet. While the high alcohol content of hand sanitizers can kill bacteria, it doesn't necessarily clean your hands. That is, it does not cut thorough grime like dirt, blood, feces or other bodily fluids. Therefore, soap and water must be the first choice in restrooms. It is also essential in the kitchen as alcohol doesn't kill the foodborne bacteria E. Coli as well as soap and water does.

The best way to wash your hands with soap and water is to rub hands vigorously for at least 20 seconds, scrubbing front and backs of hands, wrists, and between fingers and under fingernails, according to the Mayo Clinic. Rinse well, dry hands with a clean or disposable towel or air dryer and, if possible, use your towel to turn off the faucet.

4 things you should know about hand sanitizers4 things you should know about hand sanitizers

Curious about the hand-sanitizing products that are popping up in public places across the country? Here’s what you should know about hand sanitizers and your health

According to the Public Health Agency of Canada (PHAC), 80 percent of common infections, including the H1N1 flu virus, can be spread through contaminated hands. That’s why the PHAC and the World Health Organization (WHO) are stressing proper hand hygiene as an important first-line defense against the spread of swine flu.

While proper handwashing technique is a vital part of keeping yourself healthy, good old soap and water aren’t always around when you need them (say, when you get an unexpected hug from a runny-nosed preschooler on the playground). That’s where alcohol-based sanitizers come to the rescue. The PHAC recommends hand sanitizers that contain between 60 and 80 percent alcohol as “an excellent” way to clean your hands when you’re not near a sink. Here’s what you should know about them.

1. Hand sanitizers are effective

If your hands aren’t actually grimy, the best way to clean them is to use hand sanitizer, says James Scott, a microbiologist at the University of Toronto’s Dalla Lana School of Public Health.“[A sanitizer] cleans your hands much better than soap and water, so it reduces the bacterial burden to a much greater extent than soap and water,” he says. “And your hands tend to stay cleaner longer than if you were to use soap and water.”

Not convinced that a bottle of gel can really get your paws squeaky clean? Scott was also doubtful. “For a long time, I was a skeptic about them, but as evidence started to emerge on the effectiveness of these alcohol-based hand sanitizers, I’m sold on them,” he says. Take the 1991 study cited by the WHO in their guidelines on hand hygiene in health care that found that alcohol-based hand sanitizer was more effective than plain soap and water in preventing the transmission of bacteria from the hands of healthcare workers to patients’ catheters.

2. Hand sanitizers don’t cause super-bacteria

The idea that frequent use of alcohol-based hand sanitizers will make bacteria resistant to treatment is bogus, Scott stresses. “The [way sanitizers work] is based on cell-membrane disruption by the alcohol, and that’s not something that bacterium can acquire resistance to. It’s not physically possible,” he says.

3. Hand sanitizers are easier on your skin than soap and water

“Most of the modern hand sanitizers have emollients in them that will actually improve skin condition,” says Scott. While that may seem counterintuitive because effective sanitizers contain so much alcohol, several studies have proven that these formulas are actually better for skin than soap. For instance, a 2004 study compared the effectiveness of alcohol-based hand sanitizers and antibacterial soap for nurses who worked in neonatal intensive care units in New York. The study found that while nurses were using the hand sanitizer, their skin condition was much better than when they used the antibacterial soap to clean their hands.

4. There’s a correct way to use hand sanitizers

To use a hand sanitizer effectively, make sure your hands are free of visible grime and dirt before applying the product. Then, apply a palm-full of product and rub vigorously for 20 to 30 seconds, making sure to distribute the sanitizer between your fingers, under your nails and jewelry, on your wrists and on the backs of each hand. When your hands are dry, you’re good to go.

Never rinse your hands with water or wipe them with a towel after using a hand sanitizer—this will counteract the effect of the product.

NHN May 2008
Another "Green Living"© writer warns of hand sanitizers

NHN Nov 2008
Early on use of immune boosting mineral fights cold and flu bug

Another "Green Living"© writer warns of hand sanitizers

UPDATE: June 1, 2009

Risk Policy Report on 1,4 Dioxane

A new EPA assessment showing significantly greater cancer risks from the solvent 1,4 dioxane -- a common contaminant at waste sites and in personal care products -- may give environmentalists greater leverage in their calls for manufacturers to remove the chemical from their products and for stricter cleanup requirements.
READ FULL ARTICLE

RELATED ARTICLE
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Back in the last two decades of the 20th Century I was teaching a series of classes titled "Green Living"© throughout the Pacific NW.

Since that time many people, especially now, are claiming to be experts in how to detoxify your home, garden, and physiological environment (inside and out).

Like the wife of a past chiropractor of mine always says, "she foregets more than most people will ever know." Others refer to me as a "walking encyclopedia".

It is something to live up to. I try, but I truly wish that those who copy our material from this blog and out websites would be open to giving credit. We often say we are often replicated, never duplicated.

This may be no more than the fact that we really have been at this work for a lot longer than most so-called and self-proclaimed experts have been alive. But many rely on us for our expert knowledge and expert opinions.

Here is something now, again a repeat of something we cautioned over 15 years ago.

If you aren't aware, now is an opportunity.

Should you wish to know how to properly select pure essential oils for making your own sprays, and how to make them as well, we will be happy to offer a consultation for your donation. You really just can't add some essential oils to a spray bottle. Some oils can be harmful to infants and small children.

In the mean time, Dr. Bornner's Super Baby Mild is a good choice for soap and water cleaning, known since the time of Ignaz Semmelweis, to be the best choice for kiling germs. Dwell time and agitation are important too.

Why It's Best to Avoid Hand Sanitizer Gel
You, Your Baby and the Environment Are Better Off with Good Old Soap and Water
March 3, 2008

Buzz up!

"You want some hand gel?"

The moment it was apparent I was pregnant, I started getting this question. It was asked so often it started to remind me of the drug pushers who used to hang around Washington Square Park when I was a teenager: "Smoke? Smoke?"

"No, thanks," was – is – my standard reply. I doubt at that point I had even read the specific ingredients of the most common gels (like Purell), or tried to find their material safety data sheets (MSDS) which list hazards that may not be printed on packaging. But I did already know that certain hand purifying gels contained, among other undesirables, the hormone disrupting antibacterial/antifungal agent triclosan, which can form dioxins when it comes into contact with water and has some worried it will create resistant strains of bacteria. Most people stared at me oddly or made a face when I turned the stuff down. Their sneers seemed to say, Didn't I know my hands had horrible scary germs on them that were about to kill my unborn child? I understand their fervor – I feel this way about toxic chemicals, not so much about germs. Well, actually, I am a germ freak, but these chemicals worry me more than microorganisms. I try to think about the hygiene hypothesis – that exposure to germs helps build a healthy immune system – when something dirty bothers me.

Of course when my itty bitty vulnerable newborn arrived in the world, the hand gel offerings grew a zillion-fold. Every person who came to meet her popped a bottle of the stuff out of their bags, slathered it all over their hands, then reached for her. I was horrified. This was in my apartment, mind you. They could have walked two inches to the bathroom and used soap and warm water to greater – and much safer – effect. But Americans like their products.

This across-the-board addiction to products when good old soap and water has been proven time and time again by many in the medical community to be all you need to clean hands falls into category I like to call eco-straneous. Extraneous stuff no one really needs that has negative environmental impact. I'd say hand gel fits the bill. But I'm totally outnumbered. Case in point: the natural/organic/green marketplace has recently been flooded with "organic" hand gels (the quotes are there because of course there is no regulation in place to certify something like hand purifier as organic). Which means it's time or me to get off my non-hand-gel-using butt and weigh in.

Here's what to avoid: Any of the conventional gels. The first thing that MUST be avoided is anything claiming to be antibacterial or containing triclosan. I just saw this crazy statistic in an abstract of a 2003-2004 National Health and Nutrition Examination Survey trying to assess exposure to the antibacterial:

"In about three-quarters of urine samples analyzed [there were 2,517].we detected concentrations of triclosan. Concentrations differed by age and socioeconomic status but not by race/ethnicity and sex. Specifically, the concentrations of triclosan appeared to be highest during the third decade of life and among people with the highest household incomes."

I don't want detectable levels of a hormone disrupter in my daughter's diaper!

Even the conventional ones that don't contain triclosan usually contain isopropyl alcohol, parabens, propylene glycol, and synthetic fragrances (which may contain phthalates). Nothing good about any of this.

Here are two being marketed as green and the ingredient information I could find on them. Read carefully and make your own decisions. If there's anything that confuses you, contact the manufacturer, especially if you find a product that says it contains something like "ethyl alcohol" but doesn't say if it is plant-derived or synthetic. And don't stop reading an ingredient list just because you see that someone is using an organic essential oil. EO Hand Sanitizer, for example, contains organic lavender as well as dimethicone (a silicone based polymer) and other synthetics. I'm not so fond of slathering synthetics on my kid's hands. Or my own. Would that I could just tell you which one to use. But, like I said, I don't use the stuff.

Another option is to make your own. Make a spray of water and essential oils thought to have antiseptic properties (lavender, jasmine, tuberose, thyme, tea tree oil, grapefruit seed extract). Look up a recipe and make sure to dilute enough. You don't want too much on a child's skin, or for oils to be rubbed into eyes.

Debra Lynn Dadd writes, "According to a Purdue university professor who teaches sanitation practices for food service workers, 'Waterless, antibacterial hand sanitizers are marketed as a way to 'wash your hands' when soap and water aren't available, and they are especially popular among parents of small children. But research shows that they do not significantly reduce the overall amount of bacteria on the hands, and in some cases they may even increase it.' The professor went on to say that a hand sanitizer can't take the place of old-fashioned soap and water at home or anywhere else."

Like I said: wash your hands!