We all live pretty busy lives these days, but there are some things you simply have to make time for. If you are a nurse you may or may not have enough time to even use the bathroom. But if you do, please DO NOT do these two things. One, it is a very bad idea to bring food into the area of the toilet, especially a public one. I believe I have mentioned this before, but for safety's sake i will mention it again. There is a term to describe what regularly occurs in the bathroom as a result of the flushing action of the toilet and that is "aerosolization". This is a fancy term meaning "things that fly around" because of the action of the water in the toilet. Think about that for a minute. Things that fly around. They have to land somewhere, right? Well consider the whole stall contaminated, because it essentially is. In this example, someone thought it a good idea to bring unwrapped cookies into the loo. So now not only have they put the paper in contact with the contaminated surface of the TP holder, but they will have touched several areas of that stall while in the loo, and by the looks of it some private areas too (notice the seat is up!). Then, if they remember, will want to take their cookies with them using contaminated hands. It appears in this example that the person who took the cookies in did not remember to bring them out, so they dodged a bullet there. But also missed out on what appears to be some awesome chocolate chip cookies! So, a bit of a double-edged sword in this instance. Also, please note they also did not flush the loo! People...common courtesy is a must in a public loo! This is one of those times where you must simply take the nanosecond it requires, to flush. But be smart about it, use your foot. Yes, your foot. Why touch that handle?!
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Fall has arrived again, and with it comes the start of the cold and Flu season. It never hurts to brush up the basics to help prevent your getting put in bed by one of these seasonal bugs.
Top 5 Things to Keep in Mind this Season:
Every once in a while you come across a video that really inspires you and deserves to be shared with everyone. This is a wonderfully inspiring video about an Veteran of the Army who had become disabled by his service. He makes a wonderful example of perseverance against all odds. Please watch it and share his story! And to you my friend... "HUAH!!" A few days ago there was an article in the NY Times that announced that hand sanitizer was ineffective against the norovirus and this got covered on a blog, and then posted to Facebook. This seems like big news until you start dissecting the information. In this case deciding not to use hand sanitizer during a norovirus outbreak could be a really bad decision. Before we go any further, let me stress again that there is no substitute for washing your hands properly with soap and water. However, we don't always find ourselves in a place with soap and water ( or a safe place anyhow), and in those moments being able to have something is better than nothing.
In the article published in the NY Times they cited the Center for Disease Control (CDC) as the source of their information. However, their source is from 2006-2007. It would seem to me that the science on this topic may have progressed since 2007. So I took it upon myself to do some research on the topic. I actually read several different scientific articles on the research. I'm most amazed at the fact that my brain has not totally been fried, but that's not as important what I discovered. It seems there is some degree of controversy on this topic within the scientific community and it has to do with the methods used to measure whether the virus is able to cause harm. The study that the NY Times article based its conclusions on a method which I can best describe as how much virus is left on the hands after the application of hand sanitizer. In simplified terms, they concluded that because it did not remove enough virus hand sanitizer is ineffective. In a later research study published in 2010, researchers used a different method of testing. It studied how much of the virus remains infective after application and discovered that there was some reduction after the application of alcohol-based hand sanitizer. So each research group was measuring effectiveness in a different way and this is where the controversy lies. Okay, so let's back up a bit at this point and review what we know about the norovirus itself. Most of us know about the norovirus because of the cruise ship nightmares we've heard about on the news. What most of us might not be aware of is that the norovirus is the leader when it comes to nonbacterial gastroenteritis (some may call it the stomach flu, or food poisoning). It's transmitted very well by the fecal to oral route, exposure to vomit of a sufferer, and aerosolization. This means you can pick it up easily by touching contaminated surfaces, vomitus, or breathing in airborne particles. According to the CDC, symptoms of the norovirus include diarrhea, nausea, vomiting (sometimes at the same time as the diarrhea -- an event I refer to as the bilateral spurts), stomach pain, and sometimes fever, headaches, and body aches. The virus can be found in your feces (poop) prior to your experiencing the illness. You are most infective to others when you are sick and for 3 days after you recover. This is why food handlers are not allowed back to work before 72 hours if they are suspected of having a norovirus-related illness. Depending on your perspective, there is some good news. Generally, the active component of the infection lasts up to only 72 hours. Those 72 hours may truly suck, but it is only 72 hours and maybe less. It is possible to get dehydrated with this disease and if you are unable to keep up with the fluid losses you should contact a physician. Especially vulnerable are the elderly and the very young. As we age our internal "dipstick" -- that part of our brain that let's us know whether we are getting low on fluids doesn't work so well. The elderly can get dehydrated to a clinically significant degree before they realize they are in fact dehydrated. So it is important to make sure that they get enough fluids. There are many strains of norovirus and getting one strain does not confer immunity against others. You can get norovirus many times over your lifetime as a result. So it's a nasty little bug, indeed! Research is ongoing into how to best prevent transmission and that brings us back to the topic at hand. In the world of science there is a lack of virus cultures or a feasible way to sustain virus cultures for the human norovirus so they have used what is called a surrogate virus for testing out things like the efficacy of hand sanitizers. In the 2010 article, it turns out that a common disinfectant in the health care world chlorhexidine was ineffective against these viruses overall. Triclosan is another agent that is often touted and used, but it too also proved to be a poor disinfectant. Alcohol-based hand sanitizers as a group did have some effect on each of the surrogate viruses but one hand sanitizer was effective at reducing the infectivity of both surrogate viruses. The effective sanitizer was one with a 72% level of ethanol and a pH of 2.9 and decreased infectivity at 1 and 5 minutes of exposure. However, just because it was effective in the method they chose to use, does not mean we can necessarily generalize the results to real life with no questions asked. The researchers acknowledge that more research is necessary to determine what level of reduction is needed in infectivity to break transmission of the disease. The good news is two-fold. One, we know that a particular hand sanitizer is potentially effective at reducing infectivity of the bug and two, consensus is starting build in how to best measure the effectiveness of hand sanitizers as a result of this study. In fact, it is the CDC which cites this particular research finding in their document online entitled: "Updated Norovirus Outbreak Management and Disease Prevention Guidelines" dated March 4, 2011 as part of their recommendations. There is still no U.S. standard of what is considered an acceptable level of reduction in viral infectivity in hand sanitizers, but hopefully this type of research will provide a common ground for that discussion. So, all in all this means what? Well, it means a few of things:
Yours in pursuit of potty excellence, Sue "...give the drive-by and the token wash the boot and add the I once went to a continuing education event where the speaker was a well-known (I never heard of him) MD big cheese in Infectious Diseases stated that "washing your hands does nothing". I think my jaw actually hit the table. Then I remembered that even big cheeses can say stupid things. He was there to discuss a new antibiotic, as a paid speaker and began touting how this antibiotic was pretty much THE ticket. I'm sure it's a perfectly good drug, but it was clearly his ticket to D.C. as a paid speaker because all I could think about was how stupid his comment about hand washing was, and, "ewwww!" if he's touching patients. Very few people will dispute the efficacy of washing your hands with soap and water. The Centers for Disease Control (CDC) has a ton of information on their website discussing how to do it, when to do it, etc. and all of it backed up by science. They are our arbiter of what is right to do, not paid speakers for antibiotics. With that in mind, has anyone given any thought as to what is happening when we wash our hands? What is the purpose of soap? What's the difference between hand washing with soap and using hand sanitizers?
So a lot of people believe you have to use hot, hot water to wash your hands. I'm here to tell you that as an RN if I constantly used such hot water on my hands when I was on the floors working I would not be able to type this now. My hands would be in bad shape from being all dried out and rashy, not too mention potentially as risk of getting infected from the microorganisms in the environment from the cracks. The importance of using warmer water is all about a comfort factor. If your hands get cold easier than by all means use warm water. However, if you are using it to kill germs it has to be much hotter than your hands could tolerate to do the trick. I'm sure we've all seen the drive-by rinse or the token wash that others (and hopefully not ourselves) have done. This kind of so-called hand washing is ineffective due to the lack of friction involved and the time it takes such friction to get rid of the germs. Friction is a major component of the hand washing process because it mechanically reduces the number of germs on the surface of your hands and fingers. If you've ever seen a surgeon scrubbing up, this becomes clear. They scrub for quite a while up to their elbows to make sure that they don't bring anything unintended to your surgery. Soap is an essential part of hand washing because without it the whole process is likely to be less effective. Soap works to disrupt the surface tension of water and the contaminants on your hands. This helps the water to slide the germs, dirt or food off your hands when you put them under the stream of water. Time is another factor in the process to achieve maximum effectiveness. No one would reasonably suggest that you scrub your hands as long as the surgeon does, however you do need to invest at least 20 seconds of your time to protect yourself and those you care about. It takes that long for the combined effects of the soap, water, and friction to work well. All four components that I mentioned above are essential to get the best results when it comes to hand washing. You can't get the most effective results from only combining some of the components. Hand washing with soap and water is still the single best way to prevent many forms of illness that can be moved by our hands. So give the drive-by and the token wash the boot and add the full-tilt rub-a-dub to your arsenal! Okay, so maybe not THE Plague, but the modern-day equivalent might be the Flu. Here in the States it is at epidemic levels throughout most of the country. So naturally it is the best time ever to talk about washing your hands.
I"m sure you've probably heard about how hand washing is one of most effective tools in the prevention of spreading disease. We hear this and at least some of the time I think we all actually hear "Blah, blah, blah....blah." Have you heard the new statistics about deaths from Flu? About 50, 000 (in the U.S.) die from it every year... from the Flu! This is a disease we seem liken to a cold in terms of severity in our society. In doing so we forget just how impactful this disease can be. I believe I heard the news anchor say last night that 20 children have died from Flu this year alone. Those families will never forget how bad Flu can be. As a community, we can practice better habits for each other that can help to mitigate the impact of these things. For one, if you're sick stay home. If you have to go out, wear a mask. No one wants to be exposed to this stuff as much as is possible. Carry a good hand sanitizer on you at all times. Use it frequently, especially if you are eating out. AARP says restaurant menus and condiments are good places to pick up bugs as they are rarely decontaminated. Don't sneeze into your hand, but do sneeze into your elbow if you don't have a tissue or handkerchief available. Airborne bugs like the cold and Flu rely on you to move them places where other hands will touch. So if you sneeze into your hand and touch something else, the bug can move to its next target. Hopefully you will immediately whip out your always-on-your-person-during-Flu-season hand sanitizer and clean your hands if you happen to sneeze into them before you touch anything else. Lastly, wash your hands correctly! Don't do the token wash or drive by rinse. Actually take the time to do it right(all of 20 seconds--not a lot of time really!). See the page on how to wash your hands on the www.pottyprognosis.com site if you need a refresher. You could be saving yourself or someone else a lot of misery this Flu season! Today AARP announced their "8 Germiest Places" . Not surprising to me was that two of them had to do with a public bathroom!
They cited the soap dispenser as one of the most potentially contaminated areas. In my efforts to check this out previously, I came across information that points to the manual soap dispenser that could pose a risk. The highest risk of contamination comes with those that require refilling by pouring product in versus product that comes in a self-contained refills. Repeated use of the pour-in types can potentially cause an environment of continuous contamination in some cases according to the research. This is because you have to touch the dispenser with contaminated hands to get the product. This is one reason I am opposed to manual soap dispensers and dirty bathrooms. However, the research also showed that dispensers that use the pre-filled refillable product significantly reduce this environment of contamination. However, "significantly reduce" stills means you have to touch it, which means the potential for contamination. I have not yet come across research that demonstrates the difference between automatic and manual dispensers and the risk of contamination. That being said, it seems to me that something isn't likely to be contaminated if it isn't repeatedly touched by contaminated hands. Until I see differently, I'm going with automatic dispensers as a better choice. The door handle of the bathroom is the second item mentioned in the AARP report. If you are not aware, you should be aware that this is indeed one of the dirtiest areas of the restroom. What we know is that people often do not wash their hands or wash them well. The American Society of Microbiology did research by doing observations of hand washing and telephonic inquiry. They found there was a definite gap between what people said and what people do. The literature is rife with examples of where people know better but don't do better in a variety of situations. This is a complex issue and usually is dependent on many variables. In the case of hand washing it seems that it is the more educated, higher-earning male that is less likely to wash their hands. When I first read this I was shocked. It seemed counterintuitive to me. If I also remember correctly, it was posited that folks who don't have a high degree of education or make lots of money can't afford to be ill, so they wash their hands. I wanted to say "Duh!" when I read that one too, in fact I think I did. But, often research confirms what we think to be common sense but haven't been able to prove thus far. It often opens up other questions too. My first question to these guys would be "What is wrong with you? Do you really think that certain areas of your skin harbor no harmful bacteria?" followed by the declarative statement "Seriously people, wash your hands!" Okay, so really what do we do about these things? Again, no easy answers except -- go automatic! However, should you find yourself in a bathroom where you have manual soap and paper towel dispensers about the best thing I could tell you is to do the following:
Basically, keep in mind that touching surfaces in a public bathroom opens up the risk of contamination, especially in a bathroom that doesn't appear to be well maintained. That contamination will travel with you to some degree if you don't make at least some attempt to minimize your exposure. I'm reminded of a quote that I read and liked years ago... "You miss 100% of the shots you don't take." Take a shot, and wash your hands!! PLEASE! Yours in pursuit of potty excellence, Sue It's interesting what we consider the "best". I was reading an article in USA Today for the iPad that cited the top 10 Best Hotel Bathrooms in Las Vegas. It caught my eye because I was in Vegas about a month ago and stayed at the Venetian with my family. It was the first time to Vegas for me and I'd always heard about how great a place it was, and it didn't disappoint. It just so happens that one of the top ten bathrooms they listed was at the same hotel we stayed at. No doubt, the bathroom was stunning! We actually walked in and went "WOW!" Aesthetically, I don't know what else you could have possibly wanted, and, like the article's description these were not paltry sized bathrooms, they were huge. We enjoyed them very much.
As I started working on this project, and saw this article, I was intrigued. In one photo, they even showed a very nice bathroom, but it appears to have carpet on the floor in the bathroom. For me, this is a no-no. First, it's a bathroom shared by many over the year... do I hear an "Ewww!" coming on? How efficiently are they able to clean that thing? Secondly, I have to tell you as much as we enjoyed our experience in the beautiful bathrooms, the marble floor is also potentially a real problem. Both my mother and my aunt have mobility issues making their balance an issue. Do you have any idea how slick wet marble is? I found out, unfortunately. While marble and slate provide beautifully aesthetic results for bathroom design, they are not the most friendly for mobility-challenged people. Unlike in our last hotel in France in October, the Venetian did provide a suction cupped shower mat for the beautiful shower with the rain shower head. This prevented both of them from breaking a hip. The hotel in France was a dicey situation and required a little improvisation. I'm glad to report no one broke a hip. I almost had a heart attack, but no broken bones ensued. But, I digress. It seems to me that there are many options in bathroom design, and surely there are options for beautiful as well as safer design. As a space the public is exposed to when they stay at a hotel, it would seem to me to be as important to be concerned with the safety of guests as it is with their aesthetic appreciation for design. Marble floors in my opinion while stunning, are dangerous to anyone when wet. Especially when they are lighter in color and the lighting in the room does not easily help you to spot wet areas. For older adults, this contrast in textures and colors can be unseen (as it was for my folks) and potentially lead to falls. At this point in the project, I am unsure as to whether there is a great database of falls in hotels out there, but I would be willing to be bet that as a private property there is no reporting of falls or falls with injury to anyone. So I suppose it is up to the consumers and projects like this, to point these things out and lead the way to potty excellence. Potty Pals unite! :)) Yours in pursuit of potty excellence, Sue After being an RN for 20+ years, I know the importance of good hand washing. In that time I have seen numerous versions of crazy hand washing routines. Years ago while out with my friends I had the unfortunate experience of witnessing one of the wait staff in the girl's room do a version of the "token wash" in the sink before returning to work. I was appalled. I don't think it had previously occurred to me to think about the fact that people outside of healthcare might not know or understand what I knew about hand washing. I mean geez, didn't we learn this when we were what...five?! The sometimes annoying part of my brain likes to percolate on solutions to these conundrums in other ways aside from marching up to the manager and reporting what I just witnessed. (Although, I have been known to do this too.)
So, it occurred to me in thinking about this problem that maybe there is also another few issues here in relation to Public Potty etiquette, and maintenance of Potty facilities that also need to be addressed. Off and on through the years I've thought about what I might do, and how I might have some fun with the ideas I came up with. Up until now, I haven't really had the guts to do it. After tonight's little culinary adventure at one of my more favorite places, I've decided the gauntlet has been thrown down and it's time to take action. Part of my plan for this blog/site is to help educate the public about how to wash your hands correctly to prevent inadvertent re-contamination of your hands and thus anything else you touch after that. It's also important to me to share with you information in general about Potty Etiquette and facts so that anyone using a public facility can better protect themselves, or at least make better choices in what's available to them. Another part of my plan is to actually show you good and bad examples of public potties. Right now, until I am able to rope one of my male friends into helping me, these potties will be girl's rooms. I will present you with a rating scale and criteria so that you may be able to look critically at the next public potty you use. My hope is that by offering the information we can as a community be safer, reduce the transmission of disease amongst us, and demand/expect better public potties when necessary. Not every venue has the resources for the top end items, but there are some basics that should be considered for every public potty, in my humble opinion. Tonight while I was waiting for the bathroom to empty out so I could shoot some shots of the bathroom for this project I noticed the staff wash their hands. One did a pretty good job, the other a token wash. I watched what appeared to be a staff member go into the stall with with phone and determined she wasn't using the stall as merely a phone booth, and come out and leave without washing her hands!! She just looked at me like "What are you going to do about it?!" with a shit-eating grin on her face. Well, I know a gauntlet when I see one. I went directly to the manager and reported it. (Okay so this is where my sister called me the Potty Police and suggested I get some sort of implement to squirt hand gel instead of bullets.) Well, I'm sorry but it's just gross! It turns out while the person was dressed as a server, she didn't work at the restaurant we were in. They suggested I go across the hall to the other one and see and for the life of me, I did. No go there too. I can't believe I actually did that! But it's important --- do you want people who handle your food and drinks to do that? I think not. So stayed tuned, I hope to have some interesting info and pictures for you to review! Yours in pursuit of potty excellence, Sue |