National center for infection control professionals, healthcare experts, manufacturers, distributors, suppliers and consumers focused on best practices in hand hygiene and hand sanitizer products
Thursday, June 18, 2009
Thu Jun 18, 2009 5:41pm EDT
*Up to 7 percent of population sick in heavily hit areas
*Flu season could last all year this year in US
By Maggie Fox, Health and Science Editor
WASHINGTON, June 18 (Reuters) - The new strain of H1N1 flu is causing "something different" to happen in the United States this year -- perhaps an extended year-round flu season that disproportionately hits young people, health officials said on Thursday.
An unusually cool late spring may be helping keep the infection going in the U.S. Northeast, especially densely populated areas in New York and Massachusetts, the officials at the U.S. Centers for Disease Control and Prevention said.
And infections among healthcare workers suggest that people are showing up at work sick -- meaning that workplace policies may be contributing to its spread, the CDC officials said.
The new strain of swine flu is officially a pandemic now, according to the World Health Organization.
So far the virus is causing mild to moderate disease, but it has killed at least 167 people and been confirmed in nearly 40,000 globally.
The United States has been hardest hit, with upward of 100,000 likely cases and probably far more, with 44 deaths and 1,600 hospitalized.
"The fact that we are seeing ongoing transmission now indicates that we are seeing something different," the CDC's Dr. Daniel Jernigan told a news briefing.
"And we believe that that may have to do with the complete lack of immunity to this particular virus among those that are most likely affected. And those are children," Jernigan added.
"The areas of the country that are most affected, some of them have very high population densities, like Boston and New York. So that may be a contributor as well. Plus the temperature in that part of the country is cooler, and we know that influenza appears to like the cooler times of the year for making transmission for effective."
Jernigan said in areas that are the most affected up to 7 percent of the population has influenza-like illness.
SUMMER OF FLU
"The United States will likely continue to see influenza activity through the summer, and at this point we're anticipating that we will see the novel H1N1 continue with activity probably all the way into our flu season in the fall and winter. The amount of activity we expect to be low, and then pick up later."
One worrying pattern: healthcare workers are being infected, and most reported they did little or nothing to protect themselves, the CDC's Dr. Mike Bell said.
People coming into emergency departments or clinics need to be checked right away for flu symptoms and anyone working with such a patient needs to wear a mask, gloves and eyewear, Bell said.
"We're beginning to see a pattern of healthcare personnel-to-healthcare personnel transmission in some of the clusters, which is also concerning, because it gets to the issue of people showing up to work sick," Bell said.
Doctors, nurses and technicians who have flu can spread it to vulnerable patients, Bell noted.
As of May 13, the CDC said it had received 48 reports of healthcare workers infected with swine flu.
Detailed case reports on 26 showed that 13 were infected in a healthcare setting such as a clinic or hospital and 12 caught it from infected patients, the CDC said in its weekly report on death and disease.
(Additional reporting by Julie Steenhuysen in Chicago, editing by Philip Barbara)
Saturday, June 13, 2009
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Subject: DOE release: Hand Sanitizers/H1N1
Dear Ms. Patrick:
In all due respect, the June 11 “information update” published by the US Department of Education re: H1N1, and your apparent promotion of the use of “alcohol hand sanitizers when washing is not convenient” has not only dismayed many school health care experts, but it has inflamed a "messaging issue" that even the CDC acknowledged as recently as three weeks ago is “inconsistent.”
The fact that the federal government’s leading school-centric agency is apparently recommending that students and teachers use alcohol-based hand sanitizers (as opposed to “appropriate hand sanitizers”) is simply frightening when considering the fact that among others, hundreds of schools and day care centers (not to mention several government agencies as well as the US Navy) have all banned alcohol-based hand sanitizers due to local mandates, or simply due to their own concerns about product efficacy and facility safety.
These entities have instead sought alcohol-free hand sanitizer products for staff, student and facility use.
In point of fact, the New York State Department of Education issued a ban on alcohol-based hand sanitizers as far back as 2004.
While many schools in question often cite a 2007 report from the US Association of Poison Control Centers, which found that in 2006 alone, alcohol-based hand sanitizers were the cause of 12,000 cases of alcohol poisoning in children; the fact is that all of these schools have determined that while alcohol might kill germs, these alcohol-based hand sanitizer products are
3. cause the skin to become dry/irritated (which in turn, increases risk of exposure to germs/viruses
4. destroy protective skin cells
5. have no efficacy when applied to dirty hands (manufacturers such as Purell recommend washing hands before applying the product),
6. cannot be applied to cuts/abrasions; which is typically the most common way that MRSA is transmitted with school environments.
7. Destructive to physical facilities (ask any hospital facilities administrator what happens when the hand sanitizer dispenser drips on to industrial floor wax)
This is a product that DOE is actually recommending for use in schools? Despite the fact that non-alcohol alternatives are widely-available, similar in price, and manufactured by a number of leading companies?
Ms. Patrick, and again, with all due respect, one merely needs to use the search term “hand sanitizer” on YouTube.com to find hundreds of “home videos” that demonstrate the many innovative ways in which students are “re-purposing” alcohol hand sanitizers, and why they’ve been banned by many school systems.
That said, it would seem obvious that DOE is deferring to the US Centers for Disease Control 1996 hand hygiene ‘guideline’, which, according to recently-replaced interim director Dr. Richard Besser, “is inconsistent” when referring to CDC’s ubiquitous use of the word “alcohol” and CDC recommendations.
Dr. Besser’s statement, acknowledging that CDC is providing unclear guidance on the topic of alcohol vs. non-alcohol hand sanitizers was provided in a May 2 email to the undersigned, and Besser concluded with: “But we’re working on the communication issues..”
Besser then designated a staff member to follow up and provide the CDC’s position on the topic.
Per your communication with Dr.Besser, and in response to your inquiry…
1. CDC recommends alcohol hand sanitizer products
2. CDC does not recommend products
3. Your inquiry [non-alcohol hand sanitizers] is beyond the scope of the CDC Infection Control Desk to reply to.
As you all know, Dr. Besser’s tenure as interim director concluded at the end of May, three weeks after his reply.
While the response from Besser’s staffer might be considered “classic Washington-speak”, ("we recommend ..products...we don't recommend products.." ); that email exchange was initiated after we received numerous calls in the midst of the Swine Flu crisis from several different government agencies, including GSA and DOT, and each caller indicated “our agency prohibits alcohol hand sanitizers in our facilities and we need a non-alcohol hand sanitizer…”
We contacted CDC because we thought it only appropriate that CDC might want to ‘re-evaluate’ the mixed message that its been sending out in the midst of yet another hand hygiene related emergency.
Over the past three years, we’ve documented no less than several thousand unsolicited requests for alcohol-free hand sanitizer products from health care officials representing more than 450 schools, government agencies, countless correctional facilities, day care centers, senior care centers, and a variety of corporate venues, including the country’s largest manufacturer of medical devices.
More recently, the US Navy formally banned alcohol hand sanitizers on board its vessels due to product concern, and has made the decision to use non-alcohol hand sanitizer products.
Each of these groups has informed us that they prohibit alcohol-based sanitizers for at least one of the following reasons, and that CDC’s communication messages are not only “off point”, but dangerously misconstrued, and completely out-dated.
The three top reasons alcohol hand sanitizers have been banned (in favor of non-alcohol, rinse free alternatives):
1. Flash point risk / property damage liability. (Ask any facility manager at a major hospital how much they spend on repairing floors and walls that have been subjected to alcohol hand sanitizer drippage)
3. Product safety/Efficacy.
All of this makes one scratch their head in wonder when reading that CDC recommends rubbing your hands with it.
More to the point, it makes one wonder why the US Department of Education is recommending that students and teachers embrace a “product” that other government agencies have determined to be inappropriate.
The active ingredient in most non-alcohol, rinse free sanitizers is an organic compound called Benzalkonium Chloride (a/k/a BAC, a/k/a BZK). This ingredient has been widely-used for decades in dozens of health care products, including Bactine antiseptic, spermicidal foams, contact lense solution, and many other OTC products.
With regard to its application as the active ingredient within a rinse-free hand sanitizer formula, this compound has been widely-documented to be equally, if not more effective than alcohol when tested against a broad spectrum of pathogens, including MRSA, Staph, Salmonella, Hepatitis, AIDS, and even H1N1.
As such, many infection control experts that have researched the topic acknowledge that these non-alcohol hand sanitizers are safer to the skin (do not cause dry/irritation like alcohol does), they’re antiseptic, hypoallergenic, non-toxic, and non-flammable.
The single largest marketer of alcohol based hand sanitizers is Johnson & Johnson; they own the license to the Purell brand, which, according to Neilsen, controls more than 52% of the hand sanitizer market, and according to estimates, will generate $250 million in US sales in 2009. Purell is manufactured by Gojo Industries, Inc., and J&J acquired the license to market the product several years ago through a corporate transaction with Pfizer.
In 2003 Gojo Industries filed a formal request with the FDA asking that FDA prohibit the registration of hand sanitizers that incorporate benzalkonium chloride, and in that brief Gojo stated “…our research has determined.…compound is not effective against germs/viruses” and “..potentially dangerous..” The FDA dismissed the filing out of hand, presumably for its lack of supporting documentation.
J&J maintains the Gojo Industries position, and its senior executives have stated that “only alcohol hand sanitizers are effective against germs”. Yet, J&J also manufactures and markets BandAid Foaming Antiseptic for Kids; which is comprised of the same active ingredient and virtually identical formula that's found in the majority of alcohol-free hand sanitizer products in the market today.
When J&J’s senior executive overseeing the Purell brand was asked about the "disconnect" and apparent inconcistentcy in their messaging at a recent conference, the executive said “BandAid is a different division here, so I can’t comment on their marketing or their products…but I’d Iove if you could send me a sample of your product to my home..!”
If DOE is actually going to take steps to investigate this matter, we’d caution you not to defer to the Chief of the Staff of the Office of the Attending Physician (OAP).
When we communicated with him last week after the Office of the Architect (AOC) stated they "relied upon OAP’s insight with regard to implementation of portable hand sanitizer stations in numerous government buildings", and we pointed out that the devices in question were dispensing alcohol foam and contained incendiary material that most fire marshals have concluded to be "potentially very dangerous", the Chief of Staff stated that “ I didn’t know that alcohol hand sanitizers are flammable…we do what the CDC says, but thanks for calling and have a great day!”
Instead, someone may actually want to ask recently appointed CDC Director Tom Frieden if they could sample the alcohol-free hand sanitizer product that's in his family's hands. Its alcohol-free, rinse free, fragrance free and dye free and dispensed in a soft foam format.
We're not looking to sell DOE anything. And we're not looking to win any federal government contracts. We've done that on the merits of our product, not with having to depend on lobbying politicians.
All that we’re asking is for a rational human being that has some type of influence to re-phrase the directives issued by DOE on the matter of hand sanitizers—and to simply recommend “wash with soap and water, and when not convenient, to use the appropriate hand sanitizer for the circumstances..”
DOE should be aware that recommending teachers and students be provided bottles of product that, aside from destroying their skin, can be converted into mini- Molotov cocktails, or mid-morning cocktails, seems “off message” to anyone that voted for the current administration, and certainly off-message within to tens of thousands of school health officials and hundreds of thousands of parents that rely upon the Government to counsel their local schools responsibly.
Friday, June 12, 2009
Mike Clarke/Agence France-Presse — Getty Images
The announcement does not mean that the illness, which has been mild in most people, has become any worse. The term pandemic reflects only the geographic spread of a new disease, not its severity. Pandemics typically infect about a third of the world in a year or two, and sometimes strike in successive waves.
“Globally, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity,” said Dr. Chan, director general of the health agency. So far, 144 people have died from H1N1.The decision to raise the pandemic alert from Phase 5 to Phase 6, its highest level, is meant to signal to countries to step up their efforts to deal with the disease.
That said, this is merely another reminder re: the importance of adhering to proper hand hygiene strategies.
Its all about common sense, and when it comes to the topic of hand sanitizer products, we're in the camp that says it makes no sense to douse hands with alcohol as a means to kill germs and bacteria. There's a reason why manufacturers of alcohol hand sanitizer products recommend washing with soap and water before applying their product..So does it make sense to pour the stuff on after washing, so that you destroy skin cells in an effort to destroy pathogens?
We don't think so. That's why we recommend alcohol-free hand sanitizer products. Shop around, and look for products that do not contain triclosan, do not have fragrances and do not have dyes. We like two different products; Soapopular or Hy5.
Thursday, June 11, 2009
News story below tells the story....coincidentally, the US Centers for Disease Control had sent a press release announcing a dial-in conference call for today at 12.45, during which CDC representatives would provide updates and respond to media questions.
Regrettably, when attempting to dial in, it was apparent that CDC communications people failed to realize that more than 10 people might try to dial in, and callers were left on hold with a message that repeatedly said "we will assist you momentarily".
Much the same way they've assisted when posed with inquiries that have asked senior officials to qualify their recommendations with regard to appropriateness of alcohol-free hand sanitizers vs. alcohol hand sanitizers. In reply, CDC has said "..[that question] is beyond the scope of the Infection Control Desk.."
GENEVA (Reuters) - The World Health Organization declared the first flu pandemic of the 21st century on Thursday, urging countries to shore up defenses against the virus which is "not stoppable" but has proved mainly mild so far.
The United Nations agency raised its pandemic flu alert to phase 6 on a six-point scale, indicating the first influenza pandemic since 1968 is under way.
"This is a very important and challenging day for all of us. It is important because we will be raising our pandemic alert level to level 6," WHO Director-General Dr. Margaret Chan told reporters on a teleconference.
"At this time, the global assessment is that we are seeing a moderate pandemic."
Acting on the recommendation of flu experts, the WHO reiterated its advice to its 193 member countries not to close borders or impose travel restrictions to halt the movement of people, goods and services.
The move to phase 6 reflects the fact that the disease, widely known as swine flu, was spreading geographically, but does not indicate how virulent it is.
A unanimous experts' decision was based on an overall assessment in the eight most heavily hit countries -- Australia, Britain, Canada, Chile, Japan, Mexico, Spain and the United States -- that the virus is spreading in a sustained way in communities, according to Chan.
"Collectively, looking at that, we are satisfied that this virus is spreading to a number of a countries and it is not stoppable," she said.
"Moving to pandemic phase six level does not imply we will see an increase in the number of deaths or very severe cases."Quite on the contrary. Many people are having mild disease, they recover without medicines in some cases and it is good news," she s
Wednesday, June 10, 2009
We actually spoke with Siobhan DeLancey at the FDA's Office of Public Affairs this morning, and Ms. DeLancey confirmed that the inspection of Clarcon's manufacturing facility "uncovered serious deviations from FDA’s current Good Manufacturing Practice requirements.
Select samples of different Clarcon products inspected onsite at the manufacturing facility were found to have low-level readings of bacterial contamination.
Because Clarcon, in its infinite wisdom (that's a sarcastic remark) does not publish the ingredients of its various products on its website, the only source of information specific to the ingredients are provided via the FDA-provided link in this posting, which are merely photocopies of photos that FDA inspectors took onsite at the manufacturing plant.
That said, and despite one FDA observation that all of the company's products appear to be the same formula, and just merely marketed using different names for different uses, upon close inspection of the photocopies of the labels, the ingredients themselves in the products do vary, and all appear to be typical to those found in many other consumer products, from soaps to non-alcohol hand sanitizers, to lotions.
This leads most educated professionals to conclude that the ingredients themselves are not the root of the nominal bacteria levels discovered in the FDA sampling, but that Clarcon's manufacturing facility itself does not conform to 'clean room' standards that are observed by most credible manufacturers of these types of products.
The fact is, almost any type of product, whether it be an antiseptic, a germ killer, an industrial cleaning product, or even something as potent as chemotherapy, can become 'tainted' in a non-clean manufacturing environment.
These are the Clarcon brands that are being re-called. Apparently none are sold via retail outlets, and only sold via distributors:
Dermassentials by Clarcon Antimicrobial Hand Sanitizer
Iron Fist Barrier Hand Treatment
Skin Shield Restaurant
Skin Shield Industrial
Skin Shield Beauty Salon Lotion
Total Skin Care Beauty
Total Skin Care Work
Saturday, June 6, 2009
Video 1: This is what we're putting into the hands of our soldiers..
Video 2: Science Class. School officials should only be as smart as the students!
Friday, June 5, 2009
As everyone knows, the last several weeks has resulted in a firestorm of activity promoting the importance of proper hand hygiene; a topic that is a number one talking point by Infection Control experts. And, for those of us that beat the drums i.e.” wash your hands, please!”, its often frustrating that this message and simple logic often falls on deaf ears.
In the midst of yet another health care alarm, its equally frustrating that the preponderance of messages with regard to hand hygiene includes the legacy recommendation “Use alcohol-based hand sanitizers!”, despite the fact that the health care industry at large is highly aware of safer and friendlier non-alcohol alternatives that are well-documented to be equally, if not more effective against a broad spectrum of pathogens (including H1N1), but that HCW’s remain handcuffed from using these alternative products simply because their organizations defer exclusively to a document published in 1996 by the US Centers for Disease Control.
This is the document that recommends alcohol hand sanitizers on the first page, includes merely one sentence acknowledging “emerging non-alcohol formulas” , as well as numerous cautionary statements and caveats i.e. alcohol-based sanitizers within the body of that 50-page document.
Yes, we all appreciate that alcohol kills germs that might be immediately on the hands.
That said, any HCW working within a venue that requires constant application of hand sanitizers also knows that alcohol not only causes dry/irritated skin, which increases risk of exposure to pathogens, but that alcohol hand sanitizer products destroy protective skin cells, along with destroying industrial floor wax and paint that may be exposed to ‘drippage’ from those dispensing devices placed on facility walls.
In a recent communication with interim CDC director Dr. Rich Besser, it was pointed out, that amongst others, no less than four federal government agencies have systematically banned alcohol-based hand sanitizers. As have tens of dozens of schools, senior care facilities, doctor offices, substance abuse centers, child care facilities, correctional facilities and most recently, the United States Navy.
The purpose of the message was to seek clarification from CDC and to advise them that all of these groups have actually contacted us unsolicited in the course of their implementing strategies to help defend their staff and their facilities against the H1N1 situation, and to otherwise expand on their hand hygiene programs. Their top 3 reasons include:
1. Flash point / facility damage risk
3. Product Risk/Reward Analysis
Dr. Besser responded with a very polite reply in which he acknowledged that CDC “might be off message, but that we’re working on it.” He then designated a staff member to follow up, and that reply was limited to:
“Per Dr. Besser’s request…I’ve been asked to follow up your message to him. Please note:
1. CDC recommends alcohol hand sanitizer products
2. CDC does not recommend products
3. Your inquiry i.e. non-alcohol formulas is beyond the scope of the CDC Infection Control Emergency Desk
It would seem to some that we're subjective in our opinion, as we are one of a select number of manufacturers that produce a line of benzalkonium chloride-based, foam format hand sanitizer products. Our two rinse-free, fragrance-free and dye- free formulas (a .13 and a .24 version of the active ingredient) have been vigorously and independently tested against a variety of the most common pathogens.Including H1N1.
While we remain emphatic that frequent washing with the appropriate soap and water is always the best defense, the efficacy comparisons between alcohol and quat-based formulas speak for themselves. As do the product safety comparisons.
We’re not talking about chemotherapy, we’re talking about hand sanitizers, and common logic.
We’re more than happy to provide product documentation and samples to those that request it.
MGS Brands, Inc.
d/b/a MGS Soapopular
2490 Black Rock Turnpike
Fairfield, Connecticut 06825
Exclusive US Distributor: Soapopular brand, the #1 Alcohol-Free hand sanitizer
Global License: Hy5 alcohol-free hand sanitizer
GREAT BLOG: HandHygieneFacts
Soapopular is a Member of the International Federation for Infection Control (IFIC)www.theific.org