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Author Topic: Swine Flu in the Winter
Phanto
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The winter may have a very serious health crisis.

In summary:

1) Swine flu and typical flu might coexist and infect different populations
2) Swine flu is unusally contagious
3) It seems swine flu isn't mutating, but it might, and become more dangerous

[ September 03, 2009, 11:51 AM: Message edited by: Phanto ]

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fugu13
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Oh, yes. Definitely expect at least twice as bad a flu season as normal, quite possibly worse.

Hopefully the number of patients needing hospitalization won't exceed local capacities anywhere. That's what would really drive death tolls up.

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Armoth
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::Buys a purell dispenser::
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rivka
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quote:
Originally posted by Armoth:
::Buys a purell dispenser::

Frequent washing with soap and water is a much better option.
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Armoth
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too lazy for that.
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rivka
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I'll remind you of this when you have the flu. [Razz]
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ClaudiaTherese
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Really? *intrigued (This is me being professionally interested, not snarky. [Smile] ) The last recommendations about hand hygiene that I know of from the CDC emphasize use of alcohol-based hand sanitizers (with sufficient alcohol percentage) over soap-and-water washing unless here are visible clumps of contaminant matter to be scrubbed off. Alcohol sanitizers are believed to be less likely than plain soap to be actual bacterial carriers, less inclined to supporting the development of resistant organisms, and to have better bacteriocidal and virucidal properties.

I think about this a lot because I work in intensive care units, and it comes up several times a week.

[And because it is so important in my context, I try to stay up to speed. I welcome updates! [Smile] ]

quote:
...Plain soaps have minimal, if any, antimicrobial activity. However, handwashing with plain soap can remove loosely adherent transient flora. For example, handwashing with plain soap and water for 15 seconds reduces bacterial counts on the skin by 0.6--1.1 log10, whereas washing for 30 seconds reduces counts by 1.8--2.8 log10 (1). However, in several studies, handwashing with plain soap failed to remove pathogens from the hands of hospital personnel (25,45). Handwashing with plain soap can result in paradoxical increases in bacterial counts on the skin (92,95--97). Non-antimicrobial soaps may be associated with considerable skin irritation and dryness (92,96,98), although adding emollients to soap preparations may reduce their propensity to cause irritation. Occasionally, plain soaps have become contaminated, which may lead to colonization of hands of personnel with gram-negative bacilli (99).
quote:
Alcohols are not appropriate for use when hands are visibly dirty or contaminated with proteinaceous materials. However, when relatively small amounts of proteinaceous material (e.g., blood) are present, ethanol and isopropanol may reduce viable bacterial counts on hands more than plain soap or antimicrobial soap (142).
quote:
Alcohols, when used in concentrations present in alcohol-based hand rubs, also have in vivo activity against several nonenveloped viruses (Table 2). For example, 70% isopropanol and 70% ethanol are more effective than medicated soap or nonmedicated soap in reducing rotavirus titers on fingerpads (137,138). A more recent study using the same test methods evaluated a commercially available product containing 60% ethanol and found that the product reduced the infectivity titers of three nonenveloped viruses (i.e., rotavirus, adenovirus, and rhinovirus) by >3 logs (81). Other nonenveloped viruses such as hepatitis A and enteroviruses (e.g., poliovirus) may require 70%--80% alcohol to be reliably inactivated (82,139). However, both 70% ethanol and a 62% ethanol foam product with emollients reduced hepatitis A virus titers on whole hands or fingertips more than nonmedicated soap; both were equally as effective as antimicrobial soap containing 4% chlorhexidine gluconate in reducing reduced viral counts on hands (140). In the same study, both 70% ethanol and the 62% ethanol foam product demonstrated greater virucidal activity against poliovirus than either non-antimicrobial soap or a 4% chlorhexidine gluconate-containing soap (140). However, depending on the alcohol concentration, the amount of time that hands are exposed to the alcohol, and viral variant, alcohol may not be effective against hepatitis A and other nonlipophilic viruses. The inactivation of nonenveloped viruses is influenced by temperature, disinfectant-virus volume ratio, and protein load (141). Ethanol has greater activity against viruses than isopropanol. Further in vitro and in vivo studies of both alcohol-based formulations and antimicrobial soaps are warranted to establish the minimal level of virucidal activity that is required to interrupt direct contact transmission of viruses in health-care settings.
----------

Edited to add PSA:

Note that the CDC has an alert out about substandard hand sanitizing solutions that may be more likely to be found in dollar stores and other discount outlets. Look for 62% alcohol content mimimum, preferably [90-95%].

[ September 06, 2009, 04:23 AM: Message edited by: ClaudiaTherese ]

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Belle
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Soap and water is also impractical in the classroom, hence teachers' devotion to GermX. [Wink]

I have been through three bottles in my classroom this year already - I teach 106 students and encourage that they use it as well as clean desks with Lysol. Thus far, we have few cases in our school but I've noticed absenteeism is creeping up each week.

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Shan
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CT -- curious question. I was told that using sanitizer over and over actually increased the bacterial load on the hands. True?
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rivka
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IME the discount stores are far from the only places where the sanitizing gels have far far less than 90% alcohol.
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ClaudiaTherese
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Santizers with 60-95% are fine, though, per the CDC. I think 62% is the standard cutoff for community use. There is some concern that >95% becomes less effective because proteins will not denature unless there is sufficient water present.

Shan, it isn't consistent with what I am aware of, but there is a lot I am not aware of. That is true for soap sometimes, as noted above in the CDC article. Maybe it has also been found true for sanitizer, but I expect that would have been updated in an addendum (and I don't see one) if it were a solid concern there, too.

To re-cite,
quote:
Handwashing with plain soap can result in paradoxical increases in bacterial counts on the skin (92,95--97).
quote:
92. Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH. Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control 1986;7:59--63.
...
95. Meers PD, Yeo GA. Shedding of bacteria and skin squames after handwashing. J Hyg (Lond) 1978;81:99--105.
96. Winnefeld M, Richard MA, Drancourt M, Grobb JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546--50.
97. Maki DG, Zilz MA, Alvarado CJ. Evaluation of the antibacterial efficacy of four agents for handwashing. In: Nelson JC, Grassi C, eds. Current chemotherapy and infectious disease proceedings of the 11th International Congress on Chemotherapy and the 19th ICACC. Washington, DC: American Society for Microbiology, 1979.



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