# 3792
Although the advice from the CDC, HHS, and just about every other public health agency around to globe to `wash your hands often’ is undoubtedly sage counsel, and can protect you against a wide range of illnesses and disease, there appears to be little evidence that it will prevent the spread of influenza.
Oh, I still wash (or sanitize) my hands incessantly. And I will continue to do so, but I’ve been a inveterate hand washer for decades. No doubt a habit instilled in me from working as a paramedic during a time when latex gloves were rarely worn.
The scientific evidence supporting the notion that hand washing will prevent you from getting the flu, however, is scant to non-existent.
Sorry, I don’t make up the facts. I just report them.
This is of course distressing to public health officials who have made hand washing the mainstay of their pandemic advice. Something I wrote about last month in The Flaw In The Ointment.
Yesterday, the CMAJ (Canadian Medical Association Journal) ran an article about the disconnect between the advice being offered by public health officials, and the currently available science.
October 1, 2009
Conflict emerges over value of handwashing as a preventive flu transmission measure
Prominent microbiologist Dr. Donald Low argues that the Public Health Agency of Canada's hand hygiene recommendations "are not evidence-based."
Photo Credit: ©2009 Jupiterimages Corp.
There’s no evidence that good hand hygiene practices prevent influenza transmission, according to a Council of Canadian Academies report commissioned by the Public Health Agency of Canada.
But N95 particulate respirator-type masks are a proven “final layer of protection” against even the smallest viral particles of influenza, says the Influenza Transmission and the Role of Personal Protective Respiratory Equipment: An Assessment of the Evidence report prepared by an expert panel on influenza and personal protective respiratory equipment, chaired by Dr. Donald Low, microbiologist-in-chief at Mount Sinai Hospital in Toronto, Ontario.
Despite those 2007 findings, PHAC still recommends handwashing as the primary preventive measure against flu transmission. The agency also states on its website that there is no evidence that wearing masks “will prevent the spread of infection in the general population. Improper use of masks may in fact increase the risk of infection.”
Moreover, PHAC states in an email to CMAJ that “there is substantial evidence to support hand hygiene as a basic premise of infection prevention and control measures.” The agency also indicated that its hand hygiene recommendations are based on a combination of expert opinion and evidence, including a recent Cochrane Collaboration systematic review (BMJ 2009;339:b3675).
But the contradictory evidence and recommendations on preventive measures and other pandemic (H1N1) 2009 issues leaves Canadian doctors at a loss as to the best advice to provide patients, says College of Family Physicians of Canada President Dr. Sarah Kredentser.
While I personally believe that hand washing may prevent at least some flu transmission, I readily concede that most influenza is transmitted through large droplet or aerosol routes.
And I suspect most public health officials, if cornered, would agree.
Hand washing is probably of limited value in preventing the spread of influenza.
But you have to have something to tell the public. Hand washing is simple, easy to do (for most of us), and has proven benefits as part of basic disease prevention and hygiene.
Like the `duck & cover’ drills of my childhood during the 1960s, hiding under your (civil defense approved!) school desk during an H-Bomb attack may not really help, but it couldn’t hurt.
I am sympathetic to public health agencies who must distill the science (which isn’t always complete, or clear) down to simple, easy to follow advice for the public.
They must take into account practical considerations – such as costs and availability - as well as the scientific evidence. Not an easy task when it comes to something as complicated as an influenza pandemic.
But I admit to being a tad uncomfortable with how hand washing is being `oversold’ by public health officials as a pandemic flu preventative measure.
While washing your hands, covering your coughs and sneezes, staying home when you are sick, and getting the vaccine when it becomes available are all good ideas, nothing says you have to stop there.
Which is why I view the advice from public health agencies as a solid foundation upon which to base my personal pandemic and disaster plans, but not as the total solution.
I’ve made no secret of the fact that I advocate going the extra mile when it comes to preparedness. That a 72-hour kit is a nice start, but you really need at least 2-weeks worth of supplies in your home, along with a proper first aid kit, a weather radio, and other emergency supplies.
I’ve also endorsed the stockpiling (and use) of facemasks and respirators when caring for flu victims in your household.
Admittedly, not everyone can do these things, and so public health officials sometimes find them difficult to recommend. But that doesn’t mean you shouldn’t go the extra mile if you are able to.
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