Today, 15th October 2012 is Global Handwashing Day.

“Human feces are the main source of diarrheal pathogens. They are the source of shigellosis, typhoid, cholera, all other common endemic gastro-enteric infections and some respiratory infections such as influenza and pneumonia. A single gram of human feces can contain 10 million viruses and one million bacteria.

These pathogens are passed from an infected host to a new one via various routes but all of these illnesses emanate from feces. Removing excreta and cleaning hands with soap after contact with fecal material –from using the toilet or cleaning a child – prevents the transmission of the bacteria, viruses and protozoa that cause diarrheal diseases.

Other measures (food handling, water purification, and fly control) have an impact on these diseases as well, but sanitation and handwashing provide the necessary protection against fecal contact. They start by creating initial barriers to fecal pathogens from reaching the domestic environment. Handwashing with soap stops the transmission of disease agents and so can significantly reduce diarrhea and respiratory infections, and may impact skin and eye infections.

Research shows that children living in households exposed to handwashing promotion and soap had half the diarrheal rates of children living in control neighborhoods. Because handwashing can prevent the transmission of a variety of pathogens, it may be more effective than any single vaccine. Promoted on a wide enough scale, handwashing with soap can be thought of as a “do-it-yourself” vaccine. Ingraining the habit of handwashing could save more lives than any single vaccine or medical intervention.”

GLOBAL HANDWASHING

COUNTRY : WORLDWIDE

Why Handwashing with Soap?
Handwashing with soap is the most effective and inexpensive way to prevent diarrheal and acute respiratory infections, which take the lives of millions of children in developing countries every year. Together, they are responsible for the majority of all child deaths. Yet, despite its lifesaving potential, handwashing with soap is seldom practiced and difficult to promote.

Turning handwashing with soap before eating and after using the toilet into an ingrained habit could save more lives than any single vaccine or medical intervention, cutting deaths from diarrhea by almost half and deaths from acute respiratory infections by one-quarter. A vast change in handwashing behavior is critical to meeting the Millennium Development Goal of reducing deaths among children under the age of five by two-thirds by 2015.

Global Handwashing Day focuses on children because not only do they suffer disproportionately from diarrheal and respiratory diseases and deaths, but research shows that children – the segment of society so often the most energetic, enthusiastic, and open to new ideas – can also be powerful agents for changing behaviors like handwashing with soap in their communities.

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Norovirus, sometimes called Norwalk virus or small round structured virus causes winter vomiting disease. Although commoner in the winter months, it can occur at any time of the year. It is the commonest cause of vomiting and diarrhoea in the UK and is highly infectious. Indeed if it appears in the hospital setting it frequently leads to ward closure since this is often the only way to contain the infection.

Hand-washing alone often is not enough to contain the virus. It is not, however, a hospital acquired infection as such and is brought in by a member of staff, visitor or patient who has acquired it in the community. It is important, therefore not to visit patients if you have recently suffered from a brief episode of diarrhoea because of the havoc this virus can cause to the everyday running of a hospital. Usually you are no longer infectious after being symptom free for 48 hours.

Norovirus is transmitted very easily in the following ways:

Not washing hands after using the toilet

Being exposed to the virus when cleaning up vomit or diarrhoea of infected person

By breathing in virus from the air e.g. after projectile vomiting

Touching surfaces that have virus on them eg toilet seats, furniture, door handles, keyboards etc.

By eating contaminated food eg oysters contaminated from sewage in sea water

Here are some commonly asked questions regarding Norovirus infection:

NOROVIRUS : FREQUENTLY ASKED QUESTIONS

COUNTRY : ENGLAND

What are the symptoms?

The most common symptoms are nausea, vomiting and diarrhoea. Symptoms often start with the sudden onset of nausea followed by projectile vomiting and watery diarrhoea. However, not all of those infected will experience all of the symptoms. Some people may also have a raised temperature, headaches and aching limbs.

Symptoms usually begin around 12 to 48 hours after becoming infected. The illness is self-limiting and the symptoms will last for 12 to 60 hours. Most people make a full recovery within 1-2 days, however some people (usually the very young or elderly) may become very dehydrated and require hospital treatment.

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COUNTRY: INTERNATIONAL

On the other side of the World Health Organisation’s brochure mentioned in yesterdays post, there is information on how to treat gastro-intestinal infections when travelling.

DOWNLOAD THE WORLD HEALTH ORGANISATION PAMPHLET “PREVENTION OF FOODBORNE DISEASES: FIVE KEYS TO SAFER FOOD

Most diarrhoeal attacks are self-limited and clear up in a few days. Diarrhoea may be accompanied by nausea, vomiting and/ or fever. The important thing is to avoid becoming dehydrated. Ensure that you always drink sufficient amounts of fluids, particularly when travelling in a hot climate. This is extremely important for children. If the child is restless or irritable, or shows signs of strong thirst, or has sunken eyes, or dry skin with reduced elasticity, dehydration is already progressing and immediate medical attention should be sought.
Should bowel movements be very frequent, very watery or contain blood, or last beyond 3 days you should seek medical help. Where there is no medical help available a complete 3-day course of ciprofloxacin* (500 mg twice a day for adults, 15mg/kg twice a day for children) can be taken.
As soon as diarrhoea starts, drink more fluids, such as oral rehydration formula, boiled, treated or bottled water, weak tea, soups or other safe fluids. Avoid any drinks that tend to remove more water from the body, including coffee, overly sweetened drinks, some medicinal teas and alcohol.
Age group Amount of fluids or ORS** to drink
Children less than 2 years Up to ½ cup after each loose stool
Children 2-10 years Up to 1 cup after each loose stool
Older children and adults Unlimited amount
Contrary to common belief, medicines which reduce bowel movements are not recommended. In children, these preparations should never be used as they may cause intestinal obstruction.

* generic name – can be sold under other names

** If ORS are not available, mix 6 teaspoons of sugar plus
one level teaspoon of salt in one litre of safe water (“taste of
tears”) and drink as indicated in the table.

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