The Human Hand

Ulysses, Marco Polo, Charles Gerba, Amelia Earhart, Indiana Jones, Neil Armstrong, and Mary Guinan took lessons from the greatest explorer of all time. The Human Hand!

A microscopic view of our skin would reveal that our clean hands can quickly acquire a cocktail of dirt, dust, food, fats, proteins, spores, viruses, and various bacteria, which all mingle in the top skin layer. Our hands constantly touch, manipulate, explore, work, or play on a wide range of hard and soft surfaces during our daily activities in homes, schools, workplaces, shopping centers, and vehicles.

Under our fingernails, in the depths of our palm creases, and between our fingers lives this sticky, thriving microbial biofilm slime that stubbornly resists proper handwashing techniques and antimicrobial soaps.

This pathogenic microbial population, E. coli, doubles every 20 minutes. Within 24 hours, two diarrhea-causing E. coli bacteria can form colonies of millions, thriving on healthy, clean-looking hands.

Pathogenic colonization continues to multiply until the food supply is depleted, and then this microbial civilization starves and dies unless your fingers are holding French fries or other food.

• Hepatitis B only needs ten HPV pathogens to spread the infection.
• Different Enterobacteriaceae species need over 100,000 bacteria to make someone sick.
• Norovirus can live for weeks in refrigerated foods.
• Rotavirus can live for up to 10 days.
• Norovirus can survive for 7 days or more on countertops in restrooms and kitchens.
• Rhinoviruses can live for up to 18 hours on a hard surface, such as a kitchen countertop.

According to a Study Conducted by Michigan State University. 3,749 People Use Public Toilets

• One out of three people did not wash their hands with soap after using the toilet.
• Only 5 percent of people washed their hands long enough for soap’s solvents to remove germs after using the bathroom.
• Ten percent of people did not wash their hands at all. (1)

Public restrooms are central transmission hubs that bring all our hands together, encircling our homes, communities, and the world at large. International airports, transcontinental railroads and highways, ocean liners, sporting arenas, school dances, and musical concerts all attract large crowds that need clean public restrooms with plenty of toilet paper, soap, paper towels, and clean floors.

The National Center for Biotechnology Information (NCBI) reported the study, “Effect of Washing Hands With Soap on Diarrhea Risk in the Community,” explores whether handwashing with soap had an impact on the risk of contracting diarrheal diseases in the community:

Current evidence suggests that handwashing with soap can reduce the risk of diarrhea by 42–47%. (2)

The common cold virus is transmitted via:

• Airborne droplets (aerosols);
• Direct contact with infected nasal secretions. Handshake, ATM buttons, door handles, etc., and
• Touching contaminated objects (fomites). (3)

Hand-to-hand and hand-to-surface-to-hand contact seem more prevalent than aerosol transmission of the virus.

Do you know what others know about how to protect yourself from becoming a host (infected) for the colonization of transient, pathogenic, microbial life forms? These bacteria, viruses, and spores could be hitching rides on you in any number of ways.

• Under your fingernails. One long fingernail can puncture four sheets of toilet paper while wiping buttocks. After washing hands with soap for ten seconds, there is a thriving, determined pathogen colonization happening under the protection of your long, beautifully manicured fingernails.
• By pushing the elevator floor button with a fingertip, making a call, and then holding the phone against your face, possibly touching your lips.
• On the bottoms of your shoes, walking from the toilet stall back to the office, classroom, or restaurant.
• On the bottoms of grocery bags, from sitting in a dirty shopping cart to automobile floorboards, to kitchen counters, or worse, on kitchen floors.
• Your body is used as their taxi.

Where does the bottom of your purse sit all night?

The Hermes Matte Crocodile Biking Bag’s daily routine is to park, fly, park, fly, and park on many different surfaces until returning home. The bottoms of purses, briefcases, and backpacks can carry pathogenic microorganisms into our homes. (4) After the Crocodile Biking Bag flies through the front door of your home, your purse will park on many different communal surfaces before finding a place to rest.

Unfortunately, the bottom of this beautiful handbag is left sitting on the bathroom countertop for 6 hours, cross-contaminating the same surface where you apply makeup and brush your teeth. This countertop surface now provides the microbial pathogen with two entry points into your human host (you) via your fingertips, enabling cross-infection by touching your mouth and eyes.

Centers for Disease Control (IDC) study estimates that the Norovirus is responsible each year for:

• 20 million acute cases of stomach flu (gastroenteritis)
• 56,000–71,000 hospitalizations
• 570–800 deaths
• 58 percent of acquired foodborne illnesses in the United States (5)

The World Health Organization (WHO) estimates that 1.5 million people worldwide died from diarrheal diseases in 2005 (6).

E. coli is a global traveler who loves airplanes, long fingernails, diarrhea, and people who do not wash their hands with soap long enough to remove Mr. Big Eddy Coli and his relatives from harboring on their hands.

Ignorance about the public restroom biosphere is one reason our families and local communities will be more vulnerable to future pandemics, which can quickly spread down the street and throughout our cities. Any one of us can unwittingly become a host to an alien or indigenous prehistoric infection, or to a genetically mutated microbial bioweapon.

Our Midas pathogenic touch is a pandemic golden taxi for reproducing colonies of:

• Severe Acute Respiratory Syndrome

(SARS), (Coronavirus)

• Swine Flu (H1N1 Virus)
• Avian Influenza A (H7N9 virus)
• Tuberculosis (Mycobacterium tuberculosis)
• Ebola (Ebolavirus)
• Cholera (Vibrio cholerae intestinal bacterium)

The Effects of the Spanish Flu Epidemic of

1917–1919

Stanford University findings include the following:

• The Spanish flu killed more than half a million Americans.
• An estimated 40 million people died worldwide in a single year.
• More soldiers died during World War I from the Spanish flu than from enemy bullets.
• More people overall died from the Spanish flu than were killed during World War I. (7)

People intermittently touch their hair, eyes, nose, mouth, and ears with their fingertips, yet have not washed their hands since that morning.

The champion of “cross-contamination” is the handshake.

Replace the Handshake with a fist-bump!

As healthy adults, we might not get sick or show symptoms while serving as a host for a deadly pathogen, but we can be taxi hosts for bacteria, viruses, and spores living under our fingernails or in the creases of our palms. Pathogenic microbial life forms are waiting for their host to deposit them on:

• Office break room appliances
• Classrooms’ shared work areas, crayons, and water fountains
• Elevator buttons
• Shopping carts
• Cell phones
• Gas pump handles
• ATM buttons

Right-Hand Efficiency vs. Left-Hand Infectious

Disease Control Taboo

In some cultures, people never use their left hand to shake someone’s hand, even if they are left-handed. People in cultures without public sanitation and insufficient water will only use their left hand to touch, wipe, and clean the pelvic area after having a bowel movement. The right hand is for shaking hands or handling objects used by others, such as door knobs, water containers, and the local water-well bucket handle. This ancient infectious disease control (IDC) method or cultural taboo has saved lives. It seems to be a critical habit for people of all cultures who lack modern sanitation infrastructure connected to public restrooms.

Shockingly, 33% of the world’s population lacks access to toilets connected to modern sanitation systems. (8)

I live in a city with modern sanitation infrastructure, including public restrooms with working toilets, handwashing sinks, clean running water, privacy, toilet paper, and soap. I do not use my left hand while using the toilet because it is seldom used and cannot do as good a job as my dominant right hand. Maybe the real reason is that it’s automatic. I don’t think about it, and my tribe never made it taboo.

According to the University of Michigan Study on hand washing, only 5 percent of people washed their hands with soap long enough to remove pathogens. Therefore, if your fingers become soiled while wiping your bottom when using the toilet, regardless of which hand is used, it would be essential to remember:

• Handwashing does not remove all pathogenic organisms from the hands.
• Handwashing after using the toilet does not mean there are no coliform bacteria under the fingernails.
• Most soaps do not kill germs.
• Hot water does not kill germs unless you scald your skin.

The Centers for Disease Control (CDC) has information regarding how to wash hands

effectively to remove the most germs. (9)

The main ideas (action items) I hope that you, dear reader, will remember a week from now are:

1. Let the soap’s solvents soak for twenty seconds on the hands while scrubbing.
2. Then use water for rinsing and removing the soapy pathogenic foam from your hands.

A must-read! Everyone, and I do mean everyone, should click on the following link and read this World Health Organization report on infectious diseases:

Infectious diseases are now the world’s biggest killer of children and young adults. They account for more than 13 million deaths a year (one in two deaths in developing countries).

During the next hour alone, 1,500 people will die from an infectious disease, and over half of them are children under five.

One in five children under one year of age is not fully immunized. (10)

Do you wash your hands before using the public restroom toilet or urinal?

Unbeknownst to me, my right hand was contaminated two hours earlier when I did not use a paper towel on the coffee pot’s handle in the office break room. Because I did not wash my hands with soap before using the toilet or urinal, my right hand is still contaminated with a virus.

I’m now finished at the urinal and wash my hands with soap, and even use a paper towel to open the exit door. My hands are now a lot cleaner than when I entered the public restroom, but my pelvic area is now contaminated. My spouse is now vulnerable to this pathogenic virus.

Some people use toilet paper to touch their genitals while using a bathroom, but they still have dirty hands. Dirty hands are sticky, and since more stuff tends to stick to them, everything you do in the restroom should be followed by handwashing.

According to Dr. Paul Schafer, DDS, if you only brush your teeth once, then it’s better to brush your teeth before eating than to brush them after you eat.

Please wash your hands before using the restroom facilities, and then rewash them before leaving the public restroom area.

My unscientific observations of people using the toilet in public restrooms over the last three years indicate that 98 percent do not wash their hands before using the urinal or the toilet.

The Centers for Disease Control (CDC) estimates that each year:

• Eighty percent of all infections are caused by hands spreading pathogens.
• Pneumonia and influenza cause 3.2 million deaths globally. (11)

Groups of People Vulnerable to Pathogenic Infection from Hard/Soft Surfaces

• They are susceptible to bacteria and flu viruses that exist within reach of their small fingers. They touch surfaces contaminated with pathogenic germs that can cause severe illness and sometimes death, including mattresses, pillows, pillowcases, toys, car seats, carpets, pets, parents’ and siblings’ unwashed hands, and even dust.
• The elderly with weakened immune systems.
• People with compromised immune systems.
• Children and usually healthy people who are currently sick. They are more susceptible and vulnerable to new viral diseases.
• First responders, hospital emergency department (ED) doctors, nurses, supporting staff, medical office building (MOB), medical and clerical staff, epidemiologists, and public restroom cleaning professionals.
• Sick people with family and friends sitting in the ED and MOB waiting rooms.

Pathogens on a person’s hands and transferred to other surfaces are “cross-contaminating.”

Cross-contamination is the number one way to contract illness-causing germs in public restrooms, shopping centers, restaurants, office break rooms, elevators, schools, public events, sporting arenas, ocean liners, airports, bus and train stations, and our homes.

The CDC reports that 48 million people became ill from foodborne illness, 128,000 were hospitalized, and over 3,000 died in a single year. (12)

Another CDC behavioral study of food handlers in restaurants showed that restaurant workers washed their hands 32 percent of the time when needed after doing something that required hand washing before resuming food handling. (13)

University students observed using dormitory restrooms (Thumma, Aiello, & Foxman, 2008) showed:

• Females washed their hands 69 percent of the time after urinating.
• Females washed their hands 84 percent of the time after bowel movements.
• Males washed their hands 43% of the time after urinating.
• Males washed their hands 78% of the time after bowel movements. (14)

A literature review of eighty-one foodborne disease outbreaks from 1975 to 1998 involving 14,712 people (Guzewich & Ross, 1999) showed that

• the unwashed hands of food workers caused 93 percent of outbreaks. (15)

Some people are healthy and have not been sick in years. These healthy human specimens can use dirty public restrooms, not wash their hands with soap, and still not become ill. Unfortunately, these same healthy individuals can also be ignorant hosts, allowing transient pathogenic colonization to thrive on their hands. During their day’s activities, they cross-contaminate hard and soft surfaces throughout their community.

The American Society of Microbiology study of Public Restroom Hand Washing Habits revealed:

• Only 50% of middle and high school students wash their hands after using the toilet.
• Only 33 percent of girls and 8 percent of boys used soap after using the toilet. (16)

As a parent of teenage twins, it is depressing and frightening to realize that my children, along with other students, may not be washing their hands with soap long enough to remove germs and may return to the classroom, possibly infecting surfaces with E. coli, Rotavirus, and Salmonella. These highly contagious, invisible colonies of bacteria can live for 2 to 4 hours on surfaces such as doorknobs, desks, books, pencils, crayons, work tables, balls, and keyboards.

A North Carolina State University study of a Norovirus outbreak sickening 340 students at the University of Guelph in Canada: Hand-sanitation stations and informational posters are being placed at the entrance to a residence hall cafeteria where there is a high risk of cross-contamination. Findings that even during this high-profile outbreak, students followed recommended hand hygiene procedures just 17 percent of the time. (17)

The American Society of Microbiology reported:

• Ninety-one percent of people say they wash their hands after using the toilet.
• Observational data inside restrooms reveal that 75 percent of females and 58 percent of males actually wash their hands. (18)

I hope the information presented has answered the question that no one wants to ask: Can I be a healthy host for thriving pathogenic colonies that enable me to spread disease-causing microbial life forms throughout my workplace, school, or home without getting sick myself?

Our Natural “Biome” Immune Defense System

Pathogenic microbial life forms need optimal conditions to multiply in sufficient numbers to defeat the human body’s natural, healthy, resistant bacteria. Our bodies cannot exist without the miracle of bacterial colonization inside our mouths, stomach, intestines, blood, and on our hands, to name a few. Most adults are healthy because our bodies actively nurture vibrant, vigilant, healthy, resident bacterial colonies.

There are over 100 trillion bacteria in the stomach, which is more than all the stars in the Milky Way Galaxy. (19) I wonder what the total count of bacteria is that exists within and upon my human form. Maybe I am host to more bacteria than stars in the entire universe. I am a Universe. Wow!

Ok, maybe that’s over the top, and I’m embellishing the story because I’m a romantic. I’m just saying that human life and, for that matter, Mother Earth, could not exist without the beautiful and savage microbial lifeforms that exist around us and within us.

Our natural “biome” is the first line of defense in our immune system. Most bacterial colonies that live on the skin and inside the body are essential for our general overall health and well-being. The trick is to nurture our resident microbial biome to help prevent us (the host) from getting sick. (20) Does anyone want to order a side of broccoli with that grilled cheese sandwich? Or how about popping a can open of Popeye’s spinach instead of pop-top sucking a sweet soda? Oh, I know, how about having a salad with hard-boiled eggs and bacon for breakfast? Hmm, that does sound good.

Harmful transient bacteria and viruses, which can ride on people and may not immediately make their hosts sick, can still infect others through cross-contamination among individuals and on various surfaces. Thriving, healthy resident bacteria living in and on our bodies can fight and kill the harmful transient bacteria that gather on and infect our hands, faces, hair, and genital areas while we do our daily activities at home, work, and school, and when using public restrooms.

Public Restroom Human Behaviors:

• Seven out of ten people with colds have infectious cold germs on their hands.
• People with colds are more likely to transmit cold germs to others or surfaces on the second to fourth days, because nasal secretions are at their highest during this period of incubation.
• Adults touch their faces 1 to 3 times every 5 minutes; the average is 15.7 times per hour. (21)
• Children touch their hair, mouth, eyes, and other facial areas ten times every five minutes.

A (Judah et al., 2009) British study of service station restrooms used electronic sensors to record how many people used soap during handwashing.

This 32-day study observed 192,000 people 1) entering and 2) using soap and found:

• 65 percent of women washed their hands with soap, and
• 35 percent of men washed their hands with soap. (22)

Pneumonia is the number one killer of children in the world, and studies have shown that correct handwashing can lower this by 25 percent.

The second-most frequent cause of children’s death in the world is diarrhea. This could be reduced by almost 50 percent if people washed their hands with soap for at least twenty seconds and used paper towels.

Queen Mary, University of London & the London School of Hygiene and Tropical Medicine conducted this study, which found Faecal bacteria on:

• 26 percent of hands,
• 14 percent of paper money,
• 10% of credit cards. (23)

The top eight fecal-oral transmission methods can be stopped when people wash their hands effectively with soap:

• After using a public restroom
• After changing a diaper
• Before feeding a child
• Before eating
• Before preparing food
• After handling raw meat, fish or poultry
• Before and after tending to a person with a compromised immune system or sickness.
• After coughing or sneezing

Infectious diseases are becoming harder to control with drug-resistant viruses and bacteria now on the rise. The overuse of antibiotics has allowed “superbugs” to develop, which are nearly impossible to kill and can be lethal to humans.

How to Remove Microbial Biofilms Attached to Our Hands

One weakness of microbial biofilm is that the sticky attachment to the hands will dissolve in the solvents in soap. The minimum soaking period is 20 seconds, unless you are washing your hands many times a day, in which case, maybe 6 seconds. The longer the soap’s solvents have time to penetrate the surface, the better. For this process to be efficient, it’s best to use no running water while using soap.

During this time, vigorously use each hand to scrub the other because soap usually does not kill germs, but the solvents can detach these active, deadly pathogens from our hands. The scrubbing action is like peeling an onion. Pathogens become detached, suspended, and captured in the frothy white mass of soap bubbles.

After 20 seconds of soaking and scrubbing, the hands are ready to be rinsed with water to remove soap, dirt, bacteria, viruses, and spores.

Paper towels lift more germs off the hands than do hot-air hand dryers.

Many people believe that the hotter the water, the more effective hand washing is at removing dirt, gunk, and pathogens.

Hot water does not kill germs or open pores, but it can scald your skin.

The study, Water temperature as a factor in handwashing efficacy, " was conducted by Michaels, B., Gangar, V., Schultz, A., Arenas, M. Curiale, M. Ayers, T., and Paulson, D., is a must-read. (24) Thanks to the folks who funded and conducted this myth-busting study on water temperature effects while washing hands. The following excerpt is from this study:

“The temperature of the water used is not related to how well pathogens are eliminated during the handwashing process.”

Hot water does not kill germs or remove more pathogens from the skin; it’s the soap’s solvent soaking time that is all-important in dissolving the glue that binds the germs. Cold water with twenty seconds of soaking time is better than hot water with twenty seconds of soaking time because, if you wash your hands a lot, the skin's surface dries out, forming microscopic cracks in the epidermis/dermis, allowing microorganisms an entry point into their new host: you.

The idea that hot water opens your pores and cold water closes them is false. Hot water will make your hands swell, but pores do not open or close.

Studies have shown that people will wash their hands longer with warm water. But what does this accomplish? When you wash your hands for 20 seconds with soothing, warm water, the water rinses the soap off immediately. Thus, all that is performed is a nice hand massage. This method will not remove as many germs as the Smart Way of Handwashing Kata, demonstrated in Chapter 3. The warm water method may relieve stress and is good if you have been typing for the last couple of hours. Your hands deserve a little tender loving care. Just remember to wash your hands the smart way after the massage.

Hand gel soap with lotion is an excellent choice for working hands.

Happy, healthy hands to you!