Booster Shots

Oddities, musings and news from the health world

Category: hygiene

Looking for guidance on circumcision? You’re on your own

January 13, 2010 |  7:00 am

Baby1 Circumcision. It’s a delicate procedure and a loaded word, filled with connotations of pain, religious significance and hotly debated health benefits.

Some commentary in the current issue of the Archives of Pediatrics and Adolescent Medicine shows that medical professionals are not quite ready to come down on one side or the other. “Recommendations for routine newborn circumcision will need to wait for well-designed studies that verify its cost-effectiveness for the individual and/or society,” the editorial said.

But another paper in the same issue pointed to three recent studies that found circumcision helped reduce HIV acquisition by up to 60%.

In this L.A. Times story, writer Marnell Jameson highlighted the dilemma for many parents looking to circumcise:

Those who strongly oppose infant circumcision believe the procedure violates a child's human rights. …

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Bottom line: In the delivery room or afterward, no one’s going to be providing some infallible rules on circumcising your child. Do your homework before you have to decide. Here’s a brief description from the American Urological Assn. and some very helpful information from KidsHealth. Should you choose not to make the cut, the American Academy of Pediatrics has a guide on caring for an uncircumcised penis.

-- Amina Khan

Photo credit: Annie Wells / Los Angeles Times

Soda fountains could be squirting out fecal bacteria, study finds

January 8, 2010 |  5:51 pm

Soda fountain fecal bacteria contaminated virginiaAll right, two burgers with a side of fries coming up ... would you like a large fecally contaminated soda with that?

Like it or not, that's what you may be drinking, says a study published in the January print edition of the International Journal of Food Microbiology. The study looked at 90 beverages from 30 soda fountains in Virginia. A follow-up study took a look at the microbes they found in 27 drinks (including water). Researchers found that 48% of the drinks were harboring "coliform" bacteria -- which means they could contain fecal matter. 

"More than 11% of the beverages analyzed contained Escherichia coli and over 17% contained Chryseobacterium meningosepticum," according to the abstract. "Other opportunistic pathogenic microorganisms isolated from the beverages included species of Klebsiella, Staphylococcus, Stenotrophomonas, Candida, and Serratia."

Yech. That's quite a lineup. Even though the bacteria weren't strong enough to wreak havoc on most people's systems, the fact that they can and do live in soda fountains (and the fact that no one seems to know exactly how they got there, including the study authors) -- is a scary thought indeed.

This isn’t the first stomach-turning study to come out regarding the restaurant industry; as the FDA has pointed out, retail food is rife with potentially biohazardous situations. Also, carbonated beverages are not that good for you anyway. Then again, the type of restaurant where you'd typically be getting a drink from a soda fountain might not be especially healthful either.

-- Amina Khan

Photo credit: Los Angeles Times

Disinfectant misuse could help create superbugs

December 29, 2009 |  3:05 pm
Pseudomonas aeruginosa: A drug-resistant form of a bacterium usually associated with hospital-acquired infections led to the death of Brazilian beauty queen Mariana Bridi Disinfectants may be a double-edged sword in the fight against hospital-borne diseases, scientists say. 

According to a study to be published in January’s issue of Microbiology, researchers from the National University of Ireland in Galway slowly introduced higher levels of disinfectant to lab cultures of Pseudomonas aeruginosa, which lives in the soil and water around us. It can’t seriously hurt healthy people (it’s been implicated in “hot tub itch” and “swimmer’s ear”) but preys on those with compromised immune systems. This opportunistic pathogen can infect the lungs, joints, burn wounds, take advantage of a compromised urinary tract or cause blood diseases. The bacterium can live in man-made environments and colonize catheters and other medical equipment. It’s ideally suited for hospital transmission – the Online Textbook of Bacteriology calls it “the fourth most commonly-isolated nosocomial pathogen accounting for 10.1 percent of all hospital-acquired infections” – but it can infect anyone whose defenses have been weakened, whether from chemotherapy or diabetes, cystic fibrosis or AIDS. 

After gradually upping the dose of benzalkonium chloride, an antiseptic used in products that include eyedrops and wet wipes, researchers had on their hands a Frankensteinian pathogen that showed a 12-fold resistance to the common disinfectant. (Generally, showing four or five times the normal resistance level is enough to earn a newer, nastier disease “superbug” status.)

Even worse, that same variant of P. aeruginosadisplayed a whopping 256-fold increase in resistance to the antibiotic ciprofloxacin – even though it had never been exposed to the drug before. That’s worrisome, since the commonly prescribed Cipro has been used to treat such high-profile pathogens as anthrax spores.

The upshot? That hospitals that don’t use enough disinfectant to kill every last bacterium on a given surface could provide an ideal breeding ground for new superbugs. These mutations could become virtually immune to prevention and treatment.

“The message, for heaven’s sake, is use disinfectants properly,” lead author Gerard Fleming said in an interview. “The first line of defense is disinfection. The second line of defense is antibiotics.”

By misusing disinfectants, he concluded, “You're making an environment where you've now lost the first and second lines of defense.”

There’s a dangerous tendency toward using disinfectants as a clean-all, Fleming said, when there was a much more potent, proven remedy to rid oneself of germs.

“Soap and water. I am not messing with you,” Fleming said. “Why doesn’t the surgeon, when he’s going into the theater, just take a hand sanitizer? Why does he go to the sink and scrub and scrub and scrub? Because he’s physically removing the bacteria.”

-- Amina Khan

Rodent of the Week: Germ exposure in pregnancy may benefit kids, study indicates

December 11, 2009 |  1:00 pm

Rodent_of_the_week The hygiene hypothesis is the idea that exposure to germs early in life builds a stronger immune system and lowers a child's risk of developing allergies and asthma. Another piece of evidence for that concept, published this week, shows that even exposure to germs during pregnancy may reduce allergy risk in the offspring.

German researchers exposed pregnant mice to airborne barnyard microbes. (Studies in humans show children who are raised on farms develop fewer allergies than kids raised in non-farming communities.) The exposure triggered a mild inflammatory response in the pregnant mice, which was measured by an increased expression of microbe-sensing receptors called TLRs and the production of immune system substances called cytokines. The exposed mice gave birth to offspring who were resistant to allergies caused by the microbes. The study was published in the Journal of Experimental Medicine.

"...Studies have demonstrated that many factors affecting the initiation and course of respiratory allergies appear to act within a narrow window of opportunity, either prenatally and/or early in life. It is still unresolved, however, how protective signals are transferred from the mothers to the developing fetus," the authors wrote in the paper.

The paper adds "a new twist" to the hygiene hypothesis, said experts from the Center for Child Health Research at the University of Western Australia, in a commentary published with the study. The allergy response in human tissues differs from mice, they cautioned, but more attention should be paid to maternal environmental exposures during pregnancy that might influence the health of the offspring.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.

These days, a sneeze is not just a sneeze

November 3, 2009 |  6:00 am

Sneeze If "achoo!" makes you jumpy these days, you're not alone. The swine flu pandemic has made people much more reactive when they hear or see someone sneeze, according to a new study. It found that public sneezing heightens people's fears about germs and even other, totally unrelated, health hazards.

Psychology researchers at the University of Michigan stationed an experimenter in a busy campus building and instructed her to sneeze loudly as students passed by. Researchers then gave a survey to some of the students that asked them to describe their perceptions of an average American contracting a serious disease, having a heart attack before age 50, or dying from a crime or accident. The students who had just witnessed someone sneezing perceived a greater chance of falling ill, suggesting that the sneeze triggered a broad fear of all health threats, not just ones linked to airborne germs.

The study also showed that people within hearing distance of a sneeze had more negative views of the nation's healthcare system.

When the study scenario was repeated at a mall, survey participants exposed to the sneeze were more likely to favor federal spending of $1.3 billion on flu vaccine rather than spending the money on the creation of green jobs.

In times of a flu pandemic, "public sneezing has the power to shift policy," said the lead author of the study, Dr. Norbert Schwarz, in a news release.


The study will be published in an upcoming issue of Psychological Science, a journal of the Assn. for Psychological Science.

-- Shari Roan

Photo: British Chief Medical Officer Sir Liam Donaldson demonstrates how to sneeze during a visit to Tyssen Community School, in north London, to help combat the swine flu. Photo credit: Shaun Curry  /  AFP  /  Getty Images

It's Global Handwashing Day! (Do you know where your soap is?)

October 15, 2009 | 12:18 pm

Today, Global Handwashing Day is being celebrated in 70 countries around the world, with ritual hand-washing clinics, children singing about the disease-preventing benefits of hand-washing and, of course, a heartwarming study to explore what messages work best in promoting the use of soap in hand-washing. (Because -- join in with me here -- water doesn't kill germs; soap does!)

Researchers from the London School of Hygiene and Tropical Medicine spent several months leading up to last year's Global Handwashing Day peering through a camera's lens at men and women using a service station's restroom at a major crossroads in Britain. Their challenge: to gauge not only how many people actually use soap when they wash their hands, but also what messages -- flashed onto LED screens at the entrance to the toilets -- will most effectively induce people to use soap when they wash their hands?

They have gleaned these truths about men, women and hand-washing.

Continue reading »

Dude, wash your hands!

September 11, 2009 |  6:00 am

HandsMessages to reach college students about the importance of proper hygiene to prevent flu outbreaks probably isn't working, according to a new study. Already this fall, several colleges and universities have been flattened by the H1N1 (swine) flu pandemic. Swine flu has already been reported at 149 of 204 schools. Washington State University has experienced one of the harshest outbreaks, with at last 2,500 students seeking healthcare for flu-like symptoms.

In the new study, published in the September issue of the Journal of Environmental Health, researchers observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak at a university in Ontario, Canada. Only 17.4% students followed proper hand-hygiene protocols -- such as washing with soap and water for at least 20 seconds. But a whopping 83% of the students said they were complying with proper hand hygiene advice.

"Typically, health officials put up posters and signs and rely on self-reporting to determine whether these methods are effective," said a co-author of the report, Ben Chapman, of North Carolina State University, in a news release. "And people say they are washing their hands more. But, as it turns out, that's not true."

Chapman says the information aimed at students has to be compelling in order to get them to change their behavior. He suggests officials use practical ideas, such as posters that point students to the nearest hand sanitizer unit. Posters and brochures should use language that kids use, he adds. Don't say "gastrointestinal illness" when you could say, "this bug will make you puke your guts out."

"If your audience consists of students," he said. "You should use media that students use."
-- Shari Roan

Photo credit: PR Newswire

Daycare doesn't protect against asthma later

September 8, 2009 | 10:43 am

Daycare The "hygiene hypothesis" is a theory that young children who are exposed to a variety of germs will have a lower risk of developing asthma and allergies later in life. Studies on the hypothesis have been inconsistent. The latest study, published today in the American Journal of Respiratory and Critical Care Medicine, concludes that daycare has no effect on later respiratory illnesses.

The researchers, in the Netherlands, followed nearly 4,000 Dutch children over eight years. Parents completed questionnaires at various intervals of the child's life, from pregnancy to age 8. At that age, more than 3,500 of the children were assessed for specific allergies and asthma. Daycare use was also assessed each year.

The study found that children who started daycare early were twice as likely to experience wheezing in the first year of life compared with those who didn't go to daycare. But as the children became older, the illness pattern shifted. There was a trend for less wheezing among early attendees. By age 8 there was no association between daycare attendance and wheezing. The only children who stood out in the study were those who had early daycare attendance and older siblings. Those children had more than a fourfold higher risk of frequent respiratory infections and more than twofold risk of wheezing in the first year compared with children without older siblings and daycare.

"Children exposed to both early daycare and older siblings experienced most infections and symptoms in early childhood, without a protective effect on wheeze, inhaled steroid prescription or asthma symptoms until the age of eight years," the lead author of the study, Dr. Johan C. de Jongste, said in a news release. "Early daycare merely seems to shift the burden of respiratory morbidity to an earlier age where it is more troublesome than at a later age. Early daycare should not be promoted for reasons of preventing asthma and allergy."

-- Shari Roan

Photo credit: Luis Sinco  /  Los Angeles Times

Dogs and dog owners share germs

January 29, 2009 | 10:58 am

Dog1There are two kinds of people: those who allow dogs to lick their faces and those who are repulsed by that. But if you allow Fido to lick your face or sleep in your bed, you're no more likely to harbor disgusting germs than pet owners who practice stricter human-pet hygiene practices.

Research by Kansas State University veterinarian Kate Stenske looked at dog owners, their dogs and the incidence of E. coli bacteria, a common bug found in the gastrointestinal tracts of dogs and humans. Stenske found that more than half of the owners allowed their dogs to sleep in their bed and lick them on the face.

"There is such a strong bond between dogs and their owners. If you look at one study, 84% of people say their dog is like a child to them," Stenske said in a news release. "We also know diseases can be shared between dogs and people. About 75% of emerging diseases are zoonotic, meaning they are transferable between humans and other animals."

E. coli can cause serious health problems when it acquires genes that make it resistant to antibiotics. Stenske found that 10% of the dog-human pairs shared the same E. coli strains and that the strains had more antibiotic resistance than was expected. The owners had more multiple-drug resistant strains than their pets, which means it's more likely owners spread such strains to their pets than pets spread to their owners. While bed-sharing and face-licking didn't increase the prevalence of E. coli, owners who didn't wash their hands after petting their dogs or before cooking meals did have more antibiotic-resistant E. coli. The study is scheduled to appear in an upcoming issue of the American Journal of Veterinary Research.

Future studies should explore the same relationship between cats and their owners, she suggested. "We have a lot to learn. In the meantime, we should continue to own and love our pets because they provide a source of companionship. We also need to make sure we are washing our hands often."

-- Shari Roan

Photo credit: Kansas State University

Women's hands are friendlier to germs than men's hands

November 4, 2008 |  1:21 pm


For the gender that considers itself the more fastidious (and has the studies to back up the claim), we women may be chagrined to learn that we harbor more varieties of germs on our hands than men do.

In fact, we all -- male and female -- have whole worlds on our hands, and they’re more diverse than anyone suspected.

In a study published online Monday in the Proceedings of the National Academies of Science, researchers at the University of Colorado at Boulder swabbed 102 human palms and found more than 4,700 species of bacteria.

Species varied from person to person; just five were shared among all 51 of the study’s student volunteers. They even differed from hand to hand. An individual’s right had different species than the left.

It’s well-established that hands are hotbeds for bacteria. That’s why everyone from mothers on up to the national Centers for Disease Control and Prevention admonish us to wash them.

What set this study apart is that it looked not at abundance but at diversity.

It did so by extracting DNA from samples gathered on cotton swabs rather than using the standard method of trying to culture the samples in petri dishes to see what kinds of bacteria would grow. According to Noah Fierer, assistant professor of ecology and evolutionary biology and the paper’s lead author, the older technique tends to greatly underestimate the number of species.

"Bacteria are tough to identify," he said. "Most of them can’t be grown in the lab. The best way we have of identifying them is to look for their DNA."

Fierer doesn’t know why women have a greater variety of bacteria than men do. It could be that men’s more acidic skin discourages some species, or that sweat, hormones or women’s greater use of hand creams play a role.

"The findings don’t necessarily mean that women have more germs than men, just more variety," he said, rather gallantly, in a phone interview.

Not all bacteria found on hands are harmful. Most are probably neutral, Fierer said, and some may protect the skin from pathogenic varieties. But until scientists better understand what’s normal across individuals, it will be difficult to determine which species contribute to or protect from diseases.

Washing hands, by the way, reduces the abundance but not the variety of microbes. A diverse community re-establishes itself within hours, the study found.

This doesn’t mean that applying soap and water is futile.

"We’re not saying at all that washing hands is not a good idea," Fierer said. "We know that it reduces abundance and has a large effect on pathogens."

The study was funded by the National Institutes of Health and the National Science Foundation. (For a video interview with the researchers, click here.)

-- Mary Engel

Photo: Human palms are home to many species of bacteria. Here, hands reach for the ball during an Olympic volleyball game in August.

Credit: Robert Gauthier / Los Angeles Times


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