A handful of infections

Dr Vikas Sharma

The handshake is so common a social custom that we often do it without even giving it a thought. In recent years, however, there has been increasing recognition of the significance of hands as vectors for infection, leading to formal recommendations and policies regarding hand hygiene in hospitals and other health-care facilities.

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Don’t do it

Atopics or those having hand dermatitis or eczemas, palmar psoriasis should, as a rule, avoid using hand sanitisers as their existing skin cell disturbances can get aggravated or worsen. Hand sanitisers can be useful if you have no soap or water around but if soaps are available then it’s much better to opt for these. Be pro-active and must check the labels on the hand sanitiser bottle mentioning the component and the concentration of active ingredients to be safe.

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Mode of transmission

Hospital-acquired infections are a tremendous problem. The Centers for Disease Control and Prevention (CDC), USA, estimates that on any given day, about one in 25 hospital patients have at least one healthcare-associated infection. These infections are especially harmful in hospitals, where patients, who are recovering and have a compromised immune system, are vulnerable. And the more these pathogens within hospitals get to spread, the more resistant to conventional treatments these can become. If we ever do cross into a post-antibiotic age, the problem of superbugs in hospitals will only get worse.

The handshake has been established as a pathogen-transmitting practice since the twentieth century. Hospitals all over the world have instituted hand-cleaning practices as a result. However, hospital staff compliance to this practice can be as low as 40 per cent. Alcohol-based soaps, used in hospitals to clean hands, aren’t nearly as effective as we think. These can be even harmful in the long run.

The duration of survival of bacteria and viruses on the hands of health-care workers varies by pathogen and environmental factors. Moreover, hand-related transmission of organisms in the health-care setting can contribute to the burden of antimicrobial resistance.

The bad touch

Fungal skin infections can get transmitted by direct skin contact. There has been a rise in incidence of fungal skin infections and also an increase in incidence of resistance to conventional antifungal medicines. Similarly, some viral infections can also be transmitted via direct contact. Mite infestations like scabies can also get transmitted.

Diabetics, patients on dialysis for chronic renal failure, and those with chronic dermatitis are particularly likely to have skin areas colonised with harmful bacteria.

Despite efforts to cleanse the hands of hospital workers, handshakes are still very likely to transfer pathogens between patients and doctors and nurses. 

Use sanitisers cautiously

At times, hospital staff can over indulge in the usage of sanitisers. This over usage of some hand sanitisers is also harmful as some of these contain certain harmful ingredients.

Triclosan, the active ingredient in hand sanitiser, can kill off the good bacteria on your hands and allow antibiotic-resistant bad bacteria to grow. Triclosan-based products, if used in excess, can make bacteria resistant to antibiotics.

Some hand sanitisers that contain Bisphenol, if used in excess, can be dangerous. Studies have linked high amounts of Bisphenol to hormone disorders, heart disease, infertility and even diabetes.

Most commonly used hand sanitisers contain chemicals that increase the ability of certain compounds to penetrate deep under the skin.

Bisphenol also lingers on the skin, so if a person eats immediately after using sanitiser on their hands, he or she would be effectively getting a double dose of the chemical, once through the skin, and the second time by eating it.

Triclosan in higher quantities can also negatively affect human immune function. Compromising of the immune system can make people more susceptible to allergies and more vulnerable to the toxic chemical Bisphenol. 

If your hand sanitiser is scented, then it’s likely to be loaded with toxic chemicals. Companies aren’t required to disclose all ingredients that make up their so called secret scents. Most of these products generally include various other chemicals as well. Among these are some synthetic fragrances known to contain phthalates which are endocrine disrupters that mimic hormones and could alter genital development in children. 

We should avoid shaking hands in hospitals considering the tremendous social and economic burden of hospital-acquired infections and antimicrobial resistance.

 — The writer is chief consultant dermatologist, National Skin Hospital, Panchkula