Hand sanitizers work!

As is often the case, the best new wilderness medicine news is not in the outdoor or the wilderness medicine literature. Instead, it can be found in rigorous studies reported in major peer-reviewed journals. A recent study reported in the Pediatric Infectious Disease Journal is a case in point.

With the recognition that poor personal hygiene, not drinking water, is the real culprit leading to gastrointestinal distress among backpackers, more attention is being paid to hand sanitation. Although good ol' soap and water is the tried and true approach to this, it is not always practical in the backcountry. Lately, a lot of folks have been using alcohol-based hand sanitizers instead. Although I have admired their attention to hygiene, I have wondered if this approach was effective.

A group of French investigators have studied the hand sanitizer intervention in a group with a huge susceptability to hand-to-mouth transmission of gastroenteritis: 5 to 10 year old kids. Basically, the intervention was quite simple. In one school, all students underwent supervised use of hand sanitizers several times a day. In another school, they did not. The numbers of children developing diarrhea and/or vomiting during the study period were compared between the schools. The "intervention" school experienced about half of the number of GI infections as the control school. There were similar differences demonstrated between the schools in doctor visits, days lost from school, and working days lost by parents. There were no complications associated with the use of the gel.

Other studies have looked at the biology of this (effectiveness of gels in killing organisms in the lab) and at the use of the agents in the health care setting. This is the first well-designed trial of such an intervention among laypersons. The results are pretty impressive.

Sure, a French elementary school ain't a trek in the wilderness. Yet, the impressive results in a very high-risk group with very large numbers is compelling. I think that we can rest assured that this approach in the back country is now evidence-based.

The exact citation for the study is: Pediatric Infectious Disease Journal 2010;29(11)994-998.