NATIONAL HANDWASHING AWARENESS WEEK, DECEMBER 5th-11th

Elizabeth Bentley, PharmD Candidate 2011

“No part of human skin is spared from bacteria. Bacterial counts on the hands range from five thousand to five million colony-forming units per square centimeter.”¹

—Atul Gawande in Better: A Surgeon’s Notes on Performance

Tired of missing classes and finals because you have a bad case of the sniffles? In the midst of the cold and flu season, National Handwashing Awareness Week (December 5 to 11) emphasizes the importance of keeping your hands clean to prevent nasty infections. In addition to getting a seasonal flu vaccine, handwashing is a powerful weapon in stopping the spread of disease.

The Centers for Disease Control and Prevention stress the need to wash hands to lower the incidence of infections of all kinds.² Roll up your sleeves, and get out the soap and water:

·       Before preparing a meal

·       After handling raw meat

·       After changing a diaper

·       After coughing, sneezing, or blowing your nose

·       After going to the bathroom

·       After touching an animal or anything in its immediate surroundings

In addition to making handwashing a habit, it’s essential to complete your task in the right way.² Using soap and warm water, rub your hands together to make a good lather that completely covers your skin. Try to keep this up for 15 to 20 seconds, or approximately the time it takes to sing “Happy Birthday” twice. Beatles fans may want to try repeating the refrain to “Let It Be.” During this time, interlace your fingers to reach all the creases.³ Let the water run again, and rinse your hands thoroughly. After drying with a paper towel, take that same towel to turn off the faucet.

Alcohol-based hand sanitizers are good options when you can’t get to a sink.² Simply apply the product to one palm, and rub both hands together until dry. Make sure the product contains at least 60% alcohol, because anything less than that won’t be effective.⁴ It’s important to know that these products do not eliminate all bacteria and are not effective if hands are visibly dirty.² In these cases, it’s best to find a sink and scrub up.

Dr. Will Sawyer, who has been promoting infection prevention for more than a decade through his Henry the Hand Foundation, emphasizes the 4 principles of hand awareness.⁵ This goes a step beyond mere handwashing. 1) Always wash your hands if they are dirty and before you eat a meal. 2) Don’t cough into your hands. 3) Don’t sneeze into your hands; use the crook of your elbow or a tissue instead. 4) Don’t put your fingers in your eyes, nose, or mouth.

So remember: Before you ask Aunt Martha to pass the pumpkin pie this holiday season, make sure you’ve both washed your hands.

For More Information

Centers for Disease Control and Prevention: http://www.cdc.gov

Henry the Hand Foundation: http://www.henrythehand.com

World Health Organization: http://www.who.int

References

1. Gawande A. Better: A Surgeon’s Notes on Performance. New York, NY: Picador; 2007.

2. Centers for Disease Control and Prevention. Wash your hands. http://www.cdc.gov/features/handwashing/. Accessed December 2, 2010.

3. World Health Organization. Five moments for hand hygiene. http://www.who.int/gpsc/tools/Five_moments/en/index.html. Accessed December 2, 2010.

4. Franklin D. Hand sanitizers, good or bad? New York Times. http://www.nytimes.com/2006/03/21/health/21cons.html. Published March 21, 2006. Accessed December 3, 2010.

5. Henry the Hand Foundation.  Henry the hand—champion handwasher: national handwashing awareness week. http://www.henrythehand.com/pages/content/hwaw.html. Accessed December 2, 2010.

 HEALTHY SKIN

Xin Zhang, PharmD Student, Class of 2014

Nikki Herlich, PharmD Candidate, Class of 2011

When the Chicago winds blow in December, that usually signifies another tough winter season, so it's is a good time to talk about how to protect your skin when the weather gets cold and the heaters turn on. We will focus on two topics:  dry skin and sunburn.

Dry Skin

In winter, the air outside loses humidity, and the steady use of heaters inside makes the air even drier. Dry air leads to dry skin.  We need to protect the skin’s balance between water and oil to prevent dryness.¹

What can I do to prevent dry skin?

To bring the skin’s water and oil content back into balance, a cleanser or a moisturizer is helpful.² A mild cleanser, like Cetaphil, helps to remove excessive oil from the skin while avoiding irritation.^2,3  Soaps that are closer to neutral pH and have higher oil content are also less drying.⁴ Examples of these are glycerin soaps or unscented Dove (fragrance is irritating to sensitive skin). Bathing 2-3 times per week in tepid water, not hot, with bath oil for 3-5 minutes is helpful to treat dry skin as well, but longer than 10 minutes is drying.^1,4 Avoid products containing alcohol and the alkali metals sodium and potassium because when mixed with water they are harsh on the skin.

A moisturizer helps to trap and maintain water content in the skin. Of the moisturizers, ointments are thicker, more occlusive options whereas lotions and creams are lighter lubricating agents.⁴  Avoid gels as they are drying.  When choosing a moisturizing product, you should pay attention to the active ingredients. Products like Eucerin are emollients that help lubricate the skin. Some ingredients, such as urea, glycerin, and alpha hydroxy acids, function by absorbing water from their surroundings. Thus, they work best after bathing when the skin is still wet.⁵ If you have sensitive skin, consider a fragrance-free moisturizer because fragrance may cause irritation or allergy.⁶

A healthy lifestyle is also important in preventing dry skin.⁵ The association is not clear, but data suggest a healthy diet keeps skin young and fresh. For that reason, remember to drink plenty of water every day. In addition, you should try to include sufficient amounts of vegetables, fruits, and whole grains in your diet. Take steps toward quitting smoking. Smoking is harmful for your skin because of the exposure to a variety of toxins. Since stress also causes wear of the skin, managing your stress level is good for your mind and your skin. Schoolwork is a major source of stress for a college student. When possible, you should try to relax and do something you enjoy.

Sunburn

Most people enjoy basking in warm sunshine, and sunlight is necessary for Vitamin D development, calcium absorption, and bone development.⁷ Unfortunately, excessive exposure to sunlight, especially ultraviolet (UV) light, may result in sunburn, accelerated aging of the skin, or even skin cancer.⁸ People tend to pay less attention to sunburn risk in winter. However, the sunlight and its accompanying ultraviolet radiation can be just as strong in winter as it is in summer. Snow actually reflects UV light, which increases the risk.⁹ A cloudy day does not mean you should go outside unprotected.

How can I prevent sunburn?

Sunburn prevention can be as simple as seeking shade and wearing long-sleeved clothing while outdoors.⁸ In August 2010, the American Academy of Dermatology installed shade structures in two parks in Chicago.¹⁰ The new structures, at 4712 W. Belmont and the corner of Lincoln and Addison, are part of the Academy’s Be Sun Smart^Ò initiative to reduce the incidence of skin cancer. The skin not covered by shade should be protected by sunscreen, the key to prevent sunburn. Despite skin type, a broad-spectrum, water resistant sunscreen with at least sun protection factor (SPF) 30 is recommended year-round by the American Academy of Dermatology.⁹ Most people think SPF is the strength of protection a sunscreen provides, but that is a misnomer.  It actually describes the length of time a person can stay in the sun before burning compared to the time it would take to burn without sunscreen.¹¹  SPF 30 should allow a person to stay in the sun 30 times longer than usual before burning, assuming the person reapplies appropriately. To get the glow of tan skin without the risk, use a sunless self-tanning lotion instead of tanning beds.⁵

Some tips for choosing and using sunscreen products

Use of a broad-spectrum sunscreen ensures that you are protected against both UVA (the “aging” UV light) and UVB rays (the “burning” UV light).⁸ When you are choosing a sunscreen product, pay attention to the active ingredient(s) in it. For example, avobenzone is a common active ingredient for chemical protection, while zinc oxide is a common active ingredient for physical protection. Both are good options that work in different ways; chemical sunscreens absorb the sun’s rays while physical sunscreens reflect the sun’s rays.¹² The chemical p-Aminobenzoic acid (PABA) used to be a common active ingredient; now most sunscreens are PABA-free because of its potential to induce allergic reactions.¹³

For optimal protection, you should remember to apply sunscreen within 15 minutes to half an hour before going outside.¹² Don’t forget to apply a sufficient amount, which is about one ounce for the whole body.⁹ Reapply your sunscreen every 2 hours, or after swimming or perspiring heavily.¹²  A water-resistant sunscreen lasts longer than normal sunscreens if you are perspiring or swimming, but even a water-resistant sunscreen needs to be reapplied often, since its activity is lost if you are in water for more than 40 minutes.⁹

When should I see a dermatologist?

If you have any concerns, do not hesitate to see a doctor. If your dry skin is resistant or you have any cause for worry, like bleeding or infection, contact your physician.⁶ He or she will assess your skin and work with you to develop an effective treatment plan. See a dermatologist if you see any new moles or changes in existing moles as these may be signs of skin cancer.⁸ When caught early, skin cancer has a good prognosis. You can look for changes in moles at home using the ABCDE model.¹⁴ If any of these pertain to you, make an appointment with a dermatologist immediately: 

·      
A   A – Assymetry

·        B – Border irregularity

·        C – Color variation

·        D – Diameter greater than 6mm

·        E – Evolving and Elevated

References

1. American Academy of Dermatology. Dry skin & keratosis pilaris. http://www.aad.org/public/publications/pamphlets/skin_dry.html. Accessed October 27, 2010.

2. American Academy of Dermatology. Cosmeceutical facts and your skin. http://www.aad.org/public/publications/pamphlets/general_cosmeceutical.html. Accessed October 27, 2010.

3. Cetaphil. Cetaphil cleansers:  ingredients. http://www.cetaphil.com/Products/GentleSkinCleanser.aspx. Accessed October 28, 2010.

4.  Scott SA, Martin RW III. Atopic dermatitis and dry skin. In:  Berardi RR, McDermott JH, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 16^th ed. Washington, DC:  American Pharmacists Assocation; 2004:811-830.

5. American Academy of Dermatology. Dermatologists share top 10 tips for healthy skin, hair, and nails. http://www.aad.org/public/healthy_skin.html. Accessed October 27, 2010.

6. Mayo Clinic. Moisturizers: options for softer skin. http://www.mayoclinic.com/health/moisturizers/SN00042. Published December 16, 2008. Accessed October 27, 2010.

7. Bringhurst F, Demay M, Krane S, Kronenberg H. Bone and mineral metabolism in health and disease. In: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 17th ed. http://www.accessmedicine.com.proxy.cc.uic.edu/content.aspx?aID=2882031.

8. American Academy of Dermatology. The sun and your skin. http://www.aad.org/public/publications/pamphlets/sun_sun.html. Accessed October 27, 2010.

9. American Academy of Dermatology. Facts about sunscreens. http://www.aad.org/media/background/factsheets/fact_sunscreen.htm. Accessed October 27, 2010.

10. American Academy of Dermatology. Making the outdoors safer in America: American Academy of Dermatology donates shade structures to Chicago Park District and 37 other organizations. http://www.pwrnewmedia.com/2010/aad_2010_summer_meeting_00805/downloads
/Shade_Structure_2010.pdf. Published August 5, 2010. Accessed October 27, 2010.

11.  Desimone EM II. Prevention of sun-induced skin disorders. In:  Berardi RR, McDermott JH, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 16^th ed. Washington, DC:  American Pharmacists Assocation; 2004:929-953.

12. Schwartz RN, Corporon LJ. Skin cancer. In:  DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7^th ed. New York, NY: McGraw-Hill; 2008:2311-2330.

13. Bickers D. Photosensitivity and other reactions to light. In: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 17th ed. http://www.accessmedicine.com.proxy.cc.uic.edu/content.aspx?aID=2868622.

14. American Academy of Dermatology. ABCDEs of melanoma detection. http://www.aad.org/public/exams/abcde.html. Accessed November 5, 2010.