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26/02/2018 13:48 SAST | Updated 26/02/2018 13:50 SAST

What We Can Learn About Handwashing From The Olympics Norovirus Outbreak

Over 250 staff, volunteers and athletes have been taken ill.

An unwelcome visitor plagued the Winter Olympics in PyeongChang. More than 250 staff, volunteers and athletes have contracted Norovirus, an extremely contagious illness that causes debilitating abdominal pain, vomiting, diarrhoea, fever and muscle aches.

Infection occurs by ingestion of microscopic particles of the stool or vomit of an infected person, which can occur more easily than you'd like to imagine. Contaminated food, doorknobs – even handshaking can facilitate transmission. So not surprisingly, there's serious talk about saying goodbye to the traditional post-game handshake, in particular following a friendly game of ice hockey.

As a doctor, I'm the first to say handshaking has lost much of its lustre. But although I feel reassured by avoiding contact, it's still easy to fall victim to a microscopically infected surface. What does allow me to sleep soundly though, is knowing that I have another strong ally on my side: handwashing.

Shirking the age-old tradition of shaking hands isn't your best defence against a big bad bug like norovirus. That would be soap and water.

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According to the U.S. Centers for Disease Control (CDC), soap and water is your best bet against norovirus, as this germ may resist the powers of ethanol-based hand sanitiser. In fact, over-reliance on such hand sanitisers may predispose a population to norovirus outbreaks. Yet as the outbreak in PyeongChang unfolded, media excerpts continued to describe military-like enforcement of hand-sanitiser use; of distributing "hundreds of bottles of 62-percent ethanol hand sanitiser." What was needed to come to the rescue is good old-fashioned soap and water.

If you're a hand-sanitiser convert, you may feel like your world's been turned upside down. There's no need to change up your daily routine, though; in most cases, you're still going to be battling everyday bugs effectively. But it's important to be aware of what science tell us, what the experts recommend when it comes to washing (and why), and what scenarios may warrant a change from your usual routine.

Studies have compared different handwashing techniques in a variety of settings both in vitro (in the lab) and in vivo (on us.) Most of the time, for common infections such as those that cause run-of-the-mill common colds and gastroenteritis (vomiting and diarrhoea,) alcohol-based hand sanitiser comes out on top. When it comes to the flu (influenza) under the microscope, soap and water eradicates a bit more of the virus, but their effectiveness in everyday life is fairly equal.

The problem lies in the few big powerhouse germs that may resist the powers of alcohol-based hand sanitisers: cryptosporidium, clostridium difficile and the norovirus. Cryptosporidium is a parasite that causes diarrhoea; clostridium difficile is a bacteria that capitalises on bowels stripped of their good bacteria through antibiotic use, often resulting in severe diarrhoea, dehydration and hospitalisation. Soap and water are required in these situations.

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Here's a basic review of the CDC's recommendations on hand-washing:

1. For visibly soiled hands (you can see the dirt), a good lather with soap and water is a must. These big particles need the friction that we create with our scrub to be eliminated.

2. When washing with soap and water, ensure you're covering all fingers, thumbs, backs of the hands and in between. Scrub for at least 20 seconds (or singing "Happy Birthday" twice,) rinse well with running water and dry with air or by a clean towel.

3. If a good scrub with soap and water using proper techniques is not available to you, choose an alcohol-based hand sanitiser instead – but one that has at least 65 percent alcohol content.

Hand sanitiser isn't recommended as a first-line defence because in real-life conditions, people don't use enough product, and they don't rub it in until it fully dries, limiting its effectiveness. Plus, pesticides and heavy metals can also be found on our palms, and require the friction of soap and water washing to be removed effectively.

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If you're on-the-go, and you just don't have access to soap and water, you can certainly use a convenient pocket hand sanitiser. But be sure to pick one with at least 65 percent alcohol content and use it as directed. When soap and water become available, suds-up occasionally in order to get rid of chemicals and other contaminants.

So that's the low-down. The most important part? Make sure you're washing regularly. If you know of a particular bug that's responsible for making others around you sick, choose your weapon wisely. And whether you choose to fist-pump or handshake, know that a good hand wash has your back.

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