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Don’t Stop Hygiene – Hold on to that Feelin’!

If there were a theme song for the past few months, I think we would all agree it would be something closely resembling Hear Comes the Sun, the classic by the Beatles. The smiles are returning, and it certainly feels like years since the long, cold lonely COVID-19 winter began! However, as a public health professional, I wish we were all singing the 80’s classic Don’t Stop Believin’ by Journey because this epidemiologist wants you holding on to the feeling of hygiene. I want us, though we are excited to re-open, to remember what we have learned and continue to embrace the public health awareness brought on by the pandemic.

But I cannot say everyone agrees. In the past few weeks, the number of articles written to combat “Hygiene Theater” disinfection antics is increasing at an alarming pace.1,2 The pendulum of public opinion is swinging and we are ready to move into the future by returning to the pre-2020 “normal” instead of a “new normal” as I had hoped. As I sit here contemplating how to articulate why I feel strongly we should not return to old behavior, I need to pause to reach for a tissue. I have a cold. This is a strange and rare phenomenon lately, but I have concerns it will soon be a wide-spread experience as more of us begin to re-emerge from our homes and our careful precautions give way to old habits. Instead, my hope is that as we enter a post-pandemic world, we bring forth the lessons we have learned over the past year to create a healthier future for all.

Here’s what we know: COVID-19 can be transmitted on surfaces, but it is unlikely to be the main source of transmission.

We all remember the early days of the pandemic when we would wipe down our groceries, packages, and lived in constant fear of catching the virus. We did this because we did not yet know enough about this emerging pathogen and we wanted to protect our loved ones. We now know much of this was unnecessary as the principal mode of transmission of SARS-CoV-2 is through exposure to respiratory droplets in the air and not through surfaces (or fomites).3 Though some might call this theater, I think it was simply our attempt to mitigate the risk of a very scary pathogen from entering our homes. Similarly, out of this fear and with a hope to restart our economy during a pandemic, our communities and businesses went into disinfection and sanitization overdrive (i.e., Hygiene Theater).

If a business is purely using disinfectants for show and more importantly, not using them safely and in accordance with label instructions, then I believe we will all lose sight of the lessons we have learned over the past year.

In this way, I agree with many voicing their concerns publicly. However, we cannot just throw away the public health awareness we have gained over the past year and we cannot make the mistake of thinking COVID-19 is the only pathogen posing a threat to our future health, safety and economy. My optimism on this subject in my November Hygiene Theater Blog still holds true today. We have an opportunity to turn this heightened awareness of germ transmission into actionable infection prevention in our communities.

Over the past year, we have also seemingly forgotten about all the other microbes and pathogens that live and thrive on our surfaces. 

Illnesses such as the Flu have virtually been wiped out by our COVID-19 precautions but as evidenced by my current nasal congestion, they have not gone away and will return to our spaces with us. Norovirus, for example, is a virus that causes vomiting and diarrhea and thrives on surfaces in areas where large numbers of people congregate. Norovirus outbreaks are common and frequently found on cruise ships, in long term care facilities, and in school and childcare settings. You may hear norovirus illness referred to as “food poisoning,” “stomach flu,” or “stomach bug” and because of the large number of variants, we can be infected repeatedly.Close quarters, shared spaces, and high-touch surfaces make it easy for norovirus to spread.

Although the number of norovirus outbreaks have been drastically reduced during the pandemic, norovirus, on average, each year results in over 19 to 21 million cases of vomiting and diarrhea in the United States. It is estimated by the age of five, 1 in 110,000 children will die and 1 in 160 will be hospitalized due to norovirus.4 In 2016, researchers estimated that norovirus resulted in a total of $4.2 billion in direct health system costs and $60.3 billion in societal costs (including productivity loss and income) per year.5

People are ready to return to normal life and we have an opportunity to impact what that looks like.

We must, now more than ever, implement sanitation protocols and base them on risk assessments and scientific evidence. One of the best examples of this is hand hygiene. The simple act of washing our hands more frequently is our first line of defense yet hand hygiene compliance rates are low and we often contaminate surfaces without even realizing it. In fact, nearly 80% of infectious diseases are spread by our hands and the surfaces we touch.6 This is why surface disinfection is such a critical tool in our efforts to break the chain of infection. Our approach to the use of disinfectants and sanitizers needs to be in a way that is not only effective but also efficient. This involves prioritizing places where the risk of pathogen spread is greater, like high traffic, shared spaces, and frequently touched surfaces. By utilizing SMART Disinfection practices (think “work smarter, not harder”), we can target disinfecting higher risk areas to reduce pathogen transmission while also optimizing the use of disinfectants and hopefully preventing concerns of overuse in our communities.

The curtain might be closing on COVID-19 theater, but that doesn’t mean our work is done.

References

1.       Thompson D. Deep Cleaning Isn’t a Victimless Crime The CDC has finally said what scientists have been screaming for months: The coronavirus is overwhelmingly spread through the air, not via surfaces. [Internet]. The Atlantic. 2021. Available from: https://www.theatlantic.com/ideas/archive/2021/04/end-hygiene-theater/618576/

2.          Anthes E. Has the Era of Overzealous Cleaning Finally Come to an End? [Internet]. The New York Times. [cited 2021 Apr 23]. Available from: https://www.nytimes.com/2021/04/08/health/coronavirus-hygiene-cleaning-surfaces.html

3.          CDC. Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments – Updated Apr. 5, 2021 [Internet]. Centers for Disease Crontrol and Prevention. 2021. p. 5. Available from: https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html

4.          CDC. Norovirus Burden of Norovirus Illness in the U.S. CDC [Internet]. Centers for Disease Crontrol and Prevention. 2020 [cited 2021 Apr 23]. Available from: https://www.cdc.gov/norovirus/trends-outbreaks/burden-US.html

5.          Bartsch SM, Lopman BA, Ozawa S, Hall AJ, Lee BY. Global economic burden of norovirus gastroenteritis. PLoS One [Internet]. 2016; Available from: https://pubmed.ncbi.nlm.nih.gov/27115736/

6.          Healthcare T-C. Gross! Hand hygiene and other germy facts [Internet]. 2018 [cited 2021 Apr 29]. Available from: https://www.tchc.org/blog/2018/12/12/hand-hygiene-and-germ-facts/