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Proper Sanitation (9/13/99) Friends, It's that time of the year again when we have to be concerned about colds, influenza (flu), and the serious complications these can bring to the PALS, especially those who have bulbar symptoms that involve speech, swallowing and breathing. Over the course of the past several years, I've noted some things that I'd like to pass on that could save the lives of some of you, if you follow them meticulously. Those
who have such involvement and don't follow such advice could shorten
a PALS' lifespan considerably. I don't make these comments to scare
anyone, but I share the thoughts because I've experienced several
families' grief over the premature loss of PALS due to complications
of colds and flu that can be prevented in most cases by changing
habits, taking precautionary measures, and establishing a few firm
rules of the home of a PALS that every family member and visitor
should be made aware of. 1.
A simple cold or flu can be deadly to a PALS with bulbar symptoms.
Colds, flu, bacterial or viral infections can significantly reduce
quality and quantity of life for any PALS. 2.
Some simple but important precautionary measures in the home can
help to preclude such fears or premature or unnecessary loss of
life---I call them "the A to Z sanitation practices for PALS".
a.
PALS families should take every precautionary measure possible to
shield or protect the PALS from others' germs. A CALS or child coming
in from a public area can bring in cold/flu germs. The germ may
not have had time to cause symptoms but can still cause illness
from the germs---during the fall/winter/spring months especially,
everyone in a PALS household should take every precautionary measure
possible to rid themselves of germs from public areas as soon as
they come into the house to preclude infecting the PALS. b.
Rule one. Establish a rule that everyone, no exceptions, always
washes hands after being outside or in public places---preferably
with antibacterial soap, preferably washing for 30 seconds of rubbing
with the soap, palms, in-between fingers, and backs of hands---taking
care not to merely allow water to wash the soap off the hands that
virtually eliminates the purpose of the soap---this is especially
true for children, surprisingly, for most adults as well. A liquid,
anti-bacterial soap in a liquid dispenser is good. Bars of hand
soap tend to spread germs. Attending a one-time training session
for volunteer hospital workers is often highly valuable and requires
no more than about one hour of one's time. The hour-long course
will teach one to wet one's hands first, then press liquid antibacterial
soap on the hands, rubbing the soap around fingers, backs of hands,
and thoroughly rubbing hands for a full 30 seconds before ever putting
hands back under the water for scrubbing for an additional 30 seconds.
The globs of liquid antibacterial soap in a lavatory is one of the
first indications that one doesn't know how to wash hands correctly.
c.
Everyone in the household should have their own hand towel and separate
bath towel---no exceptions. Guests should have their own---if a
guest, even a friend of a child's schoolmate, comes in for a few
minutes and uses a family member's hand towel, it should be thrown
in the dirty clothes hamper immediately after the child leaves and
replaced with a clean towel to help preclude spreading cold/flu
germs to a family member and the PALS---because colds or flu may
not show symptoms for hours or days after infection, the possibly
infected visitor may be infected and not know it or not show any
symptoms. Any "community" towel in the kitchen should
not be used by the PALS---a different solution for the PALS is to
use paper disposable towels in the kitchen---or to do away with
a community towel in the kitchen and everyone's using paper towels.
d.
Never allow anyone---ANY VISITOR---to enter the home of a PALS who
has bulbar symptoms, if that visitor might have a cold, flu, runny
nose, who may be coughing or sneezing, may look "peeked"
or pale as if sick, or any other similar symptoms. It doesn't matter
if it's a visiting mother, father or the president---don't allow
a visitor with such symptoms in the house, or, as a minimum, in
the same room with a PALS with bulbar symptoms. It's far better
to have someone experience a bit of disappointment (or even hurt
feelings) than to end the life of a PALS prematurely and unnecessarily
with a cold/flu germ. This is important---crucially significant---I've
seen, witnessed and observed people who have very good hearts, who
didn't want to offend a visiting friend or relative, who allowed
the visitor to come in, shake hands, hug, sneeze, cough or other
action that caused the PALS with bulbar involvement to catch the
same bug and die within days. The "loving" parent who
"just wants to give their son/daughter a little hug or kiss"
may be giving a kiss of death, if infected with a cold or flu germ----such
folks are usually self-serving for their own self-edification, not
for the patient----so hurting their feelings is a much less severe
consequence than premature death of the patient. Normally, this
is a totally unnecessary and preventable tragedy. (Suggest printing
this and giving all potential visitors, caregivers, nurses, relatives
and others a copy for educational purposes and to prevent hurt feelings---if
it might help, blame the "rules" on Ron White!!!) e.
Disinfect (don't just clean or wipe) every door knob (especially
on entrance/exit doors), water faucets, toilet, refrigerator/microwave
door and handle, and every lavatory in the house at least once per
week, and after every use by anyone in the family who has a cold/flu---better
yet, have a healthy family member serve the infected family member
with their water and other practical things to preclude spreading
germs to others in the same household. Having a can of spray Lysol
in every bathroom and kitchen (and leaving them out to use often,
daily, when anyone in the household is ill) would be prudent and
a good investment. f.
Never use and re-use handkerchiefs when anyone in the family has
a cold or flu---handkerchiefs simply retain germs that get on hands
after every use and spread thousands of germs. Instead, invest in
plenty of disposable tissues (DON'T use a roll of toilet tissue---such
is equally as bad as handkerchief use---I've been in some homes
of PALS, the family of which could afford to buy a dozen tissue
manufacturing plants, but have a roll of toilet tissue located centrally
for common use by everyone in the family---naturally, everyone in
the family had the same bug). Wash hands with antibacterial soap
after every use of a tissue when coughing, sneezing or wiping nose.
Do NOT use disposable tissues more than once. (I know---this sounds
rather gross and more common sensical than anything, but many readers
would be surprised at the number of people who "keep"
one single Kleenex for use a dozen or more times and never wash
after any single or multiple uses---spreading the germs not only
to their hands multiple times, but also getting the germs in their
pockets and clothing to be spread later, even after washing hands.)
(I've experienced times when I wished for a rubber decontamination
suit when visiting some folks with poor sanitation practices.) g.
Every member of the household should bathe or shower daily. Some
develop a habit in wintertime of not doing this, due to colder weather
and lack of perspiration. (Many Europeans, Canadians and others
do not take many baths or showers but "sponge bathe" most
of the time---this does NOT get rid of germs. It is much preferable
to shower or bathe by immersion in water than a mere sponge bath.
This is also true for CALS who may think a sponge bath is okay for
PALS----it isn't. Please try to get some assistance, if the CALS
can't manage to shower or bathe the PALS for whatever reason.) h. Change clothes daily and always wash clothes that have been worn once. This could be a nuisance for some, an inconvenience to others, and totally impractical for those who wear suits to work. The additional wear of washable clothing by changing daily can be a very wise and worthwhile precautionary action---the cost of clothing and washing clothes is nothing compared to the potential cost of a PALS shortened lifespan---(just to keep things in perspective).
j.
Steering wheels and auto door handles should not be omitted in disinfecting
and sanitizing items, especially when a PALS is ambulatory and/or
still being transported by vehicle. k.
A wheelchair is one of the most often omitted and forgotten items
to disinfect regularly, but is handled, pushed, and covered in others'
germs every time it is used, especially manual chairs, but also
battery-powered chairs. Seat cushions have millions of bacteria---whether
wheelchairs, sofa, rocking chair, or auto seats---and should be
routinely disinfected along with steering wheels, door handles and
chair handles. l.
Anyone who prepares food for PALS should take extra precautions
about spreading germs to PALS.It
is impossible to be "too sanitary" around a PALS, especially
in food preparation. Wash all fresh vegetables thoroughly---they've
been handled by pickers, packers, grocery stockers, the public,
and cashiers before you purchased them---and most of these had very
dirty hands and some handled some very dirty, germ-laden money.
Make sure PALS have fresh, clean drinking glasses---at least daily----if
in doubt about any dish, glass or utensil, getting a clean one is
always a good option. Also, I deplore servers who put their dirty,
greasy fingers on drinking glasses where I put my mouth to drink!!!
Develop a habit of picking up, serving or refilling glasses and
cups by picking them up from the bottom, rather than the drinking
edges---handle eating utensils by the handles, rather than the eating
parts. m.
NEVER allow an outside nurse or CALS to come to take care of a PALS
if the CALS has a cold or flu. There has to be some other alternative
(always have a back-up plan for this eventuality). Always inform
hired or volunteer CALS that they are to notify the PALS family
in advance and at the first sign of a cold/flu or feeling bad, so
alternate provisions can be made. One would be surprised at the
number of CALS, including nurses, who (without thinking) knock on
the door and come into the PALS' home sick as can be with the flu
to tell them how bad they may feel and "may not be able to
work today." Some nurses or aides will do this due to the need
for the income. Such is not worth the risk to either party. The
above information and precautions should be part of any interview
of any prospective volunteer or hired CALS. Simply tell hired employees
that they shall not come to work, if sick, and if they violate this
rule, their employment will terminate immediately with no recourse.
Let them know the rules "up front" and to notify you in
advance, even if the person "doesn't think anything serious
is wrong, but just doesn't feel well" so alternate arrangements
may be made. n.
Bathing and hygiene of the PALS is very important. It is difficult
for those who are no longer ambulatory, but a necessity nevertheless---regularly.
The PALS not only feels better after a shower or bath, but it also
gets rid of germs that may not have yet infected or shown symptoms
with the PALS. If the PALS takes a bath, it is often helpful once
or twice per week to pour two to four caps (up to a cup per five
to ten gallons of water) of household bleach (such as Chlorox) in
the bath water----it not only kills germs, but some PALS indicate
they actually feel better, have more strength and vitality afterwards---compared
to a "normal" bath with no bleach. This small amount of
bleach poured and stirred into bathwater should not affect color
of hair in any manner, nor should it irritate sensitive skin---if
in doubt, test sensitive skin with the bathwater before immersing
the PALS. (ALWAYS wash hands after using the bathroom---both the
PALS and the CALS who may be assisting the PALS!!! Without fail!!!
I know a nurse and her husband who never wash their hands after
using the facilities!!! Unbelievable, but true. This is usually
how a strain of hepatitis is contracted.) o.
Toothbrushes. Hanging toothbrushes close together on the same "convenient"
holder is a bad idea and a terrible invention from a health point
of view. Every toothbrush in the household should be kept in a sanitary
place totally separate from anyone else's. Toothbrushes should be
allowed to air and dry after use---do not put them in cabinet drawers
where they can accumulate germs, become infected, cause mold or
mildew, or cause other fungus to grow on them---always rinse toothbrushes
after use---preferably disinfect them before and after use due to
the living germs from the mouth where more bacteria grow than most
any other part of the body or environment. p.
Every member of the household should have his or her own tube of
toothpaste---never allow one tube to be used by more than one member,
as some families get in the habit of doing. q.
Be as sanitary with family pets in the home of a PALS as possible.
Anyone who is infected with a cold/flu should not have any physical
contact with the pet while infected to preclude spreading germs
to the PALS. Pets can get many germs and infections from humans,
but humans don't catch very many things from animals----and pets
can pass human contagions on to other humans. Just as good sanitation
practices might include washing before and after using the bathroom
by every member of the family, so might washing hands before and
after petting the dog or cat preclude passing germs to the PALS.
r.
Some adults, men and women alike, like perfumed hand lotion on their
hands at all times---some won't wash their hands when they should
to preclude washing the lotion off their hands---some use an expensive
hand lotion that smells good and makes them feel good---winter time,
weather, cold, and less humidity in the air may cause dry skin that
makes the use of hand lotions more desirable or necessary---and
other "reasons". Old habits and personal desires are hard
to break, but for the sake of the PALS, such things should be a
secondary consideration, habits broken or changed, and (if necessary)
apply lotion as much as ten or more times per day rather than taking
the chance of infecting a PALS with killer cold/flu germs, especially
if someone in the family or household is already infected. (If ever
I'm hospitalized, which is seldom, or when visiting a patient, I
literally "hate" it when a nurse comes in with her expensive
hand lotion on her hands----she most likely doesn't wash her hands
between care of multiple patients and other unsanitary activities.)
s.
Disinfect with a disinfectant that states on the bottle or spray
can that it is for this purpose. Something like "Lysol"
or other disinfectant should be used. Common household bleach diluted
with water kills germs as well. Merely washing with water, whether
hot water or cold, is totally unacceptable---but one should do this,
if this is all that is available---daily, if water is the only thing
available. Again, keeping a can of spray Lysol or other disinfectant
on every bath counter and a separate one for the kitchen can be
a prudent, sanitary and healthy thing to do. (Don't forget to sanitize
the cans and other things from commercial stores---a one-time sanitizing
when taken from the bag should be sufficient.) t.
Suggest purchasing one or two boxes of sanitary gloves (like the
type used in hospitals in a 250 count or more box) for cleaning,
for certain hygiene actions with the PALS, for use of bleach or
Lysol type disinfectants, (and for feeding a PALS, if a sole CALS
has a cold/flu and nobody else is available to assist---if the sole
CALS has a cold/flu, use of a face mask over the mouth and nose
is also advisable when feeding or caring for the PALS). In the U.S.,
such boxes of disposable gloves can be purchased at a SAMS or Wal-Mart
or other supplier of sanitary items. They are not expensive, but
they can be very valuable insurance at little cost. Such disposable
gloves should only be used ONCE!!! Once used, they are best to be
grabbed at the top and pulled off by turning them wrong-side out----then
immediately thrown in the trash---not laid on something to be contaminated
with germs. u.
If one has a dishwasher, consider using a "hot" cycle
during the cold months. For those who wash dishes by hand, the use
of bleach (such as Clorox) in the water (one cap per gallon) will
provide a germ killing solution and help get dishes and eating utensils
clean. (NOTE: Clorox and most bleaches are poison. However, one
can actually purify drinking water using such a mixture as one cap
per gallon of water, allowing it to sit an hour so the chlorine
gases and poisons evaporate---after about one hour, the dishes are
normally dry, and once dry, have no possibility of being toxic to
the user.) Those who hand-wash dishes should also consider rinsing
with a very hot water, perhaps boiling water, as a good practice.
v.
Computer mouse, keyboard and other items used commonly by members
of the same household should receive attention for disinfecting
regularly, making sure electrical items are unplugged and adequate
care/precautions are taken to ensure water doesn't get in/on electrical
parts. This is prudent, even if the PALS does not use the computer.
w.
Because wintertime is a time that many people have colds and contagious
viral infections, eating in public facilities can be a health hazard
to PALS. Nothing (short of an attentive manager/owner/supervisor)
prevents health care workers or food providers from working when
they have a contagious cold or viral/bacterial infection. Because
of this fact, eating out often can be hazardous to PALS. If a PALS
goes into a restaurant and notices that any employee has a cold
or flu-like symptoms, get out of the place as soon as possible and
go elsewhere---disregard reservations, if cold/flu is noted by any
employee. 3.
Some folks think/believe that once one member of the family gets
a cold/flu, that everyone in the household will inevitably get the
same bug. Such mindsets are normally those who don't, won't or refuse
to adopt many of the above sanitary practices in their own homes.
I have a close relative who doesn't practice many of the above,
and all of the family is normally ill most every winter. In our
own household, if one person gets a cold, hardly ever does anyone
else in the family get the cold, because we have made it a habit
to implement the above sanitary practices year around as a matter
of routine. The old thinking that "it's just one of those things"
or "we're all going to get it anyhow" is exercising poor
judgment based on false conclusions or old wives' tales. Any reader
can prove these types of assumptions to be false by practicing the
above sanitary practices. 4.
This subject might be a good subject for a family discussion, perhaps
to open the subject up for other ideas that might be implemented
by age-appropriate members of a household. The group participation
may help others to be more aware of sanitation and its importance
to the PALS, if they're given the opportunity to participate in
discussions and decisions regarding same---this is especially true
of children who may not completely understand the issues involved
or the gravity of consequences. 5.
I, personally, don't like to address such subjects, nor do I enjoy
addressing such sensitive, personal actions or tragic consequences
of such subjects. I'm uncomfortable in doing this. However uncomfortable
this and a few other subjects may be, I feel obligated to share
some things in order to save some lives from being lost prematurely.
I am certain, beyond any doubt whatsoever, that these comments and
suggestions will save some lives. A very few will not believe them,
not heed them, or be unwilling to adequately devote the energy or
attention to these subjects, and a terrible price will be paid.
Experiencing the anguish on the face and voiced guilt of one PALS
survivor would be more than enough to convince the most skeptical.
For the obsessive/compulsive types, the things I'm suggesting here
do not require 24-hour-per-day cleaning---instead, perhaps 20 or
so minutes per day, in addition to one's normal activities will
cover most all of the above actions quite adequately (plus a bit
more time at least once per week), unless you live in a 45,000 square
foot home like Bill Gates home---if that's the case, you can afford
to hire a hundred maids to clean 24 hours per day. This is merely
a common sense, not-too-often thought of subject that can and will
save someone's life this winter who reads and heeds the above advice.
6.
A well-ventilated home can be a much healthier environment for breathing,
sleeping, keeping germs out of the home than a closed, airtight
home. Ventilation with fresh air can help keep colds at bay. Getting
accustomed to a well-ventilated home by opening a window slightly
can be beneficial. Getting accustomed to the ventilation now, before
and at the beginning of winter can help the family to adjust to
the ventilation. PALS who are not ambulatory should be kept warm
by whatever means. Homes that are already "drafty" probably
need not open windows for ventilation. The additional cost of heating
as a result of ventilation can be well worth the cost in keeping
good health or in illness-prevention. Sorry
if I "grossed anyone out"---an American cliche` to the
non-U.S. reader. Anyone
else, such as nurses or hospital workers who are given special training
on sanitation---please feel free to add to the above---and please
feel free to print and use this information. One such practice,
even for volunteer Red Cross hospital workers, is an hour-long,
thorough class on "How to Wash Hands" with a minimum of
30 seconds of washing, how to wash in between fingers, backs of
hands that are often neglected, jewelry considerations that harbor
germs and are seldom disinfected, etc. One may think such things
pretty silly until one experiences the consequences the hard way.
I'm sure someone else could have done a better job at this than
me---some may think I need not have been so graphic or detailed---sorry.
I disagree. This is one important subject that cannot be thought
of as a daily routine subject. I've been graphic to get some people's
attention who won't change old habits, won't heed the advice, won't
consider it worthwhile to implement. All of us are not alike; few
of us have the same values or habits; and these need not be taken
as being adverse comments or criticisms to any one person or family
or service provider, nor are these suggestions all inclusive of
sanitation practices. Almost
everyone occasionally gets a cold. The incidence is highest among
school children (who may have as many as 10 colds per year) and
declines with increasing age. On average, a young adult may have
two or three colds per year, an elderly person one or none at all.
(There are always exceptions.) The reason for this is that children
at school are exposed to a host of different viruses to which they
have not yet had time to become immune and which they pass to one
another. Adults gradually build up immunity against a wide variety
of viruses responsible for colds. Children also normally don't wash
their hands as often as older people. However,
many PALS have a compromised immune system and may be more susceptible
to getting colds---perhaps as easily as children who have little
or few built-up immunities. Among
the more recent cold remedies has been zinc preparations that have
proven to get rid of colds and viral cold infections in about four
days or less---one is called "Cold Eze" here in the U.S.,
and other preparations are similar in content, the active ingredient
of which is zinc and perhaps vitamin C. In
the past three or so years, some colds, influenza, and viruses that
cause colds have been extremely long in duration and hanging on
or causing victims to be reinfected multiple times ---this trend
seems to be getting worse, and folks seem to have colds as long
as one to three months. Such a cold can be devastating to the health
and well-being of a PALS. CALS should also take care of themselves
as much as possible to prevent getting overly tired, run down, and
immune system weakened to help prevent catching a cold and passing
it on to PALS. Adequate rest, adequate hydration with water (not
diuretics), intake of antioxidants and zinc might be in order for
CALS as well as PALS. One
neurosurgeon friend of mine who is a PALS posts a sign on his front
door warning anyone: DO NOT ENTER OR RING BELL, if they have any
type of cold, flu, virus, bacterium, or other infection or contagious
illness. If anyone ignores his sign, he gets almost violently angry,
regardless of who it is, because he knows the inherent dangers of
his catching a simple cold. This neurosurgeon has fired over a dozen
nurses for this very serious thing. |
