The first defense: Soap and water

It's no wonder that people are always wringing their hands about germs. Regular influenza -- easily passed from hand to hand -- affects 5% to 20% of the population annually, triggering an estimated 200,000 hospitalizations and 36,000 deaths. But in this day and age, that's hardly the only worry. Media reports of a deadly strain of avian flu in Asia, for instance, have increased overall anxiety about infectious disease. And these recent headlines come on the tails of other disturbing reports -- SARS, smallpox and monkeypox. And, of course, there is always the common cold.

It's not surprising, then, that consumers are increasingly reaching for antibiotic soaps and lotions in an effort to protect themselves and their families. But the science is unclear about whether these products actually offer a benefit or pose a public health hazard.

That's why the Food and Drug Administration's Nonprescription Drugs Advisory Committee was right to meet last month to consider the use of these products outside the health care setting. Ultimately, this advisory panel urged the agency to study the products' risks versus benefits, questioning whether they actually reduce the transmission of infection and whether they contribute to antibiotic resistance.

The American Medical Association considered the hearing a positive step. The Association has long held that until data emerge to show that antimicrobials in consumer products have no detrimental effect on public health they should be avoided. This is especially so since no data exist to indicate that their use actually reduces the transmission of infectious diseases as compared to regular soap and water.

In general, the Association encourages the FDA to expedite its regulation of the use in consumer products of antimicrobials for which acquired resistance has been demonstrated. It also urges continued research regarding their impact on the major public health problem of antimicrobial resistance.

Overall, this problem must be controlled through changes in attitude and more judicious use of antibiotics by health professionals and the public -- a point again supported in the Nov. 9 Journal of the American Medical Association article. The FDA's consideration of these specific products is a crucial endeavor.

But when it comes to a related topic -- the overall importance of hand hygiene -- there are no doubts. It's a message for physicians and other health care professionals that cannot be repeated too often.

Last month, for instance, the Centers for Disease Control and Prevention marked International Infection Prevention Week by reiterating guidelines for hand hygiene in health care settings. Specifically, in addition to traditional hand washing with soap and water, the CDC recommends the use of alcohol-based hand rubs by health care personnel because these treatments address some of the obstacles faced when caring for patients. But in non-health care settings, according to the CDC, frequent hand washing with soap and water remains what the agency calls "a sensible strategy."

The AMA offers its take on this strategy with its four key principles of hand awareness. First, hands should be washed when dirty or before eating. Then come the following two warnings: One should not cough or sneeze into the hands. And above all, people should not put their fingers into their eyes, nose or mouth.

These four principles may sound simple, but hand hygiene is so imperative that, at its Interim Meeting this month in Dallas, the Association urged the CDC, the Dept. of Health and Human Services and other agencies and organizations to collaborate to use this guidance as a public marketing tool to ensure a consistent method to help prevent the spread of disease.

Bottom line: The threat of germs -- whether the focus is fighting the flu or curbing drug-resistant bacteria -- is worth getting in a lather about. Good hand hygiene appears to be a clear course of action. And, if your patients ask, nothing seems to beat good old soap and water.