Children Cite Busy School Schedules, Untidy Restrooms as Barriers to Washing Up

By Matt McMillen
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 12, 2011 -- Children need to wash up more often at school, and parents need to set a better hand-washing example. That's according to a new survey by the American Cleaning Institute, which represents the U.S. cleaning products industry.

For the online survey, 512 children (aged 8 to 17) and 521 parents answered questions about their hand-washing habits and beliefs. Although most children (89%) reported that they washed their hands after using the restroom at school, far fewer said that they wash their hands at other times during the school day. Nearly half said that the most common reason they failed to do so was because their school schedules did not allow them time.

For many students, the state of the schools' toilets is a turn-off. Twenty-one percent of students surveyed said that they didn't like using their school's restrooms (15% found their school's restrooms "disgusting") while another 19% said their school restrooms didn't have the proper supplies. Forty-seven percent occasionally avoid the restrooms because they are dirty.

Peer pressure also apparently plays a role. Although 14% of the children surveyed said they don't wash their hands because no one else does, 77% report that seeing their friends wash their hands reminds them to wash their own.

And, finally, some kids simply need to be told but aren't: 16% said that "No one reminds me to."

Less than two-thirds of children say they wash their hands before lunch; 26% do not wash their hands after handling garbage. Only about half wash up after coughing, sneezing, or blowing their nose.

Hygiene Habits

Getting children into the habit of washing their hands starts at home. But a third of parents surveyed do not model the behavior, failing to wash their hands after using the bathroom. Another third have not taught their children how long they need to spend on hand washing. However, most parents (79%) say they insist on hand washing prior to meals at home.

Why is hand washing so important? According to the CDC, hand washing is one of the most effective means of stopping the spread of illness and infection. Most children (97%, according to the survey) already know this. Yet, the survey indicates, they -- and, in some cases, their parents -- need more time and encouragement to wash up.

"Good hygiene is one of the many life skills that schools can reinforce. Good hygiene helps keep students healthy and in school," Nancy Bock, American Cleaning Institute vice president of consumer education, says in a news release. "Parents and teachers need to prompt kids daily, because cleaning matters to our health. Lessons learned in school last a lifetime."

SOURCES: American Cleaning Institute: "2011 Handwashing Survey Findings."News release, American Cleaning Institute.CDC: "Wash Your Hands." ©2011 WebMD, LLC. All Rights Reserved.

WEDNESDAY, Oct. 5 -- The percentage of nursing home residents in the United States who receive a seasonal flu shot is lower than the national goal, and the rate is lower for blacks than for whites, a new study finds.

Brown University researchers examined annual patient records from more than 14,000 nursing homes over three flu seasons, 2006-07 to 2008-09.

The overall flu vaccination rate for nursing home residents in 2008-09 was 82.75%, below the goal of 90% set by Medicare and Medicaid. The rates were 83.46% for whites and 77.75% for blacks.

The 2008-09 rates for both whites and blacks were slightly higher than the 2006-07 rates of 82.62% for whites and 75.42% for blacks.

Overall, in 2008-09, blacks were about 23% less likely than whites to receive a flu vaccination. In individual nursing homes, black residents were about 15% less likely to be vaccinated than their white neighbors.

The study appears in the October issue of the journal Health Affairs.

"One reason you would potentially see a difference is that blacks and whites are by and large served by different nursing homes and there's lots of evidence to suggest that blacks are served in nursing homes that are not as good," senior author Vincent Mor, professor of health services policy and practice, said in a university news release. "However, we also see a pretty persistent difference within the same homes, although it is not as large and it has lessened over time."

Another reason for the disparity is that black nursing home residents are more likely to refuse flu vaccinations than white residents, the study suggests. In 2008-09, 12.88% of blacks refused flu vaccination, compared with 8.93% of whites.

Further research should investigate if black residents' higher refusal rate has to do with how flu vaccination is offered, Mor suggested.

"The way to address the within-facility disparity is to find out why there are these refusals and determine better ways of communicating the vaccine's benefits that specifically addresses patients' reluctance and refusal," he said.

-- Robert Preidt

SOURCES: Brown University, news release, Oct. 5, 2011

WEDNESDAY, Sept. 28 -- The influenza virus that killed 50 million people worldwide in 1918 was circulating in the United States at least four months before the outbreak reached pandemic levels in the fall of that year, researchers say.

Their finding comes from examinations of preserved lung tissue and other samples collected during the autopsies of 68 American soldiers who died of respiratory infections in 1918.

Proteins and genetic material from the 1918 flu virus were found in specimens from 37 of the soldiers, including four who died between May and August, months before the pandemic peaked.

Those four cases are the world's earliest known documented cases of the 1918 flu pandemic, according to the team at the U.S. National Institute of Allergy and Infectious Diseases.

The researchers also found that the tissue damage and clinical disease in the pre-pandemic victims were the same as in cases that occurred during the height of the pandemic. This indicates the virus didn't undergo major changes that could explain the unusually high number of deaths that occurred during the pandemic.

Like the 2009 H1N1 flu pandemic, the flu of 1918 also replicated in both the upper and lower respiratory tract, autopsy materials from the soldiers showed.

The study appeared recently in the Proceedings of the National Academy of Sciences.

-- Robert Preidt

SOURCE: U.S. National Institute of Allergy and Infectious Diseases, news release, Sept. 19, 2011

WEDNESDAY, Sept. 21 -- With plenty of influenza vaccine available, U.S. health officials urged Americans Wednesday to get a flu shot.

Last year, some 130.9 million Americans -- about 43% of the population -- got a shot, which represents an increase over past years. The greatest increase was among children 6 months to 17 years old. But, more adults are getting vaccinated, too, according to the U.S. Centers for Disease Control and Prevention.

"Eight million more Americans got the flu shot last year than the year before, and that's the most people who have ever been vaccinated against flu in this country," CDC Director Dr. Thomas R. Frieden said during a Wednesday morning press conference.

About 51% of American children were vaccinated last year -- a 7% increase from the year before and 22% increase from the year before that, Frieden said. However, the number of young adults with conditions such as asthma who get flu shots is still too low, he said.

One reason for the increase in vaccinations appears to be a response to the emergence of the H1N1 flu two years ago, Frieden said. But it's important to get vaccinated this year, he added.

"There are too many illnesses and deaths from influenza each year," Frieden said. "Everyone over 6 months should get a flu shot this year and every year."

Right now, more than 85 million doses of flu vaccine are available in doctors' offices, public health clinics, pharmacies and retail stores, among other sites. More doses will be available than ever before. And you don't have to go to your doctor to get a shot because pharmacists in all 50 states can administer them.

Also, there are four ways to get vaccinated: a nasal spray; the traditional injection vaccine; a high-dose injection for people 65 and older; and a new vaccine injected in the forearm using a smaller needle.

"It looks like we are going to have a vaccine that's very well matched to the circulating strains," Frieden said.

The CDC also recommends a three-step approach to protect yourself and family from the flu. First, get a flu shot. Second, use everyday preventive measures, such as hand washing and covering your mouth when you cough.

Finally, if you do get the flu, use antiviral drugs such as oseltamivir (Tamiflu) or zanamivir (Relenza) to help reduce the risk of complications.

Speaking at the press conference, Dr. Richard H. Beigi, assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh, stressed the importance of pregnant women getting a flu shot.

"The influenza vaccine during pregnancy is safe for both mothers and for babies," said Beigi, who's also a spokesman for the American College of Obstetricians and Gynecologists. "Pregnant women suffer more serious morbidity and occasional mortality from influenza. This was validated during the 2009 H1N1 flu pandemic and last year as well," he added.

Pregnant women who get the flu are also more likely to deliver early and have underweight babies, Beigi said.

"Giving mom an influenza vaccination during pregnancy not only protects the mother, but also protects the newborn infant for the first six months of life. This is important because newborns less than six months of age are not eligible to receive the influenza vaccine, but are at higher risk for morbidity and occasional mortality," he said.

Frieden also recommended that seniors get a pneumococcal vaccination to protect them from flu complications such as pneumonia and meningitis. The vaccine is also recommended for young adults who have lung, heart or liver problems or diabetes or asthma, he said.

It's impossible to predict the severity of an approaching flu season, which usually picks up steam in December and peaks in February before easing in March and April. The flu causes an estimated 200,000 hospitalizations and between 3,000 and 49,000 deaths in a typical year, according to the CDC.

SOURCES: Sept. 21, 2011, teleconference with Thomas R. Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention; Richard H. Beigi, M.D., M.Sc., assistant professor of obstetrics, gynecology and reproductive sciences, University of Pittsburgh, and spokesman, American College of Obstetricians and Gynecologists