GreenCare Forum

I am writing in response to your recent release of information regarding hand washing, and in particular not using alcohol-based, waterless hand sanitizers on children without written parent permission.  I felt the need to advise you that the SB County Public Health Department, the World Health Organization, and the Centers for Disease Control have all stated, agreed, and publicized that having children (including preschool-aged children) use waterless hand sanitizers is the preferred method of keeping children safe. In a public meeting, they all suggested its use as a way to control the spread of the H1N1 virus. We have worked very hard to educate our parents on the fact that using waterless hand sanitizers is not only safe, but preferred by these organizations. I felt it important to let you know my thoughts about your paragraph on this subject.

First, we're so grateful that you took the time and had the consideration to write, this helps us a great deal. All sources agree that frequent and thorough hand-washing is the preferred way to protect against disease transmission. The Center for Disease Control (CDC) and others do suggest "When soap and running water are not available (such as during a field trip) use an alcohol-based hand cleaner."

However, the CDC also states that alcohol-based hand sanitizers can be toxic if swallowed. We all know that the alcohol may be irritating to the skin, eyes, nose, mouth, and other sensitive tissue; and that young children will, without question, put their fingers where they don't belong.

Further, GreenCare is particularly cautions about chemicals that are designed to kill living organisms (including germs), and those that state on the label to keep out of the reach of children.

GreenCare recognizes the need for careful disease management and encourages good sanitation practices. We also recognize that soap and water are not always available and that programs may need an alternative strategy.

Given the challenge of balancing the concern for sanitation and the concern for product safety, GreenCare for Children holds that in a good "green" program, parents should be the responsible parties to decide if the product should be used. By presenting this information to parents and seeking their signed approval for use of alcohol-based sanitizers, early care professionals will be demonstrating the highest degree of concern for the safety of the children in their care.

Again, we appreciate your note, and in fact would be grateful for further input on how to phrase this so as to better address this concern. We continue to work hard to create a program with high "green" credibility, and which meets the needs of GreenCare providers. Below are a few resources and quotes considered in the development of this standard: Center for Disease Control (CDC)

• "When soap and running water are not available (such as during a field trip) use an alcohol-based hand cleaner."
• "However, some places may not allow alcohol-based hand cleaners in early childhood program settings because they can be toxic if swallowed. If alcohol-based hand cleaners are used, they should be kept in a location that children cannot reach, but adults can access when they need to dispense it."
• "Make sure your child's hands are washed often or help your younger child wash them  for 20 seconds with soap and water. If soap and water are not available, use an alcohol based hand cleaner. Alcohol-based hand cleaners can be toxic if swallowed, so keep them in a place that only you can access when you need to use it."
• Preparing for the Flu (Including 2009 H1N1 Flu)
• http://www.cdc.gov/h1n1flu/childcare/toolkit/pdf/childcare_toolkit.pdf
• "If soap and water are not available, alcohol-based hand rubs can also be used. However, hand rubs should not be used when hands are visibly soiled."
• CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season
• http://www.cdc.gov/h1n1flu/childcare/guidance.htm

Dr. Jeffrey R. Groff, Shepherd University:

• Waterless alcohol hand sanitizers can be an effective alternative to hand washing with soap and water under certain conditions.
• The first condition is that hands must not be visibly soiled.
• Another condition is that hand sanitizers should not be used in food-services, because they do not prevent the transmission of diseases through the food products that are being handled due to their ineffectiveness against spores and their ineffectiveness when hands are wet or contaminated with proteinaceous material.
• Lastly, hand sanitizers should have an alcohol concentration of 60% or greater in order to effectively reduce microbial presence.
• Hand Sanitizers: Miracle or Myth
• http://ignoringfriction.blogspot.com/2008/12/hand-sanitizers-miracle-or-myth.html