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02/23/2018 15:44 EST | Updated 02/23/2018 15:48 EST

What We Can Learn About Handwashing From The Olympics Norovirus Outbreak

Hand sanitizer isn't recommended as first-line defence because in in real-life conditions, people don't use enough product

An unwelcome visitor is plaguing this year's Winter Olympics in PyeongChang. Over 250 staff, volunteers and athletes have succumbed to Norovirus, an extremely contagious illness that causes debilitating abdominal pain, vomiting, diarrhea, fever and muscle aches.

Infection occurs upon ingesting the stool or vomit of an infected person, and this occurs more often than you'd like to imagine. Contaminated food, doorknobs, even handshaking can facilitate transmission. So, not surprisingly, there's serious talk about saying goodbye to the traditional post-game handshake, in particular, following a friendly game of ice hockey.

As a doctor, I'm the first to say handshaking has lost much of its lustre. But although I feel reassured by avoiding contact, it's still easy to fall victim to a microscopically infected surface. What does allow me to sleep soundly though, is knowing that I have another strong ally on my side: handwashing.

Shirking the age-old tradition of shaking hands isn't your best defence against a big bad bug like norovirus. That would be soap and water.

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According to the United States Centers for Disease Control (CDC), soap and water is your best bet against norovirus, as this germ may resist the powers of ethanol-based hand sanitizer. In fact, over-reliance on such hand sanitizer may predispose to norovirus outbreaks. Yet, as the outbreak in PyeongChang unfolds, media excerpts continue to describe military-like enforcement of hand sanitizer use; of distributing "hundreds of bottles of 62-percent ethanol hand sanitizer." What needs to come to the rescue is good old-fashioned soap and water.

If you're a hand-sanitizer convert, you may feel like your world's been turned upside down. There's no need to change up your daily routine, though; in most cases, you're still going to be battling everyday bugs effectively. But it's important to be aware of what science tell us, what the experts recommend when it comes to washing (and why) and what scenarios may warrant a change from your usual routine.

Studies have compared different handwashing techniques in a variety of settings both in vitro (in the lab) and in vivo (on us.) Most of the time, for common infections such as those that cause run-of-the-mill common colds and gastroenteritis (vomiting and diarrhea,) alcohol-based hand sanitizer comes out on top. When it comes to the flu (influenza), under the microscope, soap and water eradicates a bit more of the virus, but their effectiveness in everyday life is fairly equal.

The problem lies in the few big powerhouse germs that may resist the powers of alcohol-based hand sanitizers: Cryptosporidium, Clostridium difficile and the norovirus. Cryptosporidium is a parasite that causes diarrhea; Clostridium difficile is a bacteria that capitalizes on bowels stripped of their good bacteria through antibiotic use, often resulting in severe diarrhea, dehydration and hospitalization. Soap and water are required in these situations.

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Here's a basic review of the CDC's recommendations on hand-washing:

1. For visibly soiled hands (you can see the dirt), a good lather with soap and water is a must. These big particles need the friction that we create with our scrub to be eliminated.

2. When washing with soap and water, ensure you're covering all fingers, thumbs, backs of the hands and in between. Scrub for at least 20 seconds (or singing "Happy Birthday" twice,) rinse well with running water and dry with air or by a clean towel.

3. If a good scrub with soap and water using proper techniqueis not available to you, choose an alcohol-based hand sanitizer instead that has at least65 per cent alcohol content.

Hand sanitizer isn't recommended as a first-line defence because in real-life conditions, people don't use enough product, and they don't rub until it fully dries, limiting its effectiveness. Plus, pesticides and heavy metals can also be found on our palms, and require the friction of soap and water washing to be removed effectively.

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If you're on-the-go, and you just don't have access to soap and water, you can certainly use a convenient pocket hand sanitizer. But be sure to pick one with at least 65 per cent alcohol content and use it as directed. When soap and water become available, suds-up occasionally in order to get rid of chemicals and other contaminants.

So, that's the low-down for anyone at the games, and for staying safe at home. The most important part? Make sure you're washing regularly. If you know of a particular bug that's responsible for making others around you sick, choose your weapon wisely. And whether you choose to fist-pump or hand-shake, know that a good hand wash has your back.

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