HFMD, Hand Foot and Mouth Disease: Prevention

HFMD, Hand Foot and Mouth Disease: Prevention

Hand, Foot and Mouth Disease (HFMD) is a disease caused by many different viruses. It is generally mild but complications can occur affecting the lungs, nervous system and the heart. The virus is highly contagious, and present all year round in Singapore. Children and infants, especially below 5 years old, are the most affected, but adults can also get the virus. HFMD lasts about 10 days and there is no actual cure or vaccine.

Common signs & symptoms:

–          Fever;

–          Sore throat;

–          Ulcers in the throat, mouth and tongue;

–          Headache;

–          Rash with vesicles on arms, on the palm side of the hands.  It may also be located in the legs, the sole side of the feet and on the buttocks;

–          Vomiting;

–          Poor appetite;

–          Lethargy.

How does HFMD spread?

The virus spreads through direct contact with the nasal secretions, saliva, faeces and fluid from rashes and can circulate through the air through coughing and sneezing.

Some people may not have symptoms but still be infected. People are more contagious during the first week of infection but the virus remains in the body several weeks and can still be spread.

What to do if your child gets HFMD?

–          Give your child plenty of water to avoid dehydration as it is the most common complication that can occur with HFMD. Avoid juice and sodas as the acid contained inside may be painful because of mouth ulcers;

–          Change to a soft diet such as porridge, pureed fruit in case of mouth ulcers as it will be easier to swallow;

–          Resting will help your child recovering;

–          Keep your child at home until the symptoms disappear and inform the kindergarten or school.

How to reduce the risk of infection?

–          Good personal hygiene is the best way to prevent being infected. Always keep your hands clean and often wash your hands thoroughly with soap especially after changing diapers;

–          Avoid touching your eyes, nose and mouth with unwashed hands;


–          Limit contact with infected people and wash your hands after any contact;

–          Don’t share foods, drinks, plate and other personal objects;

–          Disinfect and sanitize surfaces, toys to avoid cross contamination;

–          Cover your mouth and nose when sneezing and coughing.

For more information visit: http://www.hpb.gov.sg/HOPPortal/dandc-article/792


MOH. 2014. Hand, Foot & Mouth Disease. [ONLINE] Available at: https://www.moh.gov.sg/content/moh_web/home/diseases_and_conditions/h/hfmd.html.


webmd. 2014. Facts About Hand-Foot-and-Mouth Disease. [ONLINE] Available at: http://www.webmd.com/children/hand-foot-mouth-disease.


mayoclinic. 2014. Hand-foot-and-mouth disease. [ONLINE] Available at: http://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/basics/symptoms/con-20032747

MERS-CoV: All you need to know [infographic]

MERS-CoV: All you need to know [infographic]

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness first reported in Saudi Arabia in 2012.

Since May 2015, the virus has reached Korea, making it the largest known outbreak of MERS outside the Middle East. The virus is particularly dangerous to people who have underlying medical conditions and have a high fatality rate of 36% in those infected. There is currently no vaccine or specific treatment. Protection measures shown in the infographic helps reduce the risk of infection:


All you need to know about hand sanitizers

All you need to know about hand sanitizers

Hand sanitizers are increasingly popular and with virus outbreaks occurring frequently like the recent MERS-CoV currently happening in Korea, their use have become a common and effective way to prevent infection and the spread of germs. Hand sanitizers are convenient; they don’t require particular settings to install and can be put on table tops or in dispensers to enable everyone to use them. They are also easy to use and offer a quick solution to keep your hands safe. But not all sanitizers are the same. Check our tips to help you choose your hand sanitizer and be fully protected.

Benefit and effectiveness of hand sanitizer

Alcohol based hand sanitizers are proven to eliminate 99,99% of the germs on hands. Once you have rubbed your hands with the product and it has dried, your hands are safe. Hand sanitizers kill bacteria and most viruses, by dissolving the essential proteins of the germs and disrupting their normal cell activity, unlike hand washing with water and soap that only washes germs away. Hand sanitizers are effective against many bacteria, the common cold, flu viruses, as well as fungal infections. 

Studies shows that families who use hand sanitizers, saw a lower risk of gastrointestinal and respiratory infections, and infections spread less among the members of the family. Providing hand sanitizer solutions can help increasing hand hygiene adherence necessary in healthcare settings as they offer a quick and easy alternative to hand washing. Adding them in classrooms and office can be a way to reduce absenteeism and sick leaves.

How to choose your hand sanitizer?

There are many hand sanitizers in the market and choosing the right one can be confusing. You need to read the ingredients as they are a determining factor and ensure the effectiveness of the product. Hand sanitizers contain active and inactive ingredients.

Active ingredient consists generally of alcohol. Be sure to choose a hand sanitizer with an alcohol concentration over 60% of the content. Under this amount, the product won’t be powerful enough and you will still carry germs on your hands.  Alcohol can be found under different forms; ethyl alcohol, ethanol or isopropanol. It is the central ingredient of hand sanitizers and kills most germs without causing harm to the skin. Whatever alcohol form you choose they are all suitable to ensure safe hands.

In addition to alcohol, inactive ingredients are usually part of the product. These inactive ingredients have different role. They can help for the application of the product and also prevent dryness of the skin. Choosing a sanitizer containing moisturizer agents will minimize irritation. These agents include Aloe Vera, Vitamin E and humectants, such as glycerin. With these ingredients, sanitizing hands turns out to be less drying and gentler for the hands than washing them.

Another ingredient that can be found is chlorhexidine which slows down the development of bacteria in your hands by creating a protective film on your skin, offering a good protection that can last up to 6 hours.

Hand sanitizers can also contain fragrance oils to help lessen the smell of alcohol when applying the product.

Hand sanitizers are usually in the form of Gel or Spray. Both products are equivalent in their effectiveness; the only difference will come from the texture and drying time. A gel alcohol hand sanitizer will take more time than a spray alcohol sanitizer to fully dry.

Can we replace hand washing with hand sanitizing?

Hand sanitizers are efficient at killing germs on hands, but they are not cleaning agents, and so not meant as a replacement, but as an alternative when soap and water are not available. Sanitizers are most effective when used in combination with hand washing. The majority of people don’t wash their hands long enough to completely remove all germs, using hand sanitizer is a good way to ensure a complete protection. Hand sanitizers will not get through fluids and dirt to kill germs. They must be washed away first for the alcohol in the sanitizer to be effective and so, for this situation, hand sanitizers are not a preferred solution. Handwashing with soap and water is recommended in such circumstances.





Webmd. 2013. Hand Sanitizers: Do They Help Stop All Germs?. [ONLINE] Available at: http://www.webmd.com/cold-and-flu/news/20130208/hand-sanitizers-germs.

Livestrong. 2014. Ingredients in Hand Sanitizer. [ONLINE] Available at: http://www.livestrong.com/article/164674-ingredients-in-hand-sanitizer/.

Wonderopolis. 2014. Does Hand Sanitizer Really Work?. [ONLINE] Available at: http://wonderopolis.org/wonder/does-hand-sanitizer-really-work/.

NCBI. 2008. Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. [ONLINE] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/.

How to keep your gym clean?

How to keep your gym clean?

People join gyms to be healthier and maintain a good body shape but they might actually end up with some infections considering that gyms are a hot spot for germs. Ensuring a safe and clean environment for your members is important for their safety and for you.


Multiple disease causing germs are present in gyms like influenza, staphylococcus, streptococcus, and E. coli. Studies reported that 63% of gym equipment harbour rhinovirus, the virus responsible for colds. Skin diseases including athlete’s foot and human papillomavirus, are also thriving in fitness centres. Gym facilities have also been pointed out to spread MRSA (Methicillin Resistant Staphylococcus Aureus), a life threatening bacterial infection, resistant to normal antibiotic therapy. MRSA infects people through cuts, abrasions or skin contact. Germs easily spread and people tend to touch their face several times per hours, allowing germs to enter their body through the nose and mouth, making them sick.

Dirty equipment and locker rooms, lack of cleaning products to wipe down equipment are among the principal cleaning issues experienced by customers. No one wants to exercise in a dirty gym or end up being sick each time they go to the gym. In order to ensure a disease free environment and avoid critical outbreak, which may greatly hurt one’s reputation, implementing an efficient cleaning policy is primordial. Not only will your members benefit from it, but your facility will gain a better reputation, sending a positive image of a safe and caring gym.

Evaluate your own gym centre.

Look at your gym from a new perspective, as if you were a potential customer discovering your facility for the first time. Would you be comfortable walking barefoot or using the equipment? Does your place communicate a clean feeling?

Staying in a certain environment for a long time can alter your vision, so, look for honest critics from your friends, reviews from internet, or directly ask your customers about the cleanliness. You will quickly realise which improvements are needed.

Implement a cleaning policy

Create a checklist, with different items to clean on specific days. Involve your personnel and make sure that they follow your recommendations. Some areas are more prone to germs than others and require more attention and cleaning. Be especially meticulous with these hot spot for germs areas:

–          Free weight

Free weights are one of the most used equipment in the gym and are ironically usually forgotten during the cleaning process though they should be cleaned after each use. Their hard surfaces are ideal for hosting germs that can lead to colds and other infections.

–          Locker room

Most of the germs in the locker room flourish on the floor. Shoes entering the locker room harbour faecal matter, picked up from the outside, which can give stomach flu and hepatitis A. The locker room is also the perfect place for germs like staphylococcus, streptococcus, and MRSA as well as fungi. A cut in your skin and a direct contact with germs is enough to let the germs enter your body and infect you. 

Ask your members to wear flip flops or other sandals in the locker room to avoid contact with the floor and wash it thoroughly before and after peak hours.

–          Exercise mats

Exercise mats are rarely cleaned. In the worst case, mats are reused for each class, becoming a den for germs.

Provide enough mats for two or three classes so that it can dry between training sessions and, clean it with an alcohol spray disinfectant containing at least 60 percent of alcohol to guarantee an efficient cleaning.

–          Cardio machines

Cardio machines like treadmills, bikes, and elliptical, are more likely to get wiped down after use than free weight. Yet, most of the machines have traces of rhinovirus, fungi, and yeast, especially on bike seats.

–          Showers

People shower to get rid of bacteria and be clean, but at the end, because of the high presence of fungi and other germs in this area, it can cause them more harm than good, infecting them with athlete’s foot and other fungal infections.

Plan the frequency and the method cleaning. Material cleaned regularly will be less dirty between cleanings, and have fewer microbes to remove each time. Germs and bacteria can survive days on surfaces so spray and wipe the equipment with alcohol sanitizing solutions throughout the day. When the centre is empty, operate a meticulous cleaning of the equipment with bactericide detergent. Spray the solution on surfaces and wipe with a clean towel. Wiping is an important procedure and ensures a complete removal of germs. Change towel when cleaning a different surface to avoid cross contamination by transferring germs from one surface to another. Thoroughly clean the floor, shower and other rooms with specific and adapted cleaning products.

Involve your members

You can’t always clean your equipment after each use, especially during peak hours. The best way to keep a squeaky clean gym is to make your members participate in the cleaning process. Provide cleaning supplies, sanitizing solutions and disposable paper towels within easy reach of equipment, throughout the gym, and near the exits to wipe off the equipment after each use and to sanitize hands.  You can also give each member individual travel pack sanitizer spray so they don’t need to check for supplies. Engage your trainers and staff to sanitize their hands when dealing with customers. They are the link between the members and the gym, and can encourage people to sanitize their hands and keep the equipment clean.

In many facilities, members take advantage of hand sanitizers and take part to the cleaning. Post signs to encourage members to wipe the equipment after use.

Making everyone regularly sanitizing their hands can make a difference and drastically improve the overall cleanliness, creating a safer environment that will benefit everyone.


Fitness Magazine. 2012. Germs at the Gym. [ONLINE] Available at: http://www.fitnessmagazine.com/health/germs/germs-at-the-gym/.


DailyMail. 2016. How going to the gym can be BAD for your health: Free weights found to have 362 TIMES more bacteria than a toilet seat. [ONLINE] Available at: http://www.dailymail.co.uk/health/article-3528955/How-going-gym-BAD-health-Free-weights-362-TIMES-bacteria-toilet-seat.html.


Men’s Health. 2016. How going to the gym can be BAD for your health: Free weights found to have 362 TIMES more bacteria than a toilet seat. [ONLINE] Available at: http://www.menshealth.com/health/how-dirty-is-your-gym-equipment.

Gym Insight. 2012. Keep Your Business Clean. [ONLINE] Available at: https://blog.gyminsight.com/321-keep-your-business-clean/.

Sportsmith. 2015. 9 tips you can use now to keep your club clean. [ONLINE] Available at: http://blog.sportsmith.net/fitness-equipment-maintenance/9-tips-to-keep-your-club-clean/.

Protect yourself: Wash your hands

Protect yourself: Wash your hands

You have probably been advised that regularly washing your hands is essential. People wash their hands when they are visibly dirty, but tend to forget that they can harbour invisible particles even when they seem clean. Disturbingly, only 60% of women and 38% of men clean their hands with soap and water after using the restroom.

So why is hand washing a requirement? Can it prevent you from being sick?

Frequent hand-washing is one of the most effective ways to avoid getting sick and spread illnesses. Your hands pick up many germs during your everyday life operations, through a hand shake, when working or cooking. You can easily transfer them to other people who, in turn, can spread them to others, and so on. Germs on your hands will multiply on your skin if not washed away. People touch their face several times per hours without realising it, and with dirty hands, harmful bacteria can enter your body through the nose, mouth, and eyes to make you sick. By washing hands, you reduce the spread of germs and protect yourself.

According to the Centers For Disease Control and Prevention, “washing hands with soap and water could reduce diarrhoeal disease-associated deaths by up to 50% and reduce the risk of respiratory infections by 16%”.

Is soap necessary to wash your hands? Does soap kill germs?

Using soap is the best way to ensure safe hands. Compared to soap, water only removes a negligible portion of germs on your hands

The product acts as an emulsifying agent. It suspends oil, dirt particles and germs from your skin. By rubbing your hands, you complete the action of the agent and allow the particle to be easily removed. It is the same as when you clean your teeth. When using toothpaste, you have to brush your teeth to clear away bacteria and traces of food, otherwise it won’t be effective. The longer you rub your hands, the more germs will be washed away when rinsing under water.

Plain soap only removes germs. [Antibacterial soap], on the other hand, contains antibacterial agents to ensure germs free hands, necessary in certain setting like in healthcare utilities.

How to wash your hands?

“95% of people don’t wash their hands properly”.

Most of the people don’t wash their hands long enough; it should be done for at least 20 seconds. The World Health Organization recommends the following steps to ensure safe hands:

Wet your hands with clean, running water. The temperature doesn’t influence the effectiveness of hand washing. Turn off the tap, and apply soap.

–          Rub your hands with soap and don’t forget areas like the nails, the back of the hands and between the fingers.

–          Scrub your hands for at least 20 seconds, you can sing ‘happy birthday’ twice while rubbing to make sure that you do it long enough.

–          Rinse your hands under clean water.

–          Use a clean towel or a hand dryer to dry your hands. Dry hands are harder for germs to multiply on.


When to wash your hands?

When we think about when to wash hands, the first thing that pops up in the mind is after using the toilet. But it should also be done in those situations:

–          Before, during and after handling food, cooking and before eating. Many foodborne illnesses could be avoided with a good hand washing.

–          Before and after caring  for a sick one;

–          Before and after treating a cut or wound. Bacteria enter the body through cuts and wounds.

–          After using the toilet;

–          After changing diapers;

–          After blowing your nose, coughing, or sneezing. A single sneeze can spread more than 100 000 germs around. Cover your mouth when sneezing and wash your hands after.

–          After touching an animal,or its waste or feeding the latter. Animals carry germs transferrable to humans.

–          After touching garbage.

What to do if soap and water aren’t available?

Hand Sanitizers are a good alternative when soap and water aren’t available. Choose a sanitizer containing at least 60% of alcohol. They kill most of the germs and are effective if your hands aren’t visibly dirty.


Isd423. 2015. BREAK THE CHAIN. [ONLINE] Available at: http://www.isd423.org/break-the-chain/.

CDC. 2010. Hygiene Fast Facts. [ONLINE] Available at: http://www.cdc.gov/healthywater/hygiene/fast_facts.html.

About Education. 2015. How Soap Cleans. [ONLINE] Available at: http://chemistry.about.com/od/cleanerchemistry/a/how-soap-cleans.htm.

World Health Organization. 2009. Hand Hygiene: Why, How & When?. [ONLINE] Available at: http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf.

Should you put hand sanitizers in your office?

Should you put hand sanitizers in your office?

When someone is sick in the office, you don’t have to wait long until everyone starts getting symptoms of illness. Only one person or surface infected is enough to make everyone sick. A group of researchers applied samples of a virus, bacteriophage MS-2 which is similar to Norovirus, the most common cause of gastrointestinal illness, to several surfaces such as doorknobs and table tops at the beginning of the day. In two to four hours, 40 to 60% of workers and visitors picked up the virus and spread it to many other surfaces.  The hand is a quick tool to spread germs and the close proximity of people makes it easy for germs to jump from a surface to another.


In order to avoid this situation, good hand hygiene is recommended. Employers looking to limit the spread of illnesses in the office should invest in hand sanitizer dispensers. Alcohol-based hand sanitizers reduce the number of cases of the common cold and fever in an office and decrease the number of sick days employees take due to these illnesses.

A recent study made by the University of Southampton in Southampton, England showed that increasing hand washing and hand hygiene in general can lower the rates of respiratory, gastrointestinal infections, and influenza illnesses. 20 000 people were involved in the study. Part of the group  were provided education about hand hygiene and the spread of germs and virus which led to 15 to 25 per cent reduction in infections compared to the other group.  It is the first time that a serious study has been made, showing real effects of hand hygiene. People don’t always carry one with them so providing hand sanitizers will improve hand hygiene and can ward off illnesses.

During a regular workday, using hand sanitizer three to five times is enough to already reduce the spread of germs. Place hand sanitizers containing at least 60% of alcohol where it can easily be spotted, such as in high traffic areas and in the restroom.


Washington Post. 2014. A single doorknob can contaminate up to 60 percent of people in a building in 4 hours. [ONLINE] Available at: https://www.washingtonpost.com/news/to-your-health/wp/2014/09/10/a-single-doorknob-can-contaminate-up-to-60-percent-of-people-in-a-building-in-4-hours/.

NCBI. 2008. Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. [ONLINE] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/.

Norovirus: symptoms and prevention

Norovirus: symptoms and prevention

Norovirus is the most common type of gastroenteritis, causing stomach or intestinal inflammation and many outbreaks of Norovirus occur all year long from contaminated food. Each year, in the United States, norovirus affects around 20 million cases of acute gastroenteritis according to The Center for Disease Control and Prevention. Norovirus is contagious and outbreaks are more likely to happen in crowded and closed places where the virus can quickly spread between people. Most of them occur in the food industry like restaurants because of infected food workers whom touch raw fruits and vegetables with bare hands before serving them. Norovirus is sometimes called gastric flu even if it is not related to influenza.

Anyone can be infected with norovirus and get sick. People are the most contagious when sick, and during the first few days after the recovery. There is no specific cure for norovirus. It’s usually mild and shouldn’t last more than a couple of days.


The virus causes your stomach or intestines or both to get inflamed engendering the following symptoms:


– diarrhoea

– throwing up

– nausea

– stomach pain

– fever

– headache and body aches

If you experience more serious symptoms or if they don’t disappear after a few days, you should consult your doctor.

How does norovirus spread?

Like most viruses, norovirus spread through direct contact with an infected person, stools, contaminated food or water. Touching contaminated surfaces and then your face can infect you. Norovirus can be present in your vomit and stool even before symptoms of infection appear and can stay in your stool for 2 weeks or more after recovery.

To reduce the risk of infection

Practice good hand hygiene

Wash your hands with soap and water for at least 30 seconds, especially after using the toilet and changing diapers, and always before eating, preparing, or handling food. Use an [alcohol-based hand sanitizer] if soap and water aren’t available or in addition to hand washing.

Wash fruits and vegetables and cook seafood

Wash fruits and vegetables thoroughly before preparing and eating them. Cook oysters and other shellfish before eating them.

If you are sick, avoid preparing food and caring for people who are sick

The virus is highly contagious and spread easily through food. You should not prepare food for others or provide healthcare while you are sick for at least 3 days after symptoms stop.

Keep sick infants and children out of areas where food is prepared.


Clean and disinfect surfaces

Touching a contaminated surfaces and then touching your face is enough to infect you. Often wipe down surfaces with an alcohol based solution to avoid cross contamination.

Wash laundry thoroughly

Thoroughly wash your clothes and linens if they are contaminated with vomit or stool.


CDC. 2013. U.S. Trends and Outbreaks. [ONLINE] Available at: http://www.cdc.gov/norovirus/trends-outbreaks.html.

Mayo Clinic. 2014. Norovirus Infection. [ONLINE] Available at: http://www.mayoclinic.org/diseases-conditions/norovirus/basics/symptoms/con-20029968.

CDC. 2013. Norovirus Overview. [ONLINE] Available at: http://www.cdc.gov/norovirus/about/overview.html.

How to make your child wash hands?

How to make your child wash hands?

Children are always moving around and touching everything around them. While you can’t stop their curiosity, you can prevent them from being sick and teach them the right way to protect themselves. Washing your hands might seem natural for you but it may not be the case for your kid who may not understand the importance of this small act. Teaching your child how to wash their hands and to do it regularly is essential. Hand washing can take some time to be fully integrated and can eventually become a challenge to get it done. Below are some tips to help you make it a fun and natural experience.

Make it easy and safe as well as fun

You should wash your hands with water and soap. Convert washing hands as an enjoyable experience, using fun soaps with different shapes to make it more exciting.  To remove all germs, you have to wash your hands for at least 20 seconds. Make your child sings ‘happy birthday’ twice to be sure they rub their hands long enough.

Kids may not be able to reach the sink. Give them a stool or step so that they can easily wash their hands without your help.

Repetition is the key

Make hand washing a routine, something natural that your child will do without having to think about it. Repetition is the best way to learn and make hand washing a habit. Often remind your child to wash their hands especially when it is critical, before eating, after using the restroom and after spending time in public places.


Show the good example

If you don’t wash your hands, don’t expect your kids to do it. Children tend to copy what people around them are doing, especially their parents. If you often wash your hands, they will also want to practice hand washing.

Explain why hand hygiene is important

Understanding why we need to wash hands is a crucial point especially for kids. If they don’t see the meaning of hand washing, it can be hard to teach them to wash their hands. Take some time and explain in a simplistic way what germs are and what happen if your child doesn’t wash their hands.

Use your creativity

Sit down with your child and do some activities around hand washing like creating a poster showing the steps of hand washing with pictures. Most adults don’t wash their hands properly, so be sure to teach your kid the right technique from the beginning.  You can even place posters next to the sink to help them remember how to do it.

Ask your doctor to talk about it

If they don’t listen to you and still don’t want to wash their hands, sometimes, asking exterior help can be beneficial. Ask your doctor to explain your kids why they should wash their hands.

Carry a hand sanitizer

Carry an alcohol based sanitizer so that, even if you are outside and away from soap and water, you can still practice good hand hygiene as it should be practiced all the time.


Kid spot. 2013. 9 ways to get kids to wash their hands. [ONLINE] Available at: http://www.kidspot.com.au/9-ways-to-get-kids-to-wash-their-hands/.

Todaysparent. 2010. HomeKidsPreschoolHow to get kids to wash their hands KidsPreschool How to get kids to wash their hands. [ONLINE] Available at: http://www.todaysparent.com/kids/preschool/how-to-get-kids-to-wash-their-hands/.

Soap in public restroom can contaminate your hands

Soap in public restroom can contaminate your hands

Washing your hands with soap and water is the best way to prevent the spread of illnesses and the transmission of germs according to The Centers for Disease and Prevention. It should be done regularly, for at least 30 seconds, and especially after going to the restroom. During the day, you pick up germs and touching your face with contaminated hands is enough to make you sick. Soap removes germs more effectively than water but what if the soap is dirty? Can the soap transfer germs?

Originally, bar soaps were found in public restrooms but got removed when studies showed that they were unhygienic and could transfer germs. The use of soap dispensers has been encouraged to limit contamination. But in public restrooms, studies found that“One in four dispensers is contaminated” allowing germs to thrive in soaps. Washing your hands with contaminated soap can add more bacteria on your hands than you had before washing them, thus contributing to the transmission of germs and spreading of infections.

How does the soap get dirty?

Several reasons can explain this phenomenon. Soaps contain preservatives to limit the growth of harmful microbes, but those preservatives may break down over time and become less effective.

Dispensers aren’t cleaned properly. Dispensers should be thoroughly cleaned before refilling them. Bulk soap dispensers are the most common type of dispensers found in public restrooms. To refill a bulk soap dispenser, you have to top off the soap inside through a lid while the dispenser stays mounted on the wall. The amount of bacteria found in the dispenser was 1000 times higher than the recommended limit. Researchers found that even if you take the soap out of the dispenser, disinfect the equipment with bleach, and refill it with safe and new soap, within two weeks, the soap inside the dispenser will be as contaminated as before the cleaning. Bacteria in the dispenser can be resistant to bleach, and even a small quantity of bacteria remaining is enough to contaminate the soap. Soap dispensers are usually mounted on the walls and it is harder to clean the inside properly. Previous studies have demonstrated an association between the use of bulk soap refillable dispensers and bacterial contamination of the soap. Bulk soap refillable dispensers can increase the number of germs on the hands and may play a role in the transmission of bacteria in public settings. They have been removed from healthcare settings as they increased the risk of cross contamination but are still common in public restrooms.

“Topping off” or improper refilling. The Centers for Disease Control and Prevention “Don’t recommend adding soap to a partially empty soap dispenser as it can lead to bacterial contamination of soap”.

Airborne and environmental contaminants from the restroom can enter the dispenser when open, especially in an environment where faecal bacteria are thriving. In most contaminated dispensers, coliform and faecal matters were found in important quantity.

Cleaning personnel can contaminate soap when refilling the dispenser with bacteria present on their hands, like after having just cleaned the toilets or if they aren’t wearing gloves.

Companies usually use concentrate soap that they dilute after. If the dilution is too important and more than recommended, it can make the soap less effective against germs.

How to avoid this situation?

The best and easiest solution is to replace bulk soap dispenser with sealed soap dispenser. With a sealed system, to refill the dispenser, you only have to put a sealed bottle or a pouch inside the equipment and don’t risk touching the soap.

In a study, contaminated dispensers were replaced with sealed soap dispensers. One year after the installation, the soap from the sealed soap dispensers was contamination free. The use of dispensers with sealed refills instead of bulk soap refillable dispensers can lower the risk of contamination and can reduce the spread of bacteria.

As a user, If you aren’t sure about the soap in a public restroom, you can also complement hand washing with hand sanitizing to ensure safe hands.


American Society for Microbiology. 2010. Bacterial Hand Contamination and Transfer after Use of Contaminated Bulk-Soap-Refillable Dispensers. [ONLINE] Available at: http://aem.asm.org/content/77/9/2898.full.

CDC. 2002. Guideline for Hand Hygiene in Health-Care Settings. [ONLINE] Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

How to protect yourself against the haze?

How to protect yourself against the haze?

The haze in Singapore has been back for several weeks. It is not an exceptional event, for almost every dry season, outbreaks have occurred. Thick grey smog coming from Indonesia floats over the island causing people to stay indoors, closure of schools and unhealthy levels of pollution. Singapore’s air quality even reached hazardous levels and there is no indication on how long people will have to cope with this situation.

Cause of the haze

The current haze comes from forest burning triggered by illegal fires in peatland, and forest in Indonesia’s Sumatra Island and the Indonesian part of Borneo. These fires are created to quickly clear lands for palm oil, paper and pulp plantations

What is in the haze?  How to check air quality?

The haze is predominantly composed of two types of particles:

–          – PM10 are particulate matters of 10 microns in size. They are large enough to be trapped by the nasal passages when you breathe.

–          – PM2.5 are fine particulate matters that are no larger than 2.5 microns, a thirtieth the diameter of a human hair. They can get trapped deep in the lungs and go into the bloodstream.

Short term exposure to high levels of haze particles can cause irritation of the eyes, nose, and throat in healthy individuals, while a long-term exposure to these particles on a regular basis can create heart and lung complications such as lung cancer or heart disease.

The PSI, Pollutant Standards Index gives information about air quality. Look for the three-hour PSI or 1-hour PM2.5 concentration levels published by the National Environment Agency (NEA). PSI is determined by the concentration levels PM10, PM2.5, sulphur dioxide, nitrogen dioxide, ozone, and carbon monoxide. During a normal day, without haze, the maximum concentration of PM2.5 is usually between 20 and 35 micrograms per cubic meters. The air is considered unhealthy when the concentration of PM2.5 hits 100, and hazardous when it exceeds 300.

How to protect yourself?

Stay indoors and close your windows and doors when the PSI is high

When the outdoor air quality reaches serious levels, stay indoors as much as possible and keep the windows and doors closed.

Cut down on physical activities

Exercising make you breathe deeply, allowing pollutants deep into your lungs. Reduce outdoor activities to limit your exposure to the haze especially when the PSI reaches 100 or more.

Stay hydrated

The haze causes drying conditions. Stay hydrated and drink more water than usual to flush out toxins absorbed by your body.

Use air purifiers at home.

Air purifiers and air ionizers can help to reduce the indoor particle level. Be sure to regularly change the filter to get rid of pollutants from the air efficiently.

Wear a mask.

Covering your nose with your hands is not enough to protect you. Wear a mask when the air pollutants levels are high. N95 masks seal to the face of the wearer and provide good protection against the haze as they keep fine particulate matter out. You can reuse your mask but don’t share it. Change it when it gets soiled or distorted in shape.


Teach people around you how to wear their mask. Not wearing your mask correctly can compromise its efficiency. 

step to wear mask

Surgical masks and paper masks are not effective in filtering fine particles. They can reduce the discomfort caused by the haze and prevent the larger irritant particles in the air from being breathed in but do not provide adequate protection.

Avoid smoking.

Smoking can make your lungs more sensitive to the effects of air pollutants.

Eat a balanced diet

Eat lots of vegetables and fresh fruits to get enough nutrients to help your body deal with the haze.

Eat food containing Vitamin A such as liver, carrots, sweet potatoes or spinach. Vitamin A protects your eyes and shields your lungs from air pollution. The chemicals in the haze destroy the Vitamin A contained in the lung tissues, weakening your defence against carcinogens.

Take Vitamins E and Vitamins C complements to strengthen your immune system. The two vitamins taken in combination will also keep your lung tissue healthy by building up levels of a protective protein to prevent enzymes released during inflammation from destroying the lung’s elastic properties.


National Environment Agency. 2016. HAZE SITUATION UPDATE. [ONLINE] Available at: http://www.haze.gov.sg/.

National Environment Agency. 2016. About Haze. [ONLINE] Available at: http://www.haze.gov.sg/about-haze.

Ministry of Health. 2015. MOH Haze Microsite. [ONLINE] Available at: https://www.moh.gov.sg/content/moh_web/home/pressRoom/Current_Issues/2014/haze.html.