Q&A with Dr. Allison Aiello

Dr. Allison Aiello is the John G. Searle assistant professor of public health and assistant professor of epidemiology at the University of Michigan School of Public Health and serves on SCA Tissue’s newly formed Tork® Green Hygiene Council as one of its experts in hygiene and epidemiology. She has conducted a wealth of research on hand hygiene and on social determinants of infectious diseases. Aiello has studied the link between infections and chronic diseases as well as the use of antibacterial soap and antimicrobial resistance. She also helped lead a study on the effectiveness of hand hygiene and the use of masks in reducing the spread of the seasonal flu.

Q: Do we know enough about the way influenza is transmitted to say that washing your hands can help prevent seasonal flu or H1N1?
A: Yes, hand hygiene is an integral measure for reducing an important route of influenza transmission, namely contact transmission. Contact transmission can occur through hand contact via secretions on surfaces, such as tables, phones and computer keyboards. Therefore, hand hygiene is integral for breaking the chain of contact transmission.

Q: Are there socio-economic factors that seem to put some groups more at risk than others?
A: Yes, socio-economic-related factors such as lack of access to medical care, heightened burden of chronic diseases, and lack of resources for education on prevention measures, may put individuals of low income and education at greater risk of H1N1.

Q: Describe a community “hand hygiene intervention” that you have been involved in.
A: I was a principal investigator of a study where we recruited more than 1,400 college students living in university residence halls during the 2006-2008 influenza season. Participants were assigned to one of three intervention groups: those who wore face masks, those who wore masks and used alcohol-based hand sanitizer, or a control group who received no intervention. Participants were monitored for influenza-like symptoms for six weeks. Participants in the hand hygiene and mask group received an alcohol-based hand sanitizer and face masks. Those in the mask group received a face mask only. We saw significant reductions, ranging from 35 to 51 percent, in the incidence of influenza-like symptoms starting after four weeks in the hand sanitizer/mask group and in the mask group when compared with the control group.

Q: Do communities with limited access to fresh water have the greatest need for hand hygiene interventions or is there a need for these interventions closer to home?
A: Hand hygiene is integral in both resource-poor and more developed areas of the world. Even without access to fresh water, hand hygiene can be beneficial. There are several studies showing that hand hygiene significantly reduces infectious illnesses in very poor areas of the world.

Q: Are antibacterial soaps effective or are they actually counterproductive by causing bacteria to become more resistant to antibiotics?
A: Antibacterial soaps containing triclosan are not more effective than plain soaps in reducing bacteria on hands among individuals living in the community setting. In addition, some laboratory studies demonstrate a link between exposure to triclosan and acquisition of antibiotic resistance in bacteria.

Q: What can businesses do immediately to improve hygiene at their facilities?
A: Businesses can use SCA Tissue as a model. At SCA, the bathrooms have touchless soap and paper towel dispensers, and there is often a garbage pail next to the door of the bathroom so that you can use a paper towel to open the door. There is hand sanitizer at the desks of the staff and sanitizer near the bathrooms. These are all important points of hygiene in the workplace.

Q: What are the key reasons people fail to practice good hand hygiene?
A: One of the top reported reasons individuals fail to practice proper hand hygiene is that they “forget.” Other reported factors include “being too busy” or they “didn’t think it was important.”

Q: Have you seen improvements in overall hand hygiene since you began researching it?
A: Yes, hand hygiene has improved in the hospital setting, and I think that individuals are becoming more aware of the importance of hand hygiene in the community setting. Take schools as an example. Many schools, ranging from elementary to college, have installed hand sanitizers near classrooms or in residence halls and promote daily hand hygiene.

Q: What are some of the links you have found between infections and chronic diseases?
A: We found that a common herpes-type virus, called cytomegalovirus, was associated with cardiovascular disease, cognitive decline and poorer physical functioning in older individuals in the U.S. This infection can be prevented through proper hand hygiene and cleaning.

Q: What do you hope the Tork® Green Hygiene Council will accomplish?
A: I hope that TGHC will bring together green and hygiene in a way that fundamentally changes how we approach hygiene and environmental consciousness in the workplace. I am looking forward to being part of a team that helps create a knowledge base for how to address the needs of hygiene and cleaning in an environmentally friendly and safe way.