How Effective are Hand Sanitizers?

SONY DSCThough old-fashioned hand-washing is the best way to keep hands clean and combat germs, gel hand sanitizers are a good alternative when soap and water aren’t readily available, a CHOC Children’s physician says.

“They certainly don’t take the place of proper hand-washing,” says Dr. Negar Ashouri, a CHOC infectious disease specialist. “That is still the best way to help prevent the spread of infection. But when you don’t have access to soap and water, hand sanitizers are a good alternative.”

Hand sanitizers can also supplement hand-washing, Dr. Ashouri says. The Centers for Disease Control (CDC) recommends scrubbing hands with soap and water for at least 20 seconds. However, the average person doesn’t always wash their hands long enough or effectively enough to kill germs entirely. In addition, people don’t always use enough soap, or they don’t clean the entire hand.

If you coat the whole hand with the gel, alcohol-based hand sanitizers work well to help kill germs, she says. The CDC notes that alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.

Hand sanitizers should be alcohol-based and have a concentration of at least 60 percent alcohol to be effective. Dr. Ashouri says any brand is fine as long as it meets that level of alcohol concentration.

Also, she adds that it’s a myth that people build a resistance to gel sanitizers and that long-term use renders them ineffective.

Learn more about CHOC’s infectious disease division.

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Tdap Recommended for Children Ages 7-10 with Incomplete Vaccination, Pregnant Women and More

A fairly new California state law requires all students entering seventh grade each year to provide proof of having immunization against pertussis (whooping cough). The Tdap protects against tetanus, diphtheria and pertussis – three dangerous diseases. Did you know it is  also recommended for the following persons?

• Children ages 7-10 years with incomplete vaccination
• All persons who have close contact with pregnant women or infants
• Women of childbearing age—before, during (late 2nd trimester or 3rd trimester), or immediately after pregnancy
• Adults ages 19-64 years
• Adults ages 65 years and older

Pertussis is a highly contagious bacterial illness spread by coughs and sneezes. Children with pertussis have severe coughing attacks that can last for months. Parents should be aware that the protection from childhood immunization to pertussis wears off, and adolescents may be at risk for infection without a booster.

Be sure to contact your doctor or clinic to learn more and to arrange for a Tdap booster. Don’t forget the seasonal flu shot, too!


For more information, please visit the Orange County Health Care Agency website:

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Kids and Germs

wash hands to kill germsWHAT ARE GERMS?

“Germs is a nonmedical term for any organism that can cause an infection,” says Dr. Nieves. What kind of infections? Kids, especially in schools, can contract respiratory infections as well as skin infections, says Dr. Nieves. To prevent the spread of germs, especially in classrooms, parents,  teachers and caregivers should make sure children are instructed on proper hygiene techniques, like handwashing.

Children should wash their hands:

  • Before eating
  • After going to the bathroom
  • After blowing their nose
  • After playtime


Sharing may be a good way for kids to learn social skills, but it’s not the best way to stay healthy, Dr. Nieves says. To shield children from “germ  monsters,” Dr. Nieves advises parents to encourage their children not to share items like utensils, food and drink. Also, making sure they are up-to-date on their vaccines and seasonal flu shot is key.


If you’re not sure when soap and water or alcohol-based sanitizers are in order, do a hand check. “When you see actual dirt and grime, you need soap and water,” says Dr. Nieves.  “You can use hand sanitizer when you know your child has touched something that may be contaminated, such as a door knob.”


It’s best for kids to stay home when sick, but if missing work to care for them isn’t an option, parents should ensure good communication with the school to minimize the spread of germs to other students. “If kids have a cold, they have to be extra cautious, washing their hands after touching their face or nose,” says Dr. Nieves.


  • Kids should spend 15 seconds vigorously washing their hands.
  • 60% is the lowest percentage of alcohol a hand sanitizer should contain.
  • 9-to-1 is the ratio of bleach to water in a solution that parents can make to kill germs.

View the full feature on Kids and Germs

Dr. Nieves
Dr. Delma Nieves
CHOC Research Specialist,
Pediatric Infectious Diseases


Dr. Nieves began her work at CHOC in 2010. She completed her pediatric residency at CHOC and postdoctoral fellowship in pediatric infectious diseases at the Mattel Children’s Hospital. Her clinical interests include infectious diseases of newborns and the immuno-compromised, with a  focus on pertussis. Her published works include “The Common Cold: Textbook of Pediatric Infectious Diseases,” and several peer reviewed studies on the topic of pertussis in young infants.

Dr. Nieves’ philosophy of care: “I think the most important thing is to empower parents and children to be able to take care of themselves.”

University of Washington School of Medicine

General Pediatrics and Pediatric
Infectious Diseases

More about Dr. Nieves

This article was featured in the Orange County Register on September 16, 2013 and was written by Shaleek Wilson.

Meningococcal Disease – What Parents Should Know

Please take a few minutes to check out these must-know facts and guidelines on Meningococcal disease, as recommended by the Centers for Disease Control and Prevention (CDC).

What is Meningococcal disease?
Meningococcal disease is a severe bacterial infection caused by the bacterium Neisseria meningitidis, also called meningococcus. Neisseria meningitidis bacteria are spread through the exchange of respiratory and throat secretions like spit (e.g., living in close quarters, kissing, sharing drinks, eating off same fork). People who qualify as close contacts of a person with meningococcal disease should receive antibiotics to prevent them from getting the disease.

Who can get Meningococcal disease?
Anyone can get meningococcal disease, but it is more common in infants and children. Other persons at increased risk include household contacts of a person known to have had this disease, immunocompromised people, and people traveling to parts of the world where meningococcal disease is prevalent.

What are the symptoms?
A common outcome of meningococcal infection is meningitis. When caused by Neisseria meningitidis bacteria it is known as meningococcal meningitis. When someone has meningococcal meningitis, the protective membranes covering their brain and spinal cord, known as the meninges, become infected and swell. The symptoms include:

• Fever
• Headache
• Stiff Neck
• Nausea
• Vomiting
• Increased sensitivity to light
• Altered mental status (confusion)

The symptoms of meningococcal meningitis can appear quickly or over several days. In newborns and infants, symptoms (fever, headache, neck stiffness) may be difficult to notice. The infant may appear to be irritable, inactive, vomiting or feeding poorly.

Another common outcome of meningococcal infection is bloodstream infection, either septicemia or bacteremia, and the more serious of the two is septicemia. When someone has meningococcal septicemia, the bacteria enter the bloodstream and multiply, damaging the walls of the blood vessels and causing bleeding into the skin and organs. Symptoms may include:

• Fatigue
• Vomiting
• Diarrhea
• Rapid breathing
• Cold chills
• Severe aches or pain in the muscles, joints, chest or abdomen
• Red dots which can progress to dark purple rash
Please note: Meningitis and septicemia can sometimes occur together.

If you think you or your child has any of these symptoms, call the doctor right away.

How is Meningococcal disease treated?
Meningococcal disease can be treated with a number of effective antibiotics. If meningococcal disease is suspected, antibiotics are given right away. In some cases the infection has caused too much damage to the body for antibiotics to prevent death or serious long-term problems. Depending on how serious the infection is, other treatments may also be necessary. These can include such things as breathing support, medications to treat low blood pressure, and wound care for parts of the body with damaged skin.

How can Meningococcal disease be prevented?
Vaccination is key. Keeping up to date with the recommended immunizations is the best defense against the disease. Meningococcal vaccine is recommended for all children at age 11-12 years, with a booster at 16 years. Children with certain underlying medical issues, or those who are traveling to certain areas, may need to be vaccinated earlier.

Available vaccines cover most, but not all strains. Even if you have been vaccinated, there is still a chance you can develop a meningococcal infection. People should know the symptoms of meningococcal meningitis and meningococcal septicemia since early recognition and quick medical attention are critical. In addition, maintaining healthy habits, such as getting plenty of rest and not coming into close contact with people who are sick, can help.

For more information, please visit the CDC website at

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Who Needs a Flu Vaccine?

Practically everyone. This year’s seasonal flu vaccine is recommended for everybody 6 months and older. That includes healthy kids, as well as those with medical conditions. And it also includes you, Mom, especially if you are pregnant. Did you know the flu vaccine will protect you and your baby now — and your baby for the first few months of life?

CHOC Children’s infectious diseases specialist Jasjit Singh, M.D., has some helpful answers to questions we’re frequently asked about the seasonal flu vaccine.

Q. Why does a healthy child need a flu vaccine?
A. A child’s health status does not automatically prevent some of the serious complications associated with the flu. Children under 1 year of age who get the seasonal flu have extremely high rates of hospitalization. And in the last few years, half of the pediatric deaths from influenza have occurred in previously healthy children. This year’s flu vaccine protects against two new influenza strains, plus the H1N1 virus.

Q. My baby is younger than 6 months — how can I protect him during flu season?
A. Make sure that everyone in your home — siblings and grandparents, too — and daycare providers get a flu vaccine. This reduces the likelihood of your baby coming into contact with the virus. Also important: Wash your hands and use respiratory etiquette during flu season. There are many other respiratory viruses out there besides the seasonal flu, and the flu vaccine cannot protect against all of them.

Q. I’ve been hearing about “herd immunity” — what is that exactly?
A. Herd immunity protects the youngest, most vulnerable members of our community who cannot get the flu vaccine. When more members of the community are immunized, there is less chance of an influenza outbreak.
Also, some children have weak immune systems and remain vulnerable even after getting the flu vaccine. Their protection depends on herd immunity, as well.

Q. I’ve heard there is a nasal mist alternative to the shot.
A. The traditional flu shot is approved for children 6 months and older. The intranasal flu vaccine is an option for healthy kids 2 and older.

Earlier is better, but it’s not too late to get a flu vaccine. Contact your pediatrician.

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