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While flu season is drawing to a close, transmission of germs can still lead to colds and serious respiratory diseases. In few places are individuals more exposed to a multitude of unique germs and germ carriers than during travel. Unlike some forms of travel, such as buses, where an individual can choose to get off the vehicle or find an alternate transit option, like carpooling, air travel is much less flexible. Based on data from the Bureau of Transportation Statistics, in 2010, on average 1.73 million passengers boarded domestic flights every day in the United States. On a plane, individuals are confined in a tight environment with fellow passengers often for multiple hours at a time. With high volume throughput and efficiency expected of airlines today, ground crews have limited turnaround time to clean out the airplane cabin before the next group of passengers, fresh with their own cocktails of germs, boards. In this context, how do you, the passenger, attempt to mitigate the health risks inherent to air travel?

Hand sanitation and hygiene is one answer, given that the Centers for Disease Control and Prevention estimates that 80% of the germs that make individuals sick are transmitted by hand. However, traditional hand sanitizers primarily work when wet and therefore only solve part of the problem.

Luckily, innovation in the hand hygiene market is taking place at companies like Zoono, based in Auckland, New Zealand. Zoono is focused on developing environmentally friendly antimicrobial solutions that improve upon the limitations of traditional sanitization products.

In order to learn more about the hygiene of air travel, as well as innovation in the hand sanitation market, Medgadget had the opportunity to learn more from Zoono’s Chief Scientific Officer, Dr. Andrew Alexander.

Michael Batista, Medgadget: Thank you for speaking with Medgadget, let’s start with a little bit about your background and role at Zoono.

Dr. Andrew Alexander: I’m the Chief Scientific Officer for Zoono, USA with over 25 years experience in pharmaceutical, biotech, veterinary, and medical device development and the development, testing, and commercialization of life science products. Currently, I’m focused on developing novel antimicrobial products for the human and veterinary markets. I hold degrees in Veterinary Medicine and Surgery, a Ph.D. in Biomolecular Science, and completed a post-doctoral fellowship in Oncology and Immunology. I also completed an MBA at the University of Wisconsin and am a Diplomate of the American Board of Toxicology (DABT).

Medgadget: Our specific areas of interest today are germ risks during air travel and hand sanitation. Let’s start with a clarification about getting sick on airplanes. In terms of “catching” another passengers germs and getting sick, does the severity or specific ailment of your fellow passenger matter or are germs from someone else going to have an impact on you no matter what?

Dr. Alexander: Infectious diseases that are commonly spread by touching contaminated hands and surfaces are gastrointestinal related and caused by norovirus and rotavirus, which can be spread rapidly through a plane with devastating consequences.  Respiratory diseases are spread by being in a vicinity of sick individuals that are coughing and sneezing and by hand-to-hand transmission and encountering contaminated surfaces.  A major source of disease-causing pathogens are the lavatories being used by numerous passengers including those who are sick and spreading germs on the door handles and sink faucet. Other major culprits include the tray tables and seat belt buckles which are not frequently disinfected between flights due to quick turnovers. These are all vectors for disease transmission.

For people are who are traveling internationally, the risk increases for exposure to exotic diseases not common in one’s native country; diseases that cause significant illness such as malaria, tuberculosis, and new strains of influenza. Air travel can impact the global spread of emerging and established infectious diseases and measures should be taken to help prevent transmission.

Medgadget: In the same vein, I’m sure most of our readers have had the experience of getting on a plane and hoping to avoid sitting next to someone they saw coughing or sneezing in the terminal. How likely is it for a healthy traveler to encounter and become sick from germs of their fellow passengers?

Dr. Alexander: According to research published in the Proceedings of the National Academy of Sciences, the 11 people seated closest to a person with a respiratory virus have a greater than 80% chance of catching it themselves, including people who are two seats in front or behind or to either side in the row.

For germs that are airborne, having a face mask on hand during travel is suggested, or covering your mouth and nose with a tissue.  This is particularly important for immune suppressed individuals.

The Centers for Disease Control and Prevention (CDC) estimates that 80% of the germs that we are exposed to that make us sick are transferred by our hands. So, even after we wash our hands and use traditional hand sanitizer, as soon as we touch the next dirty thing, the process of re-contamination resumes. Therefore, it is recommended to arm ourselves with preventative measures that we can apply before getting on a plane and use during travel, such as a residual, long lasting hand sanitizer and disinfectant wipes to clean the tray table, seat belt buckle, and TV monitor. While it is much more challenging these days with fully booked flights to ask for a seat change if you’re seated next to a sick passenger, if it is possible, ask. The furthest away you can be from a sick person, the better.

Medgadget: In some cases you might not have anyone visibly sick on a plane with you, but you know that other people were recently on the plane who you have not seen and some of your fellow passengers may appear outwardly healthy but can still be contagious. Are there still risks of getting sick even if your immediate fellow travelers seem to be in good health?

Dr. Alexander: Yes.  While people may appear healthy, germs can still be on their hands and be transferred to surfaces touched all around the plane. For example, if we are on a flight with 100 people and 10 percent of them get up to go to the bathroom, including us, we are touching the same doorknobs and sink handles they are, picking up their germs, and then depositing them elsewhere for others to pick up, putting us all at risk for getting sick.

Medgadget: As a traveler aware of these direct and indirect health risks of air travel, what are some strategies for mitigating your risk of getting sick on a plane before, during, and after traveling?

Dr. Alexander: (1) Before getting on a plane, be sure to get enough sleep and stay hydrated to help prevent the skin from drying and becoming susceptible to infections. (2) Wipe down the tray table with a disinfectant wipe or spray at the start of the flight, especially before meals to reduce exposure to germs from contaminated surfaces. (3) Ask to move seats, if possible, if a sick person is coughing and sneezing near you. (4) Cover your mouth with a tissue when around others who are coughing and sneezing. (5) If the flight is short and your bladder can handle it, stay put and avoid the lavatory. If you must go, be sure to wash hands well for at least 15-20 seconds and apply an alcohol-based hand sanitizer that is long-lasting when you leave the lavatory, so the next surface touched doesn’t lead to re-contamination of your hands. This is especially important to help reduce risk of picking up germs from the seat cushion, tray table, and buttons on the control screen/devices; items that are used by many other passengers.

Medgadget: Let’s use this as an opportunity to segue into our second topic, hand sanitation. As a starting point, why do most hygiene suggestions specifically focus so much on hand sanitation when there are other parts of the body that can similarly be exposed to germs?

Dr. Alexander: Hand hygiene is widely recognized as the single largest variable in the spread of infection. Germs such as viruses, bacteria, and parasites are commonly passed from individual to individual through hand-to-hand contact or transferred from contaminated surfaces to hands. If contaminated hands are not washed with soap and water or cleaned using a hand sanitizer, these germs may infect the skin or make their way into the body and cause disease. Think about how many times you touch your eyes, face, and month, rub your nose, or eat with your hands. These germs can lead to skin and eye infections, dermatitis, or gastrointestinal diseases, among other things.

The CDC estimates that 80% of the germs that make us sick are transferred by our hands. Germs on the hands are spread to other parts of the body when hands then touch itchy eyes, running noses, and during nail biting. Germs on hands are transferred to others through handshakes and when we touch the cheeks of people we love. Items such as cell phones, sports equipment, and dirty towels can also transfer germs from one part of the body to another.

While hands are not the only culprit, they are a major factor in disease transmission.  It is why proper hand hygiene is so important to reduce your risk of getting sick and reducing the transfer of germs.

Medgadget: How effective is either washing your hands or using hand sanitizer in protecting against or fighting germs? Are there other, more effective techniques for better hand sanitation?

Dr. Alexander: Hand washing remains the gold standard in killing germs and removing them from our hands. However, hand washing is only maximally effective if hands are washed with soap and water for a minimum of 20 seconds a few times throughout the day which includes scrubbing all surfaces of the hands in addition to your palms; the top of hands, in between fingers, and under nails. Hand washing should always be done after using the bathroom.  In addition, hands should be cleaned after preparing raw meat and before and after meals, especially when sharing finger food.

What product we wash our hands with also affects the potential for germ transmission. Liquid soap dispensers are preferred over bar soap and are less likely to transmit germs user-to-user, especially in public settings or in the home where there are multiple users.  In addition, avoid hand dryers as they can cause germs from the hands to become airborne and contaminate surfaces and be transferred to others if contaminated surfaces are touched.  Therefore, use disposable paper towels in public washrooms if available.  At home, a particular fabric hand towel should only be used by one person and washed every couple of days.

The moment we touch the next contaminated surface after washing our hands the process of germ transfer and re-contamination begins again. Therefore, hand sanitizers are a valuable alternative to clean the hands and kill germs when soap and water is not available. However, not all hand sanitizers are created equal. Most hand sanitizers rely solely on alcohol to clean and sanitize the hands, work only when wet, and quickly evaporate. Once dry, alcohol-based hand sanitizers lose their ability to sanitize hands. Therefore, one should consider hand sanitizers that provide residual and persistent protection on the skin for up to 24 hours. Zoono GermFree24 Hand Sanitizer is applied to the hands just like a traditional hand sanitizer but provides an invisible shield on hands for protection up to 24 hours and requires just one application. And, it works when wet or dry.

Medgadget: The presence of hand sanitizer stations seems to be on the rise in public places and airports. Are hand sanitizers all the same or are some better or worse than others?

Dr. Alexander: Not all hand sanitizers are created equal. The recommended hand sanitization strategies are not only outdated but are also limited by a lack of up-to-date technology. Traditional hand sanitizers do kill germs and sanitize the hands, but they only do so for a brief time. Traditional hand sanitizers mostly work when wet and evaporate quickly. Therefore, the next germy surface that is touched may contaminate hands and may put the person at risk of becoming infected with these germs. Furthermore, these hand sanitizers tend to be harsher on the hands, drying the skin and cuticles, which can cause cracks to form in the skin thus damaging the skin’s own protective barrier against germs.

Part of my job is to introduce better antimicrobial products and substances to the market that are gentler on the skin, safer to use, and allow the hands to stay cleaner for longer. An added advantage is that it makes people more likely to use them, and more frequently.

It is important for us to use hand sanitizers that clean our hands while also providing residual, long-lasting protection between product applications; products that don’t damage the skin’s natural defenses, therefore people will want to use the hand sanitizer on a routine basis which both protects them and others from hand-transmitted diseases.

Medgadget: I understand that Zoono is one of the companies innovating in the hand sanitization space. What are some of Zoono’s products?

Dr. Alexander: Zoono provides a wide-range of products from hand and foot sanitizers to general sanitization products.

Zoono’s GermFree24 Hand Sanitizer is a unique, long-lasting, highly effective, water-based hand sanitizer that is non-toxic, kills 99.99% of germs on contact, and keeps killing them for up to 24 hours with just one single application. Unlike traditional hand sanitizers which only work while they are wet and quickly evaporate, Zoono works once it’s dry creating a protective barrier on hands for up to 24 hours.

Zoono’s ULTRA GermFree24 Hand Sanitizer is a hospital-strength hand-sanitizer that includes a higher alcohol content that meets and exceeds the recommendations of ingredients for products of this nature by the CDC. This hand sanitizer is best used during cold and flu season and helps to protect against norovirus. It also works once it’s dry creating a protective barrier on hands for up to 24 hours.

Zoono’s Germfree24 Antiseptic Wound Cleanser is a water-based formula that delivers immediate antiseptic benefits while also providing continuous antimicrobial protection for up to 24 hours with just a single application.

Zoono’s GermFree24 Foot Guard is highly effective in combating foot odor and cures most athlete’s foot and ringworm fungi with just one single application. It relieves itching, burning, cracking, scaling, and discomfort which accompany these conditions and is effective for up to 24 hours killing 99.99% of germs that cause foot ailments. It forms an antimicrobial barrier on skin that will not wash off and is only removed by natural exfoliation.

Finally, Zoono’s Microbe Shield product is a revolutionary, highly effective water-based antimicrobial technology available in a surface sanitizer that inhibits the growth of bacteria, mold, mildew, and fungi for up to 30 days. This innovative, long-lasting antimicrobial permanently bonds to surfaces on which it is applied. The noncorrosive, nontoxic product lays down a bacteriostatic defensive layer to impart long-lasting antimicrobial protection and does not promote microbial mutation.

Medgadget: What makes Zoono’s offerings unique compared to traditional hygiene products?

Dr. Alexander: Zoono kills mechanically, not chemically. Zoono is a totally unique antimicrobial product and does not kill bacteria by poisoning. Instead, it creates a hostile barrier that resembles a “bed of nails” that punctures and kills microbes when they come into contact. This means that there is no possibility of germs building up an immunity or becoming resistant to Zoono and forming “Super-bugs.” When Zoono is applied to the hands or surfaces and allowed to dry, it leaves a thin bonded protective layer that, at the nanomolecular-level, resembles millions of sword-shaped road spikes that attract and kill germs. Because the Zoono molecule is not consumed during the germ-killing process it continues to kill all germs that encounter Zoono.  One single application of Zoono can last up to 24 hours on hands and wounds and on surfaces for up to 30 days.

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