COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEES ON PUBLIC HEALTH AND HUMAN SERVICES AND LEGISLATIVE OVERSIGHT - - - Room 400, City Hall Philadelphia, Pennsylvania Tuesday, February 13, 2007 1:25 p.m. - - - PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR COUNCILMAN JAMES F. KENNEY, CHAIR RESOLUTION 060767 - Resolution authorizing City Council's Committees on Public Health and Human Services and Legislative Oversight to hold public hearings exploring the health benefits and conveniences of installing hand sanitizer dispensers in all public elementary schools and city workplaces. - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
The Committee on Public Health and Human Services is now in session. Thank you for coming. I'd like to recognize Councilman Kenney, who is the Chair of the Legislative Oversight Committee. Other Councilmembers will be here shortly since they just left a hearing which they sat through for a few hours this morning. We'd like the Clerk to read the resolution, please.
Resolution 14 authorizing the City Council's joint Committees on Public Health and Human Services and Legislative Oversight to hold public hearings exploring the health benefits and conveniences of installing hand sanitizer dispensers in all public elementary school and City workplaces.
Thank you very much. Councilman Kenney, you have remarks.
Thank you, 3 2/13/07 - PUBLIC HEALTH - RES. 060767 Madam Chair. Good afternoon. Today's hearing will explore the health benefits and conveniences of installing hand sanitizer dispensers in public schools and City workplaces. Did you know that 80 percent of infectious disease are spread through hand contact or that some viruses and bacteria can live from minutes up to 12 two hours or more on surfaces like 13 cafeteria tables, door knobs and desks? 14 With over 197,000 students in 15 our City schools and approximately 30,000 16 City employees, installing hand 17 sanitizers is an effective way to reduce 18 the spread of germs. In turn, the 19 productivity gained from increased 20 student, teacher and City employee attendance will certainly outweigh the costs of installing and maintaining the units. While using hand sanitizers does not replace the need for proper hand 4 2/13/07 - PUBLIC HEALTH - RES. 060767 washing, the Center for Disease Control confirms that alcohol-based antiseptics are very good to excellent in killing most bacteria and viruses, which are causes of the common cold and infections. In addition, multiple studies have shown that consistent hand sanitizing with alcohol-based gels can reduce student absences between and 40 percent and 11 teacher absences by approximately ten 12 percent. 13 It is my hope that today's 14 hearing will prompt further discussion 15 and serious consideration of installing 16 hand sanitizer dispensers in public 17 schools and City workplaces. 18 We thank you for your 19 attendance today and would like to call 20 Dr. James Dean, who is the Medical Director of the Department of Public Health. Good afternoon.
Please 5 2/13/07 - PUBLIC HEALTH - RES. 060767 identify yourself for the record.
I'm Dr. James Dean. I'm the Medical Director for the Philadelphia Department of Public Health. Good afternoon, Chairwoman Tasco and Chairman Kenney and members of the Committee on Public Health and Human Services and Legislative Oversight. As I stated, I'm Dr. James Dean. I'm not only the Medical Director for the Department of Public Health, but I am also a Board-certified infectious disease specialist. I appreciate the opportunity to be here this afternoon to provide testimony on the Department's recommendations on the use of hand sanitizers in public elementary schools and City workplaces. Cleansing of the hands is acknowledged by the federal Centers for Disease Control and Prevention to be the most important measure for preventing the spread of disease-causing organisms in any setting. Although traditional hand 6 2/13/07 - PUBLIC HEALTH - RES. 060767 washing with soap and water is still regarded as the most effective method of hand hygiene, recent studies have shown that alcohol-based hand sanitizers do have effectiveness in reducing gastrointestinal illnesses in households, reducing absentee rates in elementary schools and workplaces, and in curbing illnesses in university dormitories. Alcohol-based sanitizers have several advantages over traditional hand washing in terms of convenience of access and ease of use and, therefore, can be particularly useful in instances where running hot and cold water and soap and towels are not available. Maintaining a high standard of hand hygiene in elementary schools is a particularly difficult task. Elementary schools are often a prime setting for the transmission of infections because of the closeness of the working environments and eating space and the sharing of toilet facilities by large numbers of children. 7 2/13/07 - PUBLIC HEALTH - RES. 060767 Some toilet facilities can be targets of vandalism that can result in the unavailability of soap and the unavailability of paper towels or result in other unsanitary conditions, but perhaps the most significant factor is that younger children often lack the knowledge or discipline or simply the inclination to practice hand washing. The use of alcohol-based hand sanitizers would provide an ideal adjunct to assure proper hand sanitization in the elementary school setting. To support this, a recent study involving more than 6,000 students in 16 elementary schools has shown that alcohol-based hand sanitizers are effective. In some schools in the study students and teachers used an alcohol-based hand sanitizer when both entering and when leaving the classroom. In other schools only traditional methods of hand cleansing were used. When the absentee rates for the schools that used 8 2/13/07 - PUBLIC HEALTH - RES. 060767 the hand sanitizer were compared to those in the control group, it was found that the student absentee rate had been significantly reduced by nearly 6 percent and the teacher absentee rate 7 decreased by more than ten percent. 8 Moreover, because hand sanitizer 9 dispensers can be placed in the more 10 public areas, the risk of vandalism is 11 reduced and the use of the hand sanitizer 12 by students can be more readily observed. 13 More work would be necessary to determine 14 the optimum number of dispensers needed 15 and the most effective installation 16 locations, et cetera, but we believe the 17 use of alcohol-based hand sanitizers 18 would significantly improve hand hygiene 19 and reduce transmission of 20 gastrointestinal organisms in elementary schools. Workplace environments share many of the same predisposing factors that contribute to infection transmission in schools, and recent studies also show 9 2/13/07 - PUBLIC HEALTH - RES. 060767 that the use of alcohol-based hand sanitizers in the workplace can have a similar effect in reducing the absenteeism from work.
In a study conducted on comparable populations of workers on two floors of an office building, the use of alcohol-based hand sanitizers was shown to reduce the worker absentee rate by percent. City 11 offices and workplaces, however, vary 12 significantly in their use and purpose, 13 from small office settings with little or 14 no access by the general public to large 15 public settings that are visited by 16 hundreds of clients, patients or inmates 17 each day. The efficacy and need for 18 supplemental hand sanitizing dispensers 19 in those several hundred facilities 20 operated by the City of Philadelphia 21 likewise would vary widely from facility to facility, although certainly proposal for installation of hand sanitizers certainly should be considered for review. 10 2/13/07 - PUBLIC HEALTH - RES. 060767 The safety of alcohol-based hand sanitizers has been well documented. These products have been in use in European hospitals for over 30 years with no significant problems. The Department of Public Health continues to encourage traditional hand washing as the most effective method of hand hygiene, although it is clear that alcohol-based hand sanitizers are additionally beneficial in certain situations and settings, schools and workplaces featuring prominently among them. A forum such as this is an excellent way to learn of the technical, financial and practical aspects of a recommendation for introducing hand sanitizers into some of those places over which we have control. Thank you for the opportunity to provide this testimony today and I'll now answer questions.
Thank you, Doctor. I was wondering if the Department would be willing to assist us 11 2/13/07 - PUBLIC HEALTH - RES. 060767 in any pilot program regarding where they should be installed. One of the interesting parts of your testimony was that often because bathrooms are secluded that there's opportunities for vandalism inside the bathrooms, whereas in more publicly traversed areas, they're easily kept an eye on, the hand sanitizers. So would you be willing or your Department be willing to assist us and the School District in trying to determine exactly where these would be placed or should be placed if we decide to move forward with some type of an attempt at a pilot program?
Yes, Councilman. I think that should we move forward with this, that we would need to have collaboration with the School District, especially since they know their facilities and especially in elementary schools. Those bathrooms tend to be vandalized more than, let's say, in an office setting. So we would want to work 12 2/13/07 - PUBLIC HEALTH - RES. 060767 with them to get their opinion as to where they would best be placed.
And do you have an opinion relative to the concentration of alcohol in any of these products? I had gotten a couple e-mails this morning as a result of a radio story about the level of alcohol content and whether or not there's a danger possibly in place as a result of 60 percent or so alcohol-based product.
For these products to be effective in killing the microorganisms on the skin, the alcohol content needs to be at 62 percent or greater. And at that percent concentration, there have been some case reports of either -- in one case report recently, not locally but in another state, of an inmate who drank the hand sanitizer and another of a hospital patient who drank the hand sanitizer and they became intoxicated. So, again, there is that risk. However, I believe 13 2/13/07 - PUBLIC HEALTH - RES. 060767 that the vigilance on where best to place these where they could be monitored could significantly if not eliminate that risk.
Is there any risk to children at all by the normal use of it with cleaning of the hands and ingestion through the skin?
No. As I said, these have been in use in Europe for many years, and if you've used the hand sanitizer, it evaporates quite quickly after use.
Good afternoon. Can the Health Department take this on without legislation to encourage or implement a program to put hand sanitizers in the schools and/or in public buildings?
We can certainly work with the schools. And we always encourage hand washing. One of the factors that we don't know is the financial cost for looking at all of the 14 2/13/07 - PUBLIC HEALTH - RES. 060767 facilities and the maintenance and the purchase of product, but to provide expertise in infectious disease, infection control, we have a whole division that will be more than willing to assist with this.
Thank you very much for your testimony. Ms. Rhona Cooper and Dr. Adrienne Curry from the School District.
Good afternoon, Chairwoman Tasco and Chairman Kenney and members of the Committees on Public Health and Human Services and Legislative Oversight. I'm Rhona Cooper. I'm a school Health Coordinator with the School District. Dr. Curry was not able to be with us today. I represent the Office of Specialized Services, specifically School Health Services, which is the office that provides services to the K to 12 population, and we represent the work of the school nurses in schools. I 15 2/13/07 - PUBLIC HEALTH - RES. 060767 appreciate the opportunity to be here this afternoon to provide testimony on the Department's recommendation on the use of hand sanitizers in public schools. In the year 2005-2006, the school year of 2005-2006, school nurses in public schools saw 229,000 students in their health rooms for illness, and of those, ten percent represented just six out of the 80 illness indicators that we list. Those six were cold symptoms, coughs, fever, stomachaches, conjunctivitis and diarrhea. We have always known that proper hand warning is the best and most effective way to protect one's self from most diseases that would present with the symptoms I've just mentioned. Particularly as we are in the middle of cold and flu season, we're conscious of the need to remind our students, their families and our staff that the majority of germs are passed by contact with infected bodily fluids via 16 2/13/07 - PUBLIC HEALTH - RES. 060767 unwashed hands. Hand washing is a simple but important technique for everyone to learn and use. It is the most important and cost-effective way to decrease the spread of common cold and many other infections that affect our students and staff. School is an excellent place for young and old to learn and practice hand washing. This is a skill that can be considered as important to quality of life as anything else that students might learn in school. Effective hand washing in schools can be accomplished if students, staff and others have access to warm running water, soap and paper towels and, of course, the opportunity to wash. In the absence of the opportunity to wash hands, hand sanitizing lotions are considered to be effective in killing germs when used on the skin with adequate friction; that is, the rubbing of hands. We recognize that the placement of hand sanitizers in classrooms and 17 2/13/07 - PUBLIC HEALTH - RES. 060767 cafeterias would be an excellent supplement to routine hand washing with soap and water but not a substitute. Logistical, safety, cost issues in the school setting would, of course, need to be considered, and until then, we will continue to teach these very simple rules: wash your hands often, cover your cough or sneeze with a tissue and then wash your hands, keep your hands away from your face, and stay home if you are ill. Thanks very much.
Thank you for your testimony. Any questions? (No response.)
Would the District be willing to begin to look at their school settings to determine, in your opinion, the appropriate, with the Health Department's help, the appropriate 18 2/13/07 - PUBLIC HEALTH - RES. 060767 location for these? Where I actually first came across this was on a cruise ship, and it makes a lot of sense because there's so many people on the ship sharing the same facilities that people continue to wash their hands, and they had them in the dining area for the most part. They had them in other areas of the ship, but the dining area was the main place that they had them. So would the District be willing to kind of start to take a look now at what the appropriate places may be and also to give us an idea on the extent in each building where we may have to put them so we can try to figure out a cost?
Yeah. I think that through our school health councils and our -- we have a central committee that represents school health councils across the City. We have already in some ways discussed the possibility of the use of hand sanitizers, so I know that there 19 2/13/07 - PUBLIC HEALTH - RES. 060767 are people who are very interested in them. Of course, none of us represent the authority to put financing behind those, but certainly we would be happy to advise on locations and buildings that seem to make the most sense.
And I would make that request and I will follow it up in writing, that the School District begin to start thinking about locations and schools.
And I'm sure that they would be happy to receive that. Thank you.
Thank you very much. Keith St. John and Dr. Susan Coffin. Good afternoon. Thank you for your attendance. Please identify yourself for the record.
My name is Dr. Susan Coffin. I'm the Medical Director of Infection Prevention and 20 2/13/07 - PUBLIC HEALTH - RES. 060767 Control at the Children's Hospital of Philadelphia and a pediatric infectious disease doctor.
I'm Keith St. John. I'm the Administrative Director of Infection Prevention/Control and Occupational Health at the Children's Hospital of Philadelphia and I'm a clinical microbiologist by training.
Thank you very much both Chairwoman Tasco and Chairman Kenney. We're very happy to be able to provide testimony here on this important public health initiative. We are here today to show our enthusiastic support for the resolution 20 that calls for the installation of hand sanitizers in all public elementary schools and City workplaces. The overwhelming majority of acute illnesses experienced by children and otherwise healthy adults are infections and are 21 2/13/07 - PUBLIC HEALTH - RES. 060767 spread by contaminated hands. Thus, hand cleaning is the simplest and most effective way to reduce illness. Respiratory and gastrointestinal illnesses are easily spread in schools and workplaces. Viruses that cause the common cold, such as respiratory syncytial virus, can live for hours on inanimate objects such as door knobs and keyboards of computers. Bacteria that cause food-borne illnesses, like E. coli, can survive for almost two hours on cafeteria tables. Thus, schools and workplaces are often heavily contaminated with germs that can invisibly inoculate both students and workers. The burden of illness related to these easily transmitted infections is immense. Each year over 50 million episodes of the common cold occur among people less than 17 years of age. School absenteeism undermines academic achievement. Students who are absent 22 2/13/07 - PUBLIC HEALTH - RES. 060767 cannot learn, and those who remain in school must wait for them to catch up. In addition, parents are often called to be absent from work to care for sick children. So the impact on the overall productivity of the workforce is indeed compromised. In contrast, hand cleaning is simple. New products, such as the alcohol-based hand rubs, have made it even easier. No longer are sinks and paper towels needed. Now a dispenser can be mounted virtually anywhere and provide all passers-by the opportunity to clean their hands. At CHOP we have seen that patients, parents and healthcare providers clean their hands much more frequently now that we have installed alcohol-based hand rubs widely throughout our facility. The simple activity when it's done consistently by all who provide direct patient care in our hospital has resulted in fewer healthcare-acquired 23 2/13/07 - PUBLIC HEALTH - RES. 060767 infections. Most importantly, however, for this meeting, multiple studies have demonstrated a marked reduction in student and teacher absenteeism in school settings when hand hygiene education and products are introduced. A multi-state study conducted in Delaware, Ohio, Tennessee and California found a 10 percent reduction in student and a ten 11 percent reduction in staff absenteeism 12 when alcohol hand sanitizers were 13 introduced into the classroom. An 14 elementary school in Washington state 15 found a 28 percent reduction in 16 absenteeism due to illness. Most 17 impressively, Delaware Valley researchers 18 have demonstrated that a comprehensive 19 hand washing program that included 20 education and the installation of hand sanitizer dispensers within classrooms in five independent elementary schools in Pennsylvania, these researchers found 50 percent reduction in illness-related absenteeism. 24 2/13/07 - PUBLIC HEALTH - RES. 060767 We believe that a school-based intervention is an efficient strategy to improve the health of our City. An estimated one-fifth of our population attends or works in schools. On average, teachers are absent over five days each year, where students miss about four and a half days each year due to illness. Thus, as the leadership of the CHOP Infection Prevention and Control Department, Mr. St. John and I are in firm support of this resolution to install hand sanitizer dispensers throughout Philadelphia schools. This simple intervention can improve the health and education of all of Philadelphia's children and the teachers as well.
Thank you for your testimony. Could you please proceed with your testimony.
We actually combined our testimony. 25 2/13/07 - PUBLIC HEALTH - RES. 060767
Terrific. Have you felt or seen any studies relative to the safety in use by children of alcohol-based hand sanitizers?
I know of no 8 studies that indicate in large populations that the product is unsafe. In fact, we have begun a pilot program dispensing alcohol hand rubs in the form of wipes on the cafeteria trays, which are brought up -- food trays, which are brought up to patients within our hospital.
The one other caveat I'd like to bring forth is, you have to recognize that alcohol is flammable. So there are concerns from a fire safety standpoint if there's large quantities of this product stored outside of a flammable storage cabinet. So those considerations have to be taken as well. 2/13/07 - PUBLIC HEALTH - RES. 060767
So the storage of the product needs to be done in a way that keeps it safe and obviously you wouldn't smoke around using it, at the time we're using it. I know we have a problem with our kids smoking, but hopefully they're not doing it in the hallway at school. Maybe more in the bathroom than in the hallways.
Thank you very much for taking the time to come in. We hope to issue a report from this Committee at some point, which we will share with you and the School District and the City Health Department and see if we can't get some interest in moving this forward.
I'd just 27 2/13/07 - PUBLIC HEALTH - RES. 060767 like to say that I have noticed in many ladies' rooms lately that there are, in addition to the soap and water, there are hand sanitizers in many of the ladies' rooms, public, in restaurants, particularly restaurants along the Turnpike or other public facilities.
There's interesting debate over whether the role of alcohol hand sanitizer is best used within the restroom setting or if it's more in the public or classroom setting, and as the Council goes forward, we'd be happy to participate in those discussions.
Great. Thank you for being such a great institution in our City also. Thank you. Gary Dean and anyone else who is with him. This is our final witness. Is there anyone else in the room that's interested in testifying today? (No response.) 28 2/13/07 - PUBLIC HEALTH - RES. 060767
Yes. My name is Gary Dean, Unisource Corporation, Philadelphia, Pennsylvania.
I'm Larry Schultz, Maxwell-McKenney in Haddon Heights, New Jersey. MR. McKENNEY: And Marilyn McKenney, Maxwell-McKenney in Haddon Heights, New Jersey.
Thank you for having us. It's hard to follow some physicians and people like that. We're salespeople. But we are the Purell people. We've put some product here and I'd actually like to show it to you, but I have some figures that I'd like to 29 2/13/07 - PUBLIC HEALTH - RES. 060767 cover with you, and I think I probably will reiterate what these other speakers have said. We've done a lot of work in both the classroom and in the workplace and in healthcare as well. Someone cited percent reduction in absenteeism. 9 That was actually a study that we had had 10 done at Federal Express. They are now 11 actually going to our desktop products 12 because of that. 13 What we found is that if you 14 take a look at the desktop in the 15 workplace, there are a significant amount 16 of germs there, something in the 17 neighborhood on your telephone receiver 18 of 25,000 per square inch. We all spend 19 our time eating and drinking at our 20 desks, having coffee and things, and we 21 know that that's not necessarily the cleanest environment to do it. So what we've done is, we've made products to sit on the desktop and be noticed there, things like these pump bottles. In this 30 2/13/07 - PUBLIC HEALTH - RES. 060767 study we had a percent reduction in absenteeism. The other thing that we've had a reduction in is what we would call presenteeism where people come to work and you don't feel well and you make four or five other people ill as well. So the use of this product has really reduced that a lot. In the classroom we cite 51 percent when students are educated in how to use hand sanitizer. So there have been an enormous reduction in absenteeism there. You had some questions about placement of the products. We feel very strongly that the product should not be placed by sinks but rather in supervised areas in the classroom.
Also, it seemed to me that the earlier we start children in this process and making it a routine, the easier it is to continue that throughout their lives. I mean, not that older kids can't learn also, but you get the preschoolers and the kindergartners and you have them doing that on a regular basis and you follow it through the rest of the grades, I think you'll wind up with an overall kind of generation of healthier people and teachers.
Absolutely. We actually provide lesson plans, and we only go up to sixth grade. We feel that going to 11th or 12th grade for lesson plans for teaching people how to wash their hands or to sanitize their skin is just not effective any longer.
Great. Do you have any questions, 32 2/13/07 - PUBLIC HEALTH - RES. 060767 Councilwoman?
Thank you very much for your testimony. This has probably been the shortest and most productive hearing that I've had as far as information goes. I wish they were all like this. We will develop our report. We will disseminate that to Councilmembers, to the Administration, to the administration at the School District and to the Health Department and try to begin this process of moving towards a healthier classroom and workplace. So we thank you all for your attendance today, and be careful in the weather. MS. McKENNEY: Thank you, Councilman.
Thank you. (Joint Committees on Public Health and Human Services and Legislative Oversight adjourned at 1:55 p.m.) - - - 33 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on February 13, 2007, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)