Dr. Noorali Bharwani

“When your best friend bites…” is title of an article in the Canadian Journal of Infectious Diseases (CJID). It’s not about human friends who bite but it is about animal friends – dogs and cats.

Dogs and cats are very important to millions of Canadians. It is estimated that there are more than 100 million cats and dogs owned as pets in Canada and the United States. Do these domesticated animals bite? Of course, they do! I know it and many of you have been victims of these domesticated animals. In fact, one to two million dog bites are reported in both countries every year.

The CJID article says that up to 85 percent of dog and cat bites are caused by the victims’ family pet or by a neighbour’s pet. About half of these bites are considered to have been provoked. And 5 to 9 year old males sustain dog bites most frequently. So, let us not blame our animal friends for all the injuries.

And injuries are many. According to the Canadian Injury Reporting and Prevention Program, injuries related to dog bites account for one percent of all visits to hospital emergency departments.

These injuries are more serious in children than in adults. Children are more likely to be bitten on the face, neck and head in upto 70 percent of cases. Children account for the majority of the 10 to 20 deaths from animal bites that occur annually in the United States, says the CJID article.

Is this acceptable? Can we reduce the injury rate? After all, dogs are our best friends!

We should encourage dog owners to take responsibilities with regard to training their pets. This should include discouraging aggressive behaviour when animals are young, says the article. We should teach our children and adults about the risks involved in provoking dogs and other animals. Should we certify certain breeds as being dangerous and not fit to be pets? This is debatable.

What is the appropriate treatment for dog and cat bites?

Your physician will enquire about the status of tetanus immunization and give you a booster dose. He will assess the risk of rabies and arrange appropriate prophylaxis. The wound will require cleaning with removal of dead and dirty tissue. You may require prophylactic antibiotics.

The immunization status of the animal in question should be checked. The local animal control agency should be notified so that they can quarantine the animal and keep it under observation for up to 10 days to see whether clinical symptoms develop, says the author of the CJ ID article.

Dogs and cats can be dangerous. They can be lot of fun as well. Especially for children. But we have to be careful. We do not want fun to turn into fatality.

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How many times have we seen people walk out of public washrooms without washing hands?

How many times have we seen restaurant servers wipe tables with wet cloth and then take orders without washing hands? Do we know what is going on in the kitchen? How clean are those counters at fast food restaurants where they make and dispense sandwiches? What are the hand washing habits of these servers?

What about the health care workers? Do they wash their hands after examining each patient?

In 1996, the American Society of Microbiology (ASM), did a telephone survey of 7000 Americans, 94 percent said they always washed their hands after using the toilet. But researchers, observing actual behaviour in public washrooms in five cities, found that wasn’t the case. Only 68 percent washed their hands!

A study conducted this year by ASM showed similar results. So ASM’s campaign to improve hand washing habits of Americans has not changed much among men or women, although more women tend to wash their hands than men. It is a question of instilling permanent behavioural change. And that is not always easy. So, this year’s ASM campaign slogan (DON’T GET CAUGHT DIRTY HANDED!) is to keep reinforcing this behaviour (www.washup.org).

What about the health professionals? Are they any better? An editorial in the British Medical Journal says, “Many studies have confirmed that doctors decontaminating their hands between seeing patients can reduce hospital infection rates. Nevertheless, healthcare workers still fail to wash their hands and fail to appreciate the importance of doing so.”

In one study, 50 to 95 percent of physicians reported washing their hands before patient contact. But this contrasted sharply with the observed frequency of just 9 percent! The editorial says that role models are important in hospital practice. Junior doctors washed their hands more often when senior doctors set an example. Poor practice habits are also picked up at patient bedside. Junior staff stop washing hands when they see senior staff do not bother to keep their hands clean!

About 150 years ago, it was found that if doctors performing autopsies washed their hands before delivering babies, then they could reduce mortality due to post delivery infection of the uterus from 22 to 3 per cent.

What about the people working in cattle industry? Health Canada says that failure to carefully wash hands after working around and with cattle can lead to infection with a type of E. coli bacteria. The resulting illness occasionally causes kidney failure and in rare cases, death.

These bacteria cause “hamburger disease” with symptoms of stomach cramps and bloody diarrhoea appearing two to eight days later. These symptoms last 7 to 10 days. In Canada, five cases of hamburger disease per 100,000 people were reported in 1995. In some cases, especially among people with immature or weakened immune systems, such as children or the elderly, infection with this bacteria leads to kidney failure.

So, if your mother tells you to wash your hands before meals then she is right. Hand washing is one of the most important means of preventing the spread of infection. Hand washing should be regarded as part of the normal duty of care. DON’T GET CAUGHT DIRTY HANDED!

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