Backcountry travelers have a long list of things to fear. Here are my ten favorites:
- Animal attacks by mosquitoes, bears, snakes, ticks, wolves, or locusts.
- Drinking water poisoned with giardia, crypto, amoeba, typhoid, or the bird flu.
- Running out of toilet paper and having to wipe with snow, rocks, pine cones, or spruce sprigs.
- Having to build a fire when it really counts.
- Having to push the 911 button on their SPOT because they failed to build a fire when it really counted.
- Getting their feet wet, and then having them fall off after a progression of suprahydration, maceration, epidermal separation, fissurization, staphylococcal infestation, gangrene, and rot.
- Accidentally leaving something behind, or having to justify to everyone on the Internet (in the lightweight backpacking community, at least) why they can’t leave something behind, like their Sling-light, Crocs, Frisbee, iPod, Newcons, or box of E&J.
- Hiking with other people.
- Hiking solo.
- Running out of coffee.
For the rest of you, you may be fearing the wrong things.
What you should be fearing is facilitating the transportation of fecal hitchhikers from your exhaust pipe orifice to your fuel filler neck orifice.
This article discusses how to stop these illegal immigrants en route, because we all know you can’t close the border.
The Relationship Between Hand Sanitation and GI Illnesses
The problem is an age old one: minimize gastrointestinal (GI) illness that results from backcountry activities.
The two most commonly perceived GI illnesses are (1) those acquired by drinking contaminated water, and (2) those acquired as a result of poor hygiene. This article addresses the hygiene issue, and specifically, hand sanitation.
Tod Schimelpfenig, Curriculum Director at the Wilderness Medicine Institute of the National Outdoor Leadership School (NOLS), believes that hand sanitation may play a more important role in illness transmission than drinking untreated water. "Hand washing is very important but poorly and infrequently done," says Schimelpfenig. "It’s inconvenient and must be a disciplined habit." Over a period of several years, NOLS made intentional changes to their hand sanitation practices and curriculum which resulted in significant reductions in GI illnesses (Leemon and Schimelpfenig, 2003). Currently, NOLS uses alcohol gel hand sanitizers because they are readily available and inexpensive – key decision factors for sizable programs like NOLS.
My own personal experiences are deeply rooted in a desire to keep my hands clean in the wilderness.
When I was an institutional wilderness guide in the 1980s, we cared very little about and had no policies regarding wilderness hygiene. Some of our practices included:
- Everyone eating out of the same pot, with the same spoon (to save weight, increase simplicity, and… to improve camaraderie perhaps?!)
- Leaving soap out of our kits and believing that simply washing hands and scrubbing vigorously with water was enough.
- Never washing cookware, and believing the probable lie propagated by some "lightweight backpacking enthusiasts" that it will sterilize itself the next time you boil water in it.
If these are some of your practices, a careful read of Boulware (2006) might be a wise investment of your time.
What I thought I learned during my years of institutional guiding was that we really needed better water treatment technologies, because almost all of the guides, and many of the students, experienced GI illnesses at some point during or shortly after their treks.
What I really learned, looking back, is that our poor hygiene was probably a far greater contributor to our GI distress than contaminated water, and that specifically, I can look back and be genuinely horrified at our hand sanitation practices.
Upon reviewing much of the research that began to emerge about this topic in the late 1990s and early 2000s, I realized that especially with groups of people sharing cooking and other gear, hand sanitation would be an important part of staying healthy in the wilderness.
Alcohol-Based Hand Sanitizers
I’ve been an aficionado of using alcohol-based (EtOH) sanitizers for years, for the same reason that Tod Schimelpfenig stated above: they are cheap and easy to find. However, I’ve also discovered the nasty unspoken risk of using them: the dehydration of hand skin that leads to cracking. Some companies add moisturizers into these mixes, but I’ve found them to be marginally effective and to leave greasy residues.
Some ultralight backpackers like EtOH-based sanitizers because they can serve double duty (by disinfecting the skin around wounds for first aid treatment, or as a firestarting aid). However, I never found the weight savings to be worth it, and I’ve always preferred the more robust disinfecting potential of a sterile alcohol wipe, and more efficacious methods of firestarting using dedicated supplies.
In response to skin cracking, I’ve tried a number of reactive measures to control it, including hand lotions, Hydropel, those thin fingerless "sun gloves" that saltwater fly fishermen wear, using less sanitizer, and rubbing oils from my own forehead into the skin! I wasn’t happy with any of these solutions and instead found myself caught in the vicious downward spiral of pain and discomfort by successively applying stinging alcohol gels to my cracked hands.
In addition, while I was working in the area of biofilm research in the 1990s, we discovered that cracks in the skin served as protective environments for bacterial growth, with the resulting colonies of pathogens remaining more resistant to disinfection than bacteria attached to the outside surfaces of the skin. Dyer et al. (1998) also suggest that the organic-solvent properties of EtOH strip away skin chemicals (e.g., sebum and lipids) that play a role in impeding bacterial infection.
My solution in 2008, after one particularly cold and windy spring trek with bleeding cracks on my hands, was to finally bag alcohol hand sanitizers altogether and simply use soap and water, even if it had to come from my water bottle if I wasn’t near a water source.
Alternatives to Alcohol Based Hand Sanitizers
After reviewing a variety of research discussing various hand washing methods, I’ve reverted back to the time honored practice of good old soap and water. I carry a MiniVial containing highly concentrated castile soap (my favorite is Dr. Bronner’s), and always wash my hands after bowel movements and upon arrival into camp prior to preparing the evening meal.
The efficacy of vigorous handwashing with soap relative to other methods cannot be underestimated (Simonne, 2008).
However, sometimes, washing hands with soap and water is simply inconvenient, so I do carry a benzalkonium (BAK) chloride-based hand sanitizer that is easy on the hands and has shown good efficacy in sanitization relative to alcohol-based products (Dyer et al., 1998).
A number of companies market BAK hand sanitizers, but finding them in a form useful for the ultralight backpacker has been problematic, until Adventure Medical Kits’ recent introduction of a 0.5 fl. oz. pump bottle. The form factor is small (pocketable), simple to use (just pump to spray, no lids or caps to fiddle with), and lightweight (a full bottle weighs an ounce). The manufacturer claims that the bottle holds "150 Sprays" and that it should be "applied liberally". This latter point is important with any hand sanitizer, be it soap, EtOH, or BAK: if you don’t coat and scrub the entire surface of your hands, it’s not going to be effective.
In practice, I find that six sprays deliver enough liquid for me to wash the entire surfaces of both hands, which suggests that I can get 150 / 6 = 25 full hand washings out of the bottle. If I wash with soap and water twice a day, and use hand sanitizer 3X / day (my normal routine), then the Adventure Medical Kits 0.5 fl. oz. pump bottle is enough for an eight-day trek for me. Plus, and my wife will agree, my hands aren’t "all scratchy" when I come home.
Washing with soap and water is still my preferred method of hand sanitization. It leaves my hands feeling cleaner than with any other method, and science has shown repeatedly that it remains the most effective method. I’d be awfully nervous if I saw my surgeon grab a scalpel after only a quick application of a dollop of EtOH onto the palm of his hand!
While a variety of non-soap (waterless) methods of hand sanitization exist, few of them are accessible or easy to use by wilderness backpackers. EtOH and BAK are the two primary methods available in small, light, and simple to dispense form factors. Between the two, I prefer BAK for its ability to preserve the health of my skin when used over a long period of time, and of the BAK products, I’ve found the Adventure Medical Kits 0.5 fl. oz. pump spray bottle to be an ideal product that fits in with my own philosophy of "simple, light, and effective."
- Wilderness Injury, Illness, and Evacuation: National Outdoor Leadership School’s Incident Proﬁles, 1999–2002, by Drew Leemon and Tod Schimelpfenig, Wilderness and Environmental Medicine, 14, (pp. 174-182), 2003.
- Influence of Hygiene on Gastrointestinal Illness among Wilderness Backpackers, by David R. Boulware. Journal of Travel Medicine, 11:1 (pp. 27-33), 2006.
- Hand Hygiene and Hand Sanitizers, by Amy Simonne, University of Florida IFAS Extension, http://edis.ifas.ufl.edu/pdffiles/FY/FY73200.pdf.
- Testing a New Alcohol-Free Hand Sanitizer to Combat Infection, by David L. Dyer, Kenneth B. Gerenraich, and Peter S. Wadhams, AORN Journal, 68:2 (pp. 239-251), 1998.