Don Finley
Express-News Medical Editor
At the child care center at San Antonio College, tiny hands are trained to rub and scrub with lots of lather at kid-sized sinks several times a day for the length of time it takes to sing the “Happy Birthday” song a couple of times ó about 15 seconds.
When they’re finished, the children dry their hands with a paper towel, then use that towel to shut off the water. After all, there are plenty of germs on the sink handles, too.
“It’s like all the routines that children learn in the first few years of life. They learn it through modeling and through the teachers helping them do it,” said Earlene Gonzales, lab center director at SAC’s Child Development Center. “It’s kind of a fun game at first when they’re learning it.”

It’s also a message health officials are working hard to spread now. Both state and local health departments ó although for different reasons ó are urging people to be a lot more conscientious regarding that most basic of public health measures.
Locally, a sharp rise last year in dysentery ó more accurately known as shigellosis ó has stirred the Metropolitan Health District to put the word out to day care centers and schools to promote good hand washing.
More than 600 shigellosis cases were lab-confirmed in Bexar County last year ó a number two to four times higher than normal, said Roger Sanchez, an epidemiologist with the health district. Most of the cases involved children 3 to 7.
Shigellosis is a bacterial illness that attacks the lining of the colon and is spread almost entirely by poor hygiene and person-to-person contact. The most common symptoms include bloody diarrhea, fever and abdominal cramping.
Because most cases are mild and people recover without treatment, the correct number of cases could be 20 times higher than those reported to authorities.
It’s treated with antibiotics. But the treatment is almost as problematic as the disease, said Dr. Dennis Conrad, a pediatric infectious disease specialist.
Although in true cases of shigellosis antibiotics can reduce the duration of symptoms by half, the overuse of antibiotics has made the infection resistant to treatment. And when doctors guess wrong and the bloody stool is actually caused by another bacteria called E. coli 0157H7, antibiotic treatment can increase the risk of a condition called hemolytic uremic syndrome, a common cause of sudden, short-term kidney failure in children, Conrad said.
A lab test for Shigella bacteria takes a couple of days, by which time most patients would have gotten better anyway.
“So that’s why, and this is my own personal opinion, I think the (idea) of treating every case of bloody diarrhea may not always be to the advantage of the patient,” Conrad said.
“The best way to treat Shigella is to not get it in the first place. And the best way to not get it in the first place is just practice good hand hygiene.”
Prompted by the shortage of flu vaccine this season, the Texas Department of State Health Services has mounted its own campaign to promote good hand washing.
“Hand washing is one of the most important ways to stop the spread of flu,” Dr. Eduardo Sanchez, commissioner of state health services, said last week.
“Many people aren’t cleaning their hands properly, which means they may think they’re protecting themselves when they’re not.”
State health officials cited a recent Harris poll that found that 47 percent of people don’t wash their hands for 15 to 20 seconds, or long enough to reduce the spread of illness.