Handwashing, cleaning dishes, and treating water

This was a reference off of one of BPL's articles, and I found it interesting:

http://onlinelibrary.wiley.com/doi/10.2310/7060.2004.13621/pdf

Only 7 pages. The statistics are hard to understand (it's been too long since I used stats) but the Abstract, Discussion, and Conclusions sections were interesting to read.

Lori, thanks for leading me to digress over to BPL this morning - wouldn't have found this otherwise.

Sincerely

Steadman

That link is to a medical study of backpackers and diarrhea. For those who are curious, but lazy like me, the take home message from the link is: you can get diarrhea if you fail to treat your water, but don't expect that to be enough; you also have to wash your hands "post defectation" and keep your dishes clean.

These would seem like common sense, but it is always nice to see common sense backed up by hard numbers.

Interesting. The survey was based on a postcard mailed by Appalachian Trail hikers doing at least 7 days on trail. Of the 300+ people who agreed to participate, 18 were disqualified due to having no permanent mailing address.

I know these kind of guys (and gals) very well, and in fact I got Giardia on the AT myself last year. Or something like giardia. The fact is, I don't know, I was getting over symptoms by the time I saw a doctor and so was never tested. I think *that* might be all too common, along with an inclination to state definitively what caused the problem, regardless of whatever underlying data is known (or not really known).

The fact is that few people really know where they got "it" from, whatever it is. And "it" hits different people in quite different ways. I ran into a guy in NM on the CDT this year who was taken by ambulance to get fluids pumped into him because he was so dehydrated due to diarrhea, yet just a couple of days later he was strong enough to get back on trail hiking again. My own experience was that it took me over two weeks before I had enough strength to get back on trail, well after (other) symptoms were gone.

My strongest personal conclusion on all of this is that it's too easy to form questionable conclusions. I certainly was more careful in treating my water this year, yet I still didn't always treat, and I didn't get sick, or even have any mild discomfort. I'm normally careful in after-toilet hand cleaning, but there was a goodly chunk of time after I lost my hand sanitizer gel mid-trip this year that I wasn't able to do so.

I've talked directly to quite a number of thru-hikers who have had "giardia" or something at least messing with their guts, and I think that the human tendency to find patterns and form conclusions can often trick us.

Certainly it's hard to argue with the conclusions that it's good to wash up after using the toilet, it's good to wash dishes well (if you must use 'dishes' ...), and it's good to somehow treat your water in at least many/most cases. The aggregate of those things, practiced by not only myself but those who I come into contact with, should indeed reduce my chances of getting ill.

I have a hard time accepting any sort of more specific conclusions than that, however.

Oh, wait, cattle --- nasty beasts, double treat if cattle have access to the water source. Or if there are dead animals in the water. And I learned this year to not assume that a pipe coming a long way from a spring necessarily means that the spring itself is fenced off from cow access. I'll accept those as 'conclusions' with no problem!

I haven't gotten giardia (for most of us the symptoms wouldn't show up until after we get home, since the incubation period is around 10 days), but my dog Hysson has!

The first time he got it was only 2 days after an overnight trip but almost 4 weeks after the previous trip. I'd been letting him drink out of streams and lakes, since he prefers that to drinking water out of his bowl.

All I know is that he basically exploded from the rear while we were on the way home from Seattle a couple of months ago. I stopped as soon as I could (had to get off the freeway), let him finish the job for the moment, mopped up with a couple of old towels (which I always take along in the car) and stuck towels and bedding in a plastic garbage bag (which had trash from the backpacking trip). Of course my car windows stayed wide open the rest of the way, I held my nose as much as possible and I stopped about every 20 minutes to let him out for another round of liquid effusions. Once (finally) home, I spend several hours scrubbing and disinfecting his crate and the car interior as well as letting poor Hysson out every 20-30 minutes. I finally spent $80 to have the car detailed, just to be sure.

Normally 24 to 36 hours without food and then half-rations fed in very small amounts several times per day will take care of any of Hysson's problems with his sensitive Labrador digestive system. However, these liquid explosions kept coming back (fortunately, all outdoors) about once a week. I talked to my-daughter-the-veterinarian about it several times. After the third round she was quite sure it was giardia (because of the frequent recurrence) despite the disparity of the incubation period. She sent me Flagyl via overnight mail. That cured the digestive problems promptly, but it took several weeks for the poor dog (who was looking quite skeletal by that time!) to gain back the lost weight.

All Hysson's water is now being filtered--no more drinking out of streams and lakes during dayhikes and backpacks!

Some years ago, a friend got giardia (diagnosed from lab tests) specifically from a spring where the water was coming right out of the ground. That was the only time on the trip that he didn't treat his water, and the incubation period was just right. Even with the antibiotics it kept coming back for several months. We found out much later that the spring was in a long-time popular hunting area, so the ground water was probably polluted long before the USFS started installing vault toilets there.

Of course wildlife can carry giardia, too, which is why it was once known as "beaver fever."

I strongly agree with handwashing and treating water. My spoon is my only "dishes," but it gets first licked clean and then rinsed off and dried after use, and dipped in boiling water before its next use.

OM- How do you keep a dog from drinking from streams and lakes? I thought a dog would drink wherever he pleased. Do you keep him on a leash ALL the time?

I am probably the worst example of hand washing, treating water or washing dishes and I have never had Giardia. I think suseptability is an individual thing. I have never even had mild digestive problems on the trail- in fact I never felt better!

As for cattle, a water district (client that I do work for) has grazing in their upper watershed and their water tested for Giardia. So the director of Engineering did a study- personally went out and tested tons of cow pies. He found that the cow pies created enough heat to kill the nasty microbes (southern CA). The Giardia did not show up direclty downstream of the grazing. The source of the Giardia in their water was finally tracked back to horses from several high dollar equestrian riding stables much farther downstream.

I agree with Brian Lee. There's lots of hearsay and few if any well designed studies. And I also go with that old saying, "dilution is the solution to pollution". Getting Giardia has a lot to do with the dose you get. A big burbling stream would dilute much of Giardia that may get into the water. I avoid drinking directly out of trickles or puddles. And do not drink from water down-gradient from an outhouse or campground!

One thing I learned since scouts in the 60's about water/food in the backcounty is to "think!". Try and figure out the path that water took to your point and all it passed through.
Ag runnoff is hard to escape these days. My dad has a running spring in his back yard that is sourced by several thousand acres of farmland. Yuk...good for the yard but treatable only by distilling.
I did get guiarda as a teen while fishing in Mexico. Our bait was fresh shrimp and we had tons of it. At the end of the day, we boiled, then RINSED and ate it. I was sick for a month after I got home. It was the cool rinse water that got us.

Keeping food utensils safe is an interesting subject. Homeless people in the area, we learned, sterilize with heat. We don't see much food poisoning in that community.
While backpacking along the Rio Grande in Big Bend last week, I watched some Mexican cowboys "clean" their pans in the river...which is filthy, and has a high e-coli count. But they seem to handle it, since that's all they have available. I won't even wash my hands in that river!

I don't know, but I suspect you can build an immunity to it with small exposures. And I suspect that taking antibiotics may increase your risks of illness to it.

I've never gotten sick drinking from clear rocky bottom streams here or in the Sierras. I was taught to drink from running water, not standing pools, and to consider the source.

I did get a tad sick in Cozumel after about a week. It only lasted about three days, but it got me. Everybody there drank bottled water, even the locals. It was probably eating fresh fruit and veggies that got me. I learned that from the locals too. I've been to Mexico a couple more times but I haven't had a bout with it since.

I can't prevent the dog from taking a lap or two, but it helps to give him a drink before we reach the water source so he isn't thirsty when we get there. He's also pretty good about obeying "leave it."

Good job OM!

I did an awful lot of microbiology in school. I really don't worry about most water. dishes not so much (it gets boiled).

The only thing I worry about is my hands after pooping, or visiting a backcountry privy.

most "giardia" is someone got the trots, and assumes it's "giardia". many gastrointestinal bugs can do that.

I think that was what was interesting about the article.

It makes me wonder how much of my GI health while backpacking is more driven by handwashing than water purification.