Monday, February 25, 2013

Shingles Overview

What is Shingles?

After a person has had chicken pox the virus that causes it stays sleeping for decades in nerves near the spine.  The virus is herpes zoster.  About 20% of people who have had chicken pox will later have a shingles outbreak.  Shingles usually affects older people and people with weak immune systems.

Cold sores on the lips and genital herpes are caused by different herpes viruses, herpes simplex viruses.


If the virus wakes up, it travels along nerve fibers to the skin, usually appearing in one area, on one side of the body, and along the line of a nerve.  But shingles can be anywhere on the body.  The rash is painful and has fluid-filled blisters.  The first symptoms start 1 to 5 days before the rash and include:

  • Itching
  • Tingling
  • Burning sensation
  • Pain, sometimes worse at night
Less common symptoms are fever, chills, headache and stomach ache.  Shingles near the eye or ear can cause vision or hearing loss and are usually treated aggressively.

The blisters usually scab over in 7 to 10 days and disappear completely in 2 to 4 weeks.  In most people the rash leaves no scars and the pain and itching go away after a few weeks or months.

In some people the pain from shingles stays for months or even years after the rash is gone.  The pain is from damage to the nerves in the skin.  This is called post-herpetic neuralgia. 


There is no cure for shingles.  But there are antiviral medications that can make the episode shorter and milder if given early.  They also reduce the risk of pain after the rash is gone.  The antiviral drug should be started at the first sign of symptoms to be most effective.

Over-the-counter pain and itch medicines, such as calamine lotion, work fairly well for many people.  If the pain is severe or the rash is near the eye or ear, the doctor may prescribe steroids to reduce the inflammation.  Using a compress dampened with cool water may help with itching.  Scratching should be avoided to prevent damage to the skin and to prevent breaking the blisters.


A shingles vaccine is available.  It prevents about half of shingles cases and reduces the frequency of post-shingles pain.  The Centers for Disease Control recommend that all adults 60 years and older be vaccinated.  The vaccine does not work well in people over 80 and is generally not recommended for this age group.

Is It Contagious?

Yes, but you can’t get shingles from another person; only chicken pox.  If you have never had chicken pox, or the vaccine for it, and you are then exposed to the fluid in the shingles blisters, you can get chicken pox.

Caregivers can carry the virus from one person to another and if the second person has not had chicken pox, they may get it.  Shingles can only be transmitted when the blisters have burst and are oozing, before they crust over. 

What can you do to prevent spread?
  • Prevent blisters from breaking open.
  • Keep the rash covered to prevent the blister fluid from contaminating others. 
  • Assist the resident with shingles to wash hands often. 
  • Only caregivers who have already had chicken pox should be assigned to residents with shingles. 
  • No one who is pregnant should be assigned to a resident with shingles.
  • Keep surfaces clean and disinfected.
  • If the resident has shingles on the buttocks, he or she should not use common toilets.
  • All caregivers and housekeepers should wear gloves in the resident’s room until he is no longer contagious.  Hands should be washed after removing gloves.
  • Determine if roommates or others the resident socializes with are at risk.
  • Use common sense precautions.
  • Washing Linens
People handling sheets and towels of a person with shingles should wear gloves.  Sheets and towels should not be shaken or set down on a surface, even the floor.  They should immediately be put into a linen bag.  No special procedures are needed for washing linens.

Staff with Shingles

Staff members who have shingles should not care for vulnerable residents, including people with cancer, residents with compromised immune systems or those who have not had chicken pox. 

This article was originally published in Pathways & Partners Newsletter - Issue 27.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, February 18, 2013

Hand Sanitizers vs Norovirus

People in densely populated living situations, like cruise ships and skilled nursing facilities, are reaching for the alcohol-based hand sanitizing gel in hopes of avoiding the norovirus.  But does it prevent infection from the gastrointestinal bug?  It looks like the answer is “No.”

Many studies have shown that alcohol-based sanitizers reduce germ counts on hands and can reduce the spread of some strains of flu.  But the nasty norovirus that causes vomiting and diarrhea is resistant.

Some viruses, including the flu virus, have a coating that the alcohol in the sanitizer can burst open, killing the virus.  But the norovirus doesn’t have a capsule that alcohol can penetrate.  So it lives on even when you believe your hands are disinfected.  Noroviruses are so infectious that as little as 10 missed microscopic particles can cause infection.

Bleach kills the norovirus, and a solution of 10% bleach is great for wiping down counters and surfaces that may have been contaminated.  But since we really can’t wash our hands in bleach, experts say we should wash hands frequently with plain old soap and water.

In 2011 the Centers for Disease Control and Prevention studied records from the winter of 2006-07 in 91 long-term care facilities; they found 23 outbreaks of the norovirus.  Facilities where staff regularly cleaned their hands with alcohol-based sanitizers had six times as many norovirus outbreaks than facilities where the staff used soap and water. 

The CDC says that to prevent the spread of the norovirus, alcohol sanitizers should only be used “in addition” to hand washing, but not as a substitute.

This article was originally published in Pathways & Partners Newsletter - Issue 27.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Tuesday, February 12, 2013

How Not to Catch a Cold

Meditation Works

If there were a way to avoid getting colds and the flu, would you do it?  There is some compelling evidence that there may be just such an antidote!  Meditation and exercise both appear to reduce the frequency of acute respiratory infections—colds and flu.

Researchers at the University of Wisconsin assigned 149 participants, mostly women and all over 50 years old, to one of three groups.  One group took an 8-week training program in mindfulness meditation, the second an 8-week training in moderate intensity sustained exercise and the third served as an observational control group.  They studied the participants for the duration of one cold and flu season.  These results were pretty remarkable.

Acute Respiratory Infections by Group

Meditation - 27   
Exercise - 26   
Control - 40   

Total Days of Illness by Group   
Meditation - 257   
Exercise - 241   
Control - 453   

Days of Work Missed by Group
Meditation - 16
Exercise - 32
Control - 67

The research was funded by the National Institutes of Health and reported in the Annals of Family Medicine in July, 2012.

In addition to washing your hands and getting your flu shot, this cold and flu season you may also want to engage in some mindful meditation techniques or sustained exercise!

This article was originally published in Pathways Residential Care Journal - Issue 5.  To download this issue in PDF format, or past issues, visit our newsletter archives online at