This post is all about the essential things we need to know to make sure that we are doing handwashing (most effective prevention control) exactly right. We will also discuss the role of handwashing in mitigating disease in general population. And we will define the exact steps of handwashing as suggested by WHO and CDC.
Interesting Facts:
Everybody knows how expensive healthcare costs get nowadays all around the world. But are you aware of the most cost-effective health action to reduce disease in a population? Yes, it is hygiene promotion (according to the world bank1). Do you know that almost 1 in every 4th person (2.3 billion people) lacks basic hygiene facilities with soap and water2? It means that nearly 25% of the disease burden in the world can be reduced merely by providing soap and water (e.g., research shows that only by washing hands with soap and water the diarrheal diseases in the world can be cut in half). Crazy, I know!
Father of Hand hygiene:
Ignaz Semmelweis, a Hungarian physician, introduced the concept of handwashing as an antiseptic measure in 1847. While working at Vienna General Hospital, he observed that the mortality rates among the two maternity wards varied significantly. The ward where the medical students/ doctors trained had a 2-3 times greater mortality than the ward where midwives worked, even though the medical practice and everything else was similar in both wards. This fact was known to the public, and as both these wards took patients on alternate days, the expecting mothers often begged him to be admitted into the midwifery ward. Some preferred giving birth in the streets; to his surprise, even the street births had a lower mortality rate than those in the student’s ward. He concluded that somehow the students transferred something to the mothers, increasing their mortality risk. Therefore, he introduced handwashing with chlorinated lime to reduce the risk of transmission, and immediately the mortality dropped to an all-time low of around 1%. He later published a book on his findings, “Etiology, Concept and Prophylaxis of Childbed Fever.” Unfortunately, his ideas were never accepted during his lifetime, and some doctors even mocked him. To read more about his story, you can check this article, “The Doctor Who Discovered That Handwashing Saves Lives.”
Difference between Hand Hygiene and Handwashing:
According to WHO, hand hygiene is a general term for handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis. Handwashing is defined as washing hands with plain (i.e., non-antimicrobial) soap and water. In contrast, antiseptic handwashing uses antimicrobial soap to remove as many germs as possible.
Handwashing Steps:
These are the basic steps for handwashing according to WHO guidelines:
Handwashing steps recommended by CDC:
These are the handwashing steps recommended by CDC. We will also discuss the rationale behind them.
- Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
- Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
- Scrub your hands for at least 20 seconds.
- Rinse your hands well under clean, running water.
- Dry your hands using a clean towel or an air dryer
Rationale behind Recommendations:
Now let’s discuss the rationale behind each of these recommendations.
- Running water is preferred because standing water becomes contaminated after repeated use. Water temperature does not affect the removal of microbes, but warmer water irritates the skin and is more environmentally costly.
- Soap is recommended because the surfactants in the soap help lift dirt and microbes and because people tend to scrub more thoroughly when washing their hands with soap. According to the research, antibacterial soap has no added benefit compared to plain soap 9 10.
- Lathering and rubbing create friction that helps remove dirt and microbes. All hand surfaces should be thoroughly rubbed, especially under the nails with high microbial concentration.
- The minimum time suggested by CDC guidelines is 20 seconds, but the WHO suggests an average washing time of 40-60 seconds. The main thing to understand is that greater exposure to water and rubbing increases the odds of decontamination.
When to wash hands:
- After arriving at a new place
- Before, during, and after making food
- Before and after eating food
- Before and after caring for a person who is sick, especially someone experiencing vomiting and diarrhea
- After coughing or blowing your nose
- Before and after treating a cut or a wound
- After playing with animals, touching animal feed or waste
- After using the toilet
- After changing diapers or cleaning a child who has used the toilet
- After touching garbage
- After playing outdoors
- Before and after changing contact lenses
Common ways by which germs spread:
- Touching your nose, mouth, and eyes with unwashed hands
- Coming into contact with food with unwashed hands
- Blow your nose or cough and sneeze onto your hands and then touch it to your nose or mouth or other people
- Touching dirty objects that have germs on them
