What You Should Know About Hand Washing July 2020
Hand washing is one of the best ways to protect yourself and your family from getting sick. There seems to be renewed anxiety about the spreading of a highly contagious respiratory disease, primarily COVID-19. Much emphasis is being placed on wearing a face mask. Wearing a mask has been shown to reduce spreading the disease to others, especially if you are infected and in sustained close proximity to others that are vulnerable. The importance of hand washing should not be lost in all of the rhetoric. Much emphasis has also been placed on wiping down surfaces. In the final analysis, it’s the hands. The hands are the connecting piece. You can’t necessarily control what you touch. You can’t control who else touched it. But you can look after your own hands. Learn to never touch your face until after you have washed your hands properly.
Many people are still not washing their hands frequently and when they do, the average time is about 6-10 seconds. Frequent proper hand washing should be taken more seriously if you wish to protect yourself from not only COVID-19, but from numerous other infections from germs that remain a leading cause of illness. The intent of this article is to help you learn when and how you should wash your hands to stay healthy. Germs spread primarily by touching your eyes, nose or mouth with unwashed hands.
Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.
Hand-washing — with soap and water — is a far more powerful weapon against germs than many of us realize. It works on two fronts: The first thing that’s happening is that you’re physically removing things from your hands. At the same time, for certain agents, the soap will actually be busting open that agent, breaking it apart. Corona viruses, like this year’s version, COVID-19, are encased in a lipid envelope — basically, a layer of fat. Soap can break that fat apart and make the virus unable to infect you.
The second thing soap does is mechanical. It makes skin slippery so that with enough rubbing, we can pry germs off and rinse them away.
Sounds pretty simple, but the vast majority of people still don’t do it properly.
If you wish to keep from getting sick, now with a novel virus on the loose, the stakes are even higher. It’s time to bring your technique up to speed.
Follow these five steps every time.
– 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. Need a timer? Hum the “Happy Birthday” song from beginning to end twice or simply count.
– Rinse your hands well under clean, running water.
– Dry your hands using a clean towel or air-dry them.
Rubbing your hands thoroughly with a clean dry towel contributes to removal of germs from the hands and is more effective than air-drying. Dry hands are also less likely to spread contamination than wet hands.
If you’re in control of the soap you’re using, you may want to pick a liquid or gel over foaming pump soap. A 2017 study that compared liquid and foam soaps from the same brand found that washing with foam didn’t significantly reduce bacteria on the hands of people who were in the study, while washing with a liquid soap did. Because foam washes off more quickly than gel soap, users are more likely to splash and dash after a dollop of foam, spending less time washing. What about bar soap? Numerous studies have found that bacteria can stay on bar soap that stays wet because it gets used frequently. CDC studies that have looked to see whether that’s a problem, show that the bacteria don’t seem to transfer to the next user. If your bar looks slimy, rinse it off under water before you lather your hands, and try to store it so it will dry out between uses.
If you’re in a public bathroom, and there’s no soap, just rubbing your hands together under the water does do some good. A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. Washing with soap and water brought bacterial counts down to about 8% of where they were before washing. The bottom line is to work with what you have. Doing something is better than nothing.
Fingernails and hand jewelry require special attention to mitigate against residual germs. There is an increase in periungual (under the finger nail) colonization with a variety of pathogens when fingernails are long and when artificial fingernails are worn. Artificial fingernails and inadequately cleaned native fingernails have been epidemiologically linked to outbreaks of infection in intensive care unit patients, neonates, and patients undergoing surgery.
Wearing gloves does not replace the need for hand hygiene. Gloves may have unapparent tears, and hands predictably become contaminated during glove removal.
Studies where people smother their hands with Glo Germ — a product used to teach proper hand-washing that glows under a black light — before they wash reveal the areas people tend to miss.
Typically, spots people will miss will be the back of the hands and the lower palm area. You might see some fluorescence around the fingernails and the nail bed area, where people typically don’t wash well. Be careful to work the soap or alcohol sanitizer under the nails and jewelry.
Studies have shown something that’s good to know: Intention counts. Research has shown that the more people try to get better at hand-washing — going for longer, scrubbing more thoroughly — the less likely they are to spread contamination or become ill.
If you can’t wash, reach for some hand sanitizer. Lipid membrane viruses, like corona viruses, are killed by alcohol-based hand sanitizer, Just make sure it’s at least 62% alcohol.
Make sure to use enough so that it covers all the surfaces on your hands. Rub it on until your hands feel dry, which should take about 20 seconds.
How often do you need to wash? A lot. The CDC says to wash your hands:
Immediately upon returning home after being out
Frequently while with others in any group setting
Before, during, and after food prep
Before and after tending to someone who’s sick
Before and after treating a cut or other wound
After going to the bathroom
After changing diapers or helping a child in the bathroom
After blowing your nose, coughing, or sneezing
After touching an animal, or touching pet food or pet waste
After handling pet food or pet treats
After touching garbage
If you still have some skin left on your hands after all that washing, try to keep it clean. Avoid touching contaminated surfaces. Use a clean paper towel to open bathroom doors. Disinfect dirty surfaces that you use every day, like the touch screen on your phone and your computer keyboard. And REMEMBER, do not touch your face until after you have properly washed your hands.
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Paul R. Block, MD, FACP. FCCP