This week I had an email from one of 3rd year medical students requesting topics that her student and her partner would like to concentrate on during the next teaching session. I was a bit surprised when she requested this but apparently she had failed this in a previous examination.
The main medical purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. As a general rule, handwashing protects people ill or not at all from droplet and airborne diseases, such as measles, chickenpox, influenza, and tuberculosis. It protects best against diseases transmitted through fecal-oral routes (such as many forms of diarrhoea and vomiting) and direct physical contact (such as impetigo). When visiting hospitals there is also the need to wash hands is to prevent the spread of the ‘super bug’ MRSA and Clostridium Difficile a bacteria responsible for severe diarrhoea which is life threatening particularly in the elderly.
“It is well documented that one of the most important measures for preventing the spread of infectious disease is effective hand washing.”
With the students I then went through the procedure very carefully as it has been established that doctors are probably culpable for the spread of infection in hospitals. We certainly were not taught hand washing formally let alone as part of our examinations and it is only in recent years probably since the swine flu epidemic has there been the stress on prevention of the spread of infection and emphasis of handwashing and using hand rub.
• Use warm running water
• Wet the hands before applying soap
• Ensure you create a good lather
• Follow the correct hand washing technique to ensure all areas are covered as shown below.
• Hand washing should take at least 15 seconds, but no longer than 3 minutesAll hand basins in surgeries and hospitals have instructions of how to wash hands correctly as below.
• Rinse well with the hands uppermost so that the water runs off the elbow
• Use a ‘hands-free’ (e.g. elbows) technique to turn off taps. Where ‘hands free’ tap
systems are not in place, dry the hands first with paper towels and use these to turn off
• Dry each part of the hands properly and dispose of paper towels in the appropriate waste
bin without re-contaminating your hands (e.g. use the foot pedal). Do not touch the bin lids
Effective drying of the hands is an essential part of the hand hygiene process, but there is some debate over the most effective form of drying in washrooms. A growing volume of research suggests paper towels are much more hygienic than the electric hand dryers found in many washrooms.
Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water.The main action of soaps and detergents is to reduce barriers to solution, and increase solubility. Water is an inefficient skin cleanser because fats and proteins, which are components of organic soil, are not readily dissolved in water. Cleansing is, however, aided by a reasonable flow of water.
Hot water that is comfortable for washing hands is not hot enough to kill bacteria. Bacteria grows much faster at body temperature (37 C). However, warm, soapy water is more effective than cold, soapy water at removing the natural oils on your hands which hold soils and bacteria. Contrary to popular belief however, scientific studies have shown that using warm water has no effect on reducing the microbial load on hands.
Solid soap, because of its reusable nature, may hold bacteria acquired from previous uses. Yet, it is unlikely that any bacteria are transferred to users of the soap, as the bacteria are rinsed off with the foam.
Antibacterial soaps have been heavily promoted to a health-conscious public. To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature. However, antibacterial soaps contain common antibacterial agents such as Triclosan, which has an extensive list of resistant strains of organisms. So, even if antibiotic resistant strains aren’t selected for by antibacterial soaps, they might not be as effective as they are marketed to be.
Besides this on entering a hospital and individual wards and now in GP surgeries there are facilities to use hand antiseptic and this also must be carried out on entry.
A hand sanitizer or hand antiseptic is a non-water-based hand hygiene agent. In the late 1990s and early part of the 21st century, alcohol rub non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity.
Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to decrease the drying effect of the alcohol.
Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza,and hepatitis) and fungus. Alcohol rub sanitizers containing 70% alcohol kill 99.97% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% of the bacteria on hands 1 minute after application.
Hand sanitizers are most effective against bacteria and less effective against some viruses. Alcohol-based hand sanitizers are almost entirely ineffective against norovirus or Norwalk type viruses, the most common cause of contagious gastroenteritis.