Hand-washing: a simple concept, but not enough people do it

While it is likely that most of us think and verbalize that hand washing is important, more often than not, the sink and soap are passed up. Despite the proven health benefits of hand washing, many people don’t practice this habit as often as they should — even after using the toilet. In a study about hand washing among public restroom users at the Minnesota State Fair, statistics indicated that people did not actually wash their hands after using the restroom despite responding affirmatively to the question whether they did visit the sink. Unfortunately, the spread of germs and disease starts with poor hand washing and escalates from there.
Throughout the day you accumulate germs on your hands from a variety of sources, such as direct contact with people, contaminated surfaces, foods, even animals and animal waste. If you don’t wash your hands frequently enough, you can infect yourself with these germs by touching your eyes, nose or mouth. And you can spread these germs to others by touching them or by touching surfaces that they also touch.
Infectious diseases that are commonly spread through hand-to-hand contact include the common cold, flu and gastrointestinal disorders. While most people will get over a cold, the flu can be much more serious. Some people with the flu, particularly older adults and people with chronic medical problems, can develop pneumonia. The combination of the flu and pneumonia, in fact, is the eighth-leading cause of death among Americans.
According to the American Society of Microbiology and the 2006 Minnesota Hand Washing Tool Kit, 97 percent of females and 92 percent of males said they washed. Of these only 75 percent of females and 58 percent males actually did wash their hands. In addition, students don’t wash their hands often or well. In one study, only 58 percent of female and 48 percent of male middle and high school students washed their hands after using the bathroom. And of these, only 33 percent of the females and 8 percent of the males used soap.
When is hand washing important?
It may seem obvious when a good hand washing is needed, but many people are not clear regarding the opportunities they have to curb the spread of germs that make us sick. And it is a simple habit that can keep you and your family and loved ones healthy. Before eating and while preparing or serving food is the most important time to wash. The “fecal-oral” route is one way that disease can be passed when fecal particles from one host are introduced into the mouth of another potential host. When people who have been exposed to feces, either through a contaminated water supply, after poor or absent hand washing after contact with feces or other contamination, prepare food for others, there is an increased opportunity for the spread of bacterial infections like Hepatitis A and Rotavirus and food borne illnesses such as salmonella and E. coli.
Proper hand washing includes washing your hands with soap and water or using an alcohol-based hand sanitizer. Antimicrobial wipes or towelettes are just as effective as soap and water in cleaning your hands but aren’t as good as alcohol-based sanitizers. To properly wash is to pay attention to detail. You must wet hands with warm running water and apply liquid or bar soap. Lather well and rub hands vigorously for at least 15 – 20 seconds. Scrub all surfaces of the hands, including the backs of hands, wrists, between fingers and under fingernails. Rinse well. Dry with a clean or disposable towel. Other times to wash are when hands look, feel or smell dirty, after handling raw meat, fish, poultry and before touching any other food, after changing a diaper, blowing your nose or sneezing on your hands, after using common object such as money, doorknobs and public telephones, and after touching pets or animals.
While antibacterial soaps have become increasingly popular in recent years, they are no more effective at killing germs than regular soap. Not all hand sanitizers are created equal, though. Some “waterless” hand sanitizers don’t contain alcohol, yet alcohol is the primary ingredient necessary to kill the germs. Therefore, if you need to use hand sanitizers, use only the alcohol-based products, such as Purell®. The Center for Disease Control recommends choosing products that contain at least 60 percent alcohol. If hands are visibly dirty, however, washing with soap and water is recommended.
To use an alcohol-based hand sanitizer:
Apply about 1/2 teaspoon of the product to the palm of your hand.
Rub your hands together, covering all surfaces of your hands, until they’re dry.
You should never blow on hands or fan them to dry quicker. Doing so only blows germs back onto hands from the mouth and fanning them makes the drying process quicker, perhaps reducing the germ-killing opportunity of the solution sitting on your hands.
Some amazing facts about germs
There are 229,000 germs per square inch on frequently used faucets and handles. Around 21,000 germs reside per square inch on desks — about 400 times more than the average toilet seat, and the kitchen sink also has more germs than the toilet.
In addition, absenteeism from germ-related illness can also be expensive. In America alone, nearly one-fifth of the population either attends or works in schools. When illness strikes a campus, the amount of money lost is enormous. Annually, teachers typically use more sick days than the average student rate of 4.5 days. Do the math by calculating the average teacher salary for those days that it will take to hire a substitute teacher.
So the moral of the story is, while hand washing means a commitment of time and supplies, the cost of not washing far exceeds the cost of washing.

(Tara Steitz is Epidemiology Supervisor at Scripps Memorial Hospital Encinitas.)

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