Handwashing

Handwashing is always an important way to help preserve health and safety.  Thorough washing can help kill bacteria and viruses, which reduces the risk of contact disease transmission.  However, a surprising number of people do not engage in routine recommended handwashing.  This handwashing essay will cover the basics of handwashing.  It will discuss how handwashing improves public health and if there are any risks associated with handwashing.  It will cover the different types of things people can use to wash their hands.  It discusses different alternatives people can use when traditional handwashing is impossible.  The essay also covers how handwashing is used in medical environments.  There are cultural components to handwashing and the essay will discuss handwashing in developing nations as well as the social and cultural aspects of handwashing. 

Handwashing is always an important way to help preserve health and safety.  Thorough washing can help kill bacteria and viruses, which reduces the risk of contact disease transmission.  However, a surprising number of people do not engage in routine recommended handwashing.  In this hand washing essay, we cover all of the basics of good hand hygiene and explain why handwashing is so important.  This information is critical to have to reduce disease transmission at any time, but is especially important at this time when handwashing is considered one of the most important components of slowing the spread of COVID-19, the novel Coronavirus.

Handwashing refers to any practice of cleaning one’s hands.  In developed nations, the most common method of handwashing is using soap and water to clean the hands.  In other places, other substances may be used to clean the hands.  One substitute for soap is to use ash.  Other substitutes can include hand sanitizer or sanitary wipes.  However, unless otherwise indicated, for the purposes of this essay handwashing refers to using soap and water to clean the hands.

There are several times when it is important to wash hands.   Some healthcare organizations recommend it more frequently than others.  According to the Centers for Disease Control, there are several critically important times that people need to wash their hands: before, during and after food prep; before eating; after using the toilet; before and after caring for someone who is ill (especially with vomiting or diarrhea); before and after treating cuts and wounds; after changing diapers or taking care of a child after using the toilet; after touching an animal, animal waste, or animal food; after coughing, sneezing, or blowing your nose; and after touching garbage (CDC, 2020). 

There are additional times that health care professionals and others involved in medical procedures need to wash their hands or take extra steps for hand hygiene.  Hands should be washed before and after providing any type of medical care.  Hands should be washed between patients.  If handwashing is not possible, healthcare professionals should use hand sanitizing gel or other alcohol-based sanitizers between patients.  Healthcare professionals can also use gloves to prevent cross-contamination, but they must be changed between patients.

In much of the world, handwashing is an important, affordable, and easily accessible way to help prevent the spread of disease.  Handwashing plays an important part in reducing the spread of highly infectious diseases like influenza and coronavirus.  It has helped reduce mortality rates in common medical procedures, from childbirth to patient care and surgery. It also helps reduces the spread of acute respiratory infections like pneumonia.  Hand washing is a critical component to stop the spread of diarrheal diseases, a general label that refers to any disease that can cause diarrhea. In developed nations, diarrheal diseases many not seem like a significant health risk, but they are still responsible for significant deaths in undeveloped and underdeveloped nations.  Access to clean water is one way to reduce the impact of diarrheal diseases on public health.  However, engaging in appropriate handwashing practices with soap is another way to help reduce the spread of diarrhea in communities. 

Hand washing is the most effective when it is incorporated as part of a daily habit.  Hand washing should be taught as a regular habit, especially before eating, before and after food preparation, and after using the toilet.  This intervention can save millions of lives.  In undeveloped nations, introducing handwashing is considered part of basic sanitation programs.  However, while handwashing may be more common and much easier to accomplish in developed nations, a surprising number of people fail to wash their hands regularly after using the toilet, before prepping food, or before eating.  Therefore, it is important not to assume that the people in developed nations are engaging in appropriate hand washing.

Some people may have some legitimate reasons to want to reduce their amount of hand washing.  Engaging in excessive hand washing can result in dry skin and skin damage, which might actually increase the risk of some disease transmission.  Extra dry hands can actually become raw, cracked, and even bloody.  For people with sensitive hands, alternative hand-cleaning practices or the use of lotions to preserve moisture in the hands can help ameliorate any negative side effects.

Even in countries with easy access to clean running water and soap, handwashing has not become a reliable habit.  In countries where there is a cultural or religious component to hand washing, people are much more likely to wash their hands.  However, even in relatively clean countries like the United States, only about three-fourths of people regularly wash their hands.  The easiest way to change habits is to teach hand washing to children while they are in school.  It is more difficult to teach adults to embrace the importance of regular handwashing.  Furthermore, even if people are habitual hand washers, they may not wash their hands for the suggested 20 seconds or sufficiently thoroughly (Gupta, 2020). 

People most commonly use soap to wash their hands.  Soap refers to cleansing agent that is made of fatty acids (Hickok, 2020).  Soaps make the dirt soluble, which helps remove dirt and other contaminants from what is being cleaned.  Soaps are also effective at destroying the lipid layer that protects some types of viruses and bacteria, which can actually kill these microorganisms, not just removing them from the surface.  Detergents are similar to soaps (Helmenstein, 2020).  They both remove the fats and proteins that cannot be dissolved by water, alone.  However, water is instrumental in helping wash away these contaminants. 

There are several different types of soaps that can be used for handwashing.  The most commonly used is solid soap.  This soap is easy to transport and affordable, but carries a small risk of bacteria transmission from contact contamination with each use.  Liquid soap is preferred because of the lack of contact contamination.  For a while antibacterial soap was extremely popular, but they were shown to help contribute to the creation of resistant bacterial strains, which can have an overall detrimental impact on public health.  Generally, antibacterial soaps are considered no more effective at cleaning than regular soaps for normal use.  Some antibacterial soaps may be more effective in some special settings, such as medicine. 

It is normally recommended that people use warm water to wash their hands.  This is not because warm water kills bacteria or viruses; usually water that is not hot enough to scald the user is not hot enough to kill bacteria or viruses.  Instead, it is because warm water is more effective at dissolving and removing oils.  Therefore, it may be more effective at overall cleaning than using cold water.    

When soap and water are not available, there are still ways to use practice hand hygiene.  One of the most popular ones is to use hand sanitizer.  While there are different formulations available, hand sanitizers are generally alcohol-based rubs that evaporate after they are put on the hands, killing viruses and germs.  They can be made of either isopropyl alcohol or ethanol and delivered through a variety of different mediums including gels, glycerins, and foams.  Some also contain hydrogen peroxide, which is another type of sanitizer.  To be effective, hand sanitizers need to contain at least 60% alcohol and they can contain up to 95% alcohol.  Some hand sanitizers may use benzalkonium chloride instead of alcohols.   The various hand sanitizers are effective at killing many different types of viruses, some bacteria, and even fungi.  However, they are not effective at killing the norovirus.  Hand sanitizers will not remove dirt, and should be considered an alternative to use only when soap and water are not accessible.  Furthermore, they can be a useful and effective part of a hand hygiene routine because they are portable and can be used when hand washing is not possible (Rush University Medical Center, 2020).  Another alternative is to use a wipe with 60% or more alcohol, which combines the sanitizing effects of a hand sanitizer with some of the dirt removal of hand washing.  While hand wipes can be effective at removing some surface dirt, they are not as effective as hand washing.

In areas where soap and hand sanitizers are unavailable, people may use dirt for hand washing.  Dirt can actually help reduce some larger particles from a surface, but can actually increase the risk of contamination because the dirt may contain microorganisms.  Some people also use ash to wash their hands.  When soap is unavailable, ash is a good alternative because it forms an alkaline solution when it interacts with water. 

It is not enough for people to wash their hands; they have to wash their hands properly (Manning-Schaffel, 2019).  Most people fail to wash their hands for a long enough period of time or do not wash their entire hands.  The World Health Organization has a simple multi-step guide for hand washing.  First, wet the entire surface of the hands using warm or cold running water.  Apply enough soap to thoroughly cover all surfaces of the hand.  Next, rub the hands palm to palm.  Then use the palm of the right hand to clean the top of the left hand. Next, use the palm of the left hand to clean the top of the right hand.  Lace the fingers together and wash between the fingers.  Lock the fingers together so that you can use the palm side of the fingers to clean the back of the fingers on the opposite hand.  Use the opposite hand to thoroughly clean the thumb of each hand.  Rub the tops of the fingers in the palm of the opposing hand.  This process should take at least 20 seconds.  The tip that the WHO provides is that 20 seconds is how long it takes to sing the song Happy Birthday two times.  After washing hands, it is important to dry them with a single-use towel, and then use that towel as a barrier to turn off the faucet.  When a single-use towel is unavailable, hand-drying is an acceptable alternative (WHO, 2020). 

One of the biggest barriers to hand washing in many communities is water scarcity.  While consistently running water is preferable, as long as the hands are wet thoroughly at the beginning of the hand-washing and to remove soap after the scrubbing, then hands do not have to be washed in running water.  However, when clean running water is available, washing hands in a continuous stream of running water is considered preferable.

There is also some disagreement about the best way to dry hands.  In homes, clean towels or disposable towels are considered the best way to dry hands.  However, in public restrooms the options often include a hand drying machine.  Warm-air dryers and jet-air dryers may actually increase the amount of bacteria on hands to levels that are higher than before they are washed.  In addition, because these air dryers propel air over the surface of the hands, they can actually spread contaminants into the restroom, even for people who are not using the dryers.  While paper towels may lead to bathrooms that look messier because of the possibility of improper disposal, they do not have a similar cross-contamination risk. 

Healthcare professionals run an increased risk of cross contamination because they touch multiple people throughout the day.  Therefore, handwashing is especially important for healthcare professionals.  The technique is similar to the technique suggested for everyday hand washing, but includes using a brush to clean underneath fingernails.  In addition, healthcare providers are recommended to use a paper towel to open any doors after washing their hands in order to avoid recontamination.  In addition to the standard times that any person should wash hands, healthcare professionals should hand wash before caring for a patient, after caring for a patient, after exposure to bodily fluids, before an aseptic task, and after environmental contact (WHO, 2020).  For surgical hand-scrubbing, doctors should use specialized taps, sterile scrub brushes, sterile towels for hand-drying, a wash containing chlorhexidine or iodine, and wash up to the elbows.  Patients may be instructed to specially cleanse areas prior to surgery, as well.