Hand Hygiene Handwashing and Clean Hands Saves Lives


Practicing Proper Hand Washing At Home

For many healthcare workers, hand washing has become automatic since we know that maintaining proper hand hygiene is important to preventing the spread of infectious disease. With continued reminders from Infection Control staff combined with the constant watchful eye of peers, healthcare workers are more self-aware that hand hygiene should be practiced as needed. If you know you are doing a proper job at washing your hands at work, how would you rate your performance when it comes to practicing hand hygiene at home? Do the rest of your family members, especially children, wash their hands regularly?

During a study conducted by Nicas and Best at Berkley University, they were able to quantify the amount of times people touch their face with their hands. By observing ten students for three hours, Nicas found that these subjects touched their face 15.7 times per hour on average. If we assume that individuals are awake for 16 hours on average, we are estimating that people touch their own face at least 250 times per day. Although we weren’t able to verify the following, the Hollywood movie Contagion made a bold claim that we touch our face at least two to three thousand times per day. The actual number is not that important because whether we are aware of our actions or not, most of us can agree that we touch our face with our hands frequently enough. The important matter to consider is what our hands have been touching prior to our hands touching our face. When you ask yourself this question, it becomes easier to see why we get sick at times.

Imagine for a moment that you are able to record a full day of your actions from the moment you wake up to the time you fall asleep. Better yet, let’s reflect on what you did when you woke up yesterday morning. To give you an idea of my prior morning, I was woken by the alarm clock at 6am and I hit the snooze. Several minutes later, I turned off the alarm clock, checked my phone for messages, turned on the TV for my morning news, started brewing my coffee and finally hit the shower. It hasn’t even been 5 minutes from the time I awoke and I already touched 5 different objects that I can recollect. I can’t even remember if I touched my face prior to washing up. Here’s some food for thought: When’s the last time you cleaned or disinfected your alarm clock, phone, or remote control? If we track things we touch during the middle of the day, the knowledge alone is enough to give us germ phobia. The point of this is not to disinfect everything you own, but to be aware that even in our homes we are exposed to germs in places we don’t realize. Understand that it is unavoidable to be in contact with germs in our daily lives; however, we can practice good hand hygiene to prevent contraction of harmful viruses and bacteria.

Luckily, the human body has an amazing defense mechanism against harmful pathogens. Our skin is the ultimate first line of defense while our white blood cells are like cavalry coming to the rescue. Unfortunately, there are a lot of areas on our face that does not have the protection of skin such as the eyes, nostrils, and mouth. For this reason, the face is more susceptible to contracting the flu or common cold virus. There’s a reason to every wise proverb and our parents pestering us to wash our hands before dinner is not for naught.

Most importantly, I feel it is our duty to set the right example for our friends and family when it comes to hand washing regularly and properly. If you have children in the household is even more important to set the right example because children are known to mimic adults. Let’s start a good habit of washing hands. As for your friends, don’t be shy about checking to make sure their hands are clean. Asking someone if they washed their hands is not uncouth, it is caring. Checking to see if someone washed their hands will benefit not only that person, but you and your family.

Hand Hygiene References
  • Nicas, M. A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection. Journal of Occupational and Enviornmental Hygiene. June 2008; 5(6):347-52.
  • Macias, A. Controlling the novel A (H1N1) influenza virus: don’t touch your face!. Journal of Hospital Infection. 2009: 73, 280-291. August 20, 2009.

Medical Exam Gloves Causing Reduced Hand Hygiene Compliance

Is it true that medical gloves can have a detrimental effect on hand hygiene compliance? I can understand how confusing this statement is. After all, aren’t exam gloves suppose to provide protection against the spread of infections? A recent study published in the Infection Control and Hospital Epidemiology observed that the rate of healthcare workers practicing hand hygiene when exam gloves were used was worse than when medical gloves were not worn. These findings reinforce the idea that we need to keep vigilant with educating everyone on when hand hygiene should be practiced and the importance of it.

In The Dirty Hand in the Latex Glove study, the hand hygiene compliance rate of healthcare workers who used medical gloves was 9% worse than the workers who didn’t wear exam gloves. The study concluded that there was a strong association of medical gloves being used as the reason for this discrepancy. This seems to indicate that there are numerous healthcare professions who believe donning medical gloves alone are sufficient for proper hand hygiene. Similar to drivers who are more inclined to speeding feeling protected by air bags, many of us have grown comfortable with the idea of being sufficiently protected by medical gloves. Just as wearing seat belts is the best protection for drivers, washing our hands is the best protection against hospital acquired infections. Wearing medical gloves is not suppose to act as a substitute for washing hands or using hand antisepsis, but rather be a complementary process for maintaining good hand hygiene practices.

Another reason for the decline in the rate of hand hygiene compliance is attributed to the lack of education of when gloves should be used and when hands should be cleaned with soap & water or alcohol rub. It is easy for us to remember that gloves should be used in high-risk scenarios and that hands should be washed when they are visibly contaminated, but what about the times when you are not in a high-risk scenario or when your hands are not visibly dirty? What is even considered to be a high-risk scenario? Considering how busy healthcare workers are, it is understandable that we would forget over time.

The World Health Organization (WHO) recommends that hands need to be cleaned before donning medical gloves and after taking them off. The WHO recommends that medical gloves should be used whenever you anticipate coming into contact with bodily fluids or when patients need to be protected in a sterile environment. The purpose of medical gloves is to provide barrier protection against harmful microbes, not eliminate them. It is important for everyone to understand gloves may contribute to the spread of infections if proper hand hygiene procedures are not practiced, such as changing exam gloves for new patients and cleaning hands before and after donning gloves.

At the end of the day, continued education of when and how to practice proper hand hygiene is important. Just because a nurse received training at the start of employment does not mean she will retain the information several years later. Let’s be sure our colleagues understand that exam gloves are not a substitute for hand hygiene and that we should be cleaning our hands before and after wearing them. Let’s bring the rate of healthcare acquired infections down to 0. Clean hands save lives!

Hand Hygiene References
  • Fuller, Christopher. "The Dirty Hand in the Latex Glove": A Study of Hand Hygiene Compliance When Gloves Are Worn. Infection Control and Hospital Epidemiology. November 11, 2011.
  • World Health Organization. World Health Organization on Hand Hygiene. Geneva: WHO, 2009.

Debunking the Not-so Common Knowledge of Hand Hygiene

It is easy for anyone to admit they wash their hands regularly and that it is a good habit to keep so sometimes it’s easy to overlook the fact that not everyone is knowledgeable in the nuisance details surrounding hand hygiene. Raising the awareness of hand hygiene depends on us sharing our knowledge with one another and we want to share with you that although some information may seem to be common knowledge to us, it is not so with everyone.

We should never be afraid of educating or sharing information regarding the facts on hand hygiene; however, we should do it in a matter that doesn’t discourage others. Be cognizant that encouraging proper behavior is better than any reprimanding.

We Can Easily Tell When Someone Cleaned His or Her Hands

Not true. We can usually tell if a person washed their hands by listening to the sink running or noticing if the hands are still moist, but the important question is not whether or not the person washed their hands. The key question we need to consider is whether or not the person washed their hands properly. If proper hand washing technique was followed, was the right product used for the scenario? Are soap and water being used when alcohol hand rub is not sufficient?

We All Know When We Need To Clean Our Hands

This is not necessarily the case. Most of us know we should wash our hands before we eat and after we use the restroom, but what about the numerous other scenarios such as when healthcare workers come into physical contact with patients? There is nothing wrong with giving someone a gentle reminder of performing hand hygiene when it is forgotten. More often than not, people will be appreciative of this.

People Who Don’t Adhere to Proper Hand Hygiene Don’t Care or Are Lazy

This isn’t really so. Especially within a healthcare setting, most workers try their best to do the right thing and want their patients to be safe. The key to hand hygiene is making the when and how of cleaning the hands a regular part of an individual’s routine. For some individuals, they just don’t know and just need the proper education.

If Everyone Had Excellent Hand Hygiene, Infections Would Be Eradicated

Although infections wouldn’t be eliminated, the number of infections would be reduced if everyone had excellent hand hygiene. According to reports by the CDC and WHO, bad hand hygiene is the number one contributing factor for the spread of infections. Making sure everyone practiced good hand hygiene won’t get rid of diseases, but it will keep our society healthier by helping contain infections that do occur.

Hand Hygiene Resource:
  • Center for Disease Control and Prevention: Guideline for hand hygiene in health-care settings. Morbidity and Mortality Weekly Report 51:1-45, Oct. 25, 2002.
  • WHO Guidelines on Hand Hygiene in Health Care. World Health Organization, 2006.