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.
Where do you think the most germs are located on your hands?
As studies have shown, our fingernails house the highest level of pathogens on our hands. The area under the fingernail has at least 75 times more microorganisms per density than anywhere else on the hands.
Researchers have known for long time that the hands are the primary perpetrator to the transmission of microorganisms. Clinicians have thus educated on the importance of handwashing, to restrict the spread of germs. Even with frequent handwashing with soap and water, it is nearly impossible to eliminate the presence of pathogens. For this reason, using antiseptic agents, especially alcohol-based rub or gel, are highly recommended to reduce the density of microorganisms on the hands.
Be sure to rub underneath the fingernails each time you wash your hands or apply alcohol-based antiseptic.
- Armitage, P. Statistical methods in medical research. Blackwell Scientific Pulblications, Ltd. Oxford. 1971.
- McGinley K, Larson E, Leyden J. Composition and Density of Microflora in the Subungual Space of the Hand. Journal of Clinical Microbiology. 1988;26(5):950-953.
- Price, P. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. The Journal of Infectious Diseases. 1938;63:301-318.
I can just hear you now questioning the title of this article, “How can soap and water be bad for my skin?” I may sound crazy, but bear with me while I explain.
The skin serves several purposes, but a couple are worth pointing out. First, the outer skin acts as the body’s first line of defense to foreign objects including microorganisms. Secondly, the skin serves to minimize the amount of water the body loses. It is easy to see the importance of maintaining healthy skin.
Looking at the physiology of the skin, the outermost section of the skin is called the epidermis and the outermost layer of the epidermis is called the stratum corneum (also referred to as the “horny layer”). The horny layer is composed of natural lipids that keep the skin hydrated. Without this layer, the skin would dehydrate resulting in cracked, damaged skin. The thicker the horny layer is, the more hydrated the skin is.
Every time we wash our hands, layers of natural lipids are stripped away reducing the skin’s ability to preserve water. The epidermis will regenerate the lipids, but if we wash our hands in excess our body cannot keep up with the production of this protective layer. The end result of frequent handwashing is contact dermatitis symptoms of skin irritations.
I am not claiming nor suggesting we should stop washing your hands, but rather we wash in moderation. Washing with soap and water is important to a healthy lifestyle and should be part of our regular routine. So when should we wash our hands? Proper hand hygiene states handwashing is required under the following conditions:
- Before eating a meal
- After using the bathroom
- When hands are visibly soiled or dirty.
- When contact has been made with bodily fluids or blood.
If cleaning is required at any other time, hand sanitizers are recommended to be used as a substitute. Hand sanitizers are alcohol-based and do not break down the natural lipids of the skin. For this reason, alcohol-based hand sanitizers (or antiseptic) are preferred whenever handwashing with soap and water is not required.
How much washing is considered too much? Proper handwashing technique states hands should be washed for at least 15 seconds, but not to exceed 1 minute. There are many professions, like the medical industry, that require more frequent handwashing compared to the average person. It is In these cases, handwashing should be conducted whenever needed, but extra precaution should be taken by utilizing skincare cream or lotions to assist in the restoration of the lipid layers.
For healthcare professionals, if the above handwashing requirements do not apply, use the alcohol-based antiseptic. Alcohol kills the most amount and broadest range of germs. In addition, the alcohol-based antiseptic has the quickest kill rate compared to washing with antimicrobial soap. Best of all, the alcohol-based antiseptic will not strip away the skin’s lipid layers that locks in moisture.
Although handwashing is known to strip away lipid layers of our skin, handwashing should not be avoided. On the contrary, washing hands should be encouraged as it is an important part of a healthy lifestyle. When handwashing is done properly, soap and water is not an enemy, but rather a friend to healthy skin.
- Commission for Hospital Hygiene and Infectious Disease Prevention of the Robert Koch Institute. Hand hygiene. Bundesgesundheitsbl - Gesundheitsforch - Gesundheitsschutz. 2000;43:230-233.
-Kampf G, Loeffler H. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygenic hand disinfection. Journal of Hospital Infection. 2003;55:1-7.