University of Ibadan Alumni Association
Enugu State Branch

Publications

Hand Hygiene
Prof Nene Obianyo - 14th June 2015

Introduction
Hand hygiene is the culture of 'hand washing' and 'hand sanitizing'
Hand hygiene is the act of cleansing one's hands for the purpose of removing soil, chemicals, dirt, or germs. The main health purpose of hand hygiene is to cleanse the hands of germs (including bacteria, viruses or fungi) and chemicals which can cause personal harm or disease and which can be transferred to another person. This is especially important for people who handle food or work in the medical field, but it is also an important practice for the general public.

Routes of spreading diseases

  • Airborne disease (eg. flu, TB, Measles)
  • Droplet diseases ( ego meningitis)
  • Faeco-oral diseases (eg. gastroenteritis, worms)
  • Physical contact diseases (eg. body fluids, skin diseases like impetigo)

The soil (ground etc) is heavily contaminated and more so in or environment where it is used as a toilet facility for urination and defaecation.

It is well documented that one of the most important measures for preventing the spread of germs is effective hand washing. It protects best against diseases transmitted through fecal-oral routes and direct physical contact.

Benefits of hand hygiene:

  • Helps to minimize the spread of influenza
  • Helps in the prevention of diarrheal diseases
  • Reduces the rate of respiratory infections
  • Is a preventive measure for infant deaths at their home birth deliveries

Hand washing with soap, as an automatic behavior performed in homes, schools, and communities, is the single most effective and inexpensive way to prevent diarrhea and acute respiratory infections worldwide. Pneumonia, a major respiratory infection, and diarrhea, a faeco-oral disease, together are the leading cause of death among children under five years old.

According toWHO, an ingrained habit or culture, of hand washing with soap before eating and after using the toilet can save more lives from diarrhea and acute respiratory infections than any single vaccine or medical intervention.

Acquiring the habit of hand hygiene
Group handwashing for school children at set times of the day has been used as one option in developing countries to engrain handwashing habit in them. In the Philippines and in Indonesia a school health program has been developed which includes deworming twice a year, washing hands daily with soap, and brushing teeth daily with fluoride. Training in families is equally important.

Soap and hand rub
Removal of germs from skin is enhanced by the addition of soaps or detergents to water. Water on its own is not an efficient 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. However, warm soapy water is more effective than cold soapy water at removing the natural oils on the hands which hold dirt and bacteria. Contrary to popular belief, scientific studies have shown that using warm water has no effect on reducing the germ load on hands.

Solid soap
Solid soap, because of its reusable nature, may hold bacteria acquired from previous uses. Yet, it is unlikely that bacteria are transferred to users of the soap, as the bacteria are rinsed off with the foam.

Antibacterial soap
Antibacterial soaps have been heavily promoted and marketed to the public. However, there is no evidence that antiseptic or disinfectant soap is better than plain soap for hand washing.

Hand sanitizers (Hand antiseptics)
A hand sanitizer or hand antiseptic is an alcohol-based hand hygiene agent. In the late 1990s, alcohol rub hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity. Most are based on alcohol formulated together with a thickening agent into gel, 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. They kill bacteria, viruses, fungi and ova of worms up to 99.97.

They are most effective against bacteria and less effective against some viruses. Hand washing is recommended over hand sanitizer rubs, when hands are visibly dirty. The increasing use of these agents is based on their ease of use and rapid killing activity against germs; however, they should not serve as a replacement for proper hand washing unless soap and water are unavailable.

Possible Disadvantage

  • A possible small detrimental effect of hand washing is that frequent hand washing can lead to skin damage due to drying of the skin.
  • Frequent use of alcohol-based hand sanitizers can cause dry skin unless skin moisturizers are added to the formula or used afterwards.
  • The drying effect of alcohol can be reduced or eliminated by adding glycerin or other emollients to the formula.
  • In clinical trials, alcohol-based hand sanitizers containing emollients caused substantially less skin irritation and dryness than soaps.
  • The lower tendency of sanitizers to induce irritant contact dermatitis as compared to soap and water for hand cleansing is an attraction

Techniques
What is running water?
Running water IS water that is flowing. The best running water is that from the tap. When water is scarce, various low-cost options can be made to facilitate hand washing where tap-water is not available e.g. water can flow from an improvised 'bucket & tap" or hand held cup (by an assistant) or a hanging jerrycan.

Drying with towels or hand driers
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 public washrooms. A growing volume of research suggests that disposable paper towels are much more hygienic than the electric blow dryers found in some washrooms. Reusable towels in public places should not to be encouraged.

Soap and water hand washing technique.

  • Rinse hands with water, keeping hands below wrists and forearms, to prevent contaminated water from moving from the hands to the wrists and arms.
  • Apply liquid soap to completely cover the hands, and rub wet soapy hands together, outside the running water, for at least 20 seconds.
  • The most commonly missed areas are the thumb, the wrist, the web spaces, and under fingernails. (Note that artificial nails and chipped nail polish harbor dirt and germs).
  • Rinse thoroughly, from the wrist to the fingertips to ensure that germs and dirt fall off the skin rather than fall onto skin.
  • Dry hands and arms with a clean towel (disposable or not)
  • Use a paper towel to turn off the tap or open the door (for public places).

Hand sanitizer technique
Enough hand sanitizer must be used to thoroughly cover both hands. The front and back of both hands, the web spaces, and the ends of all fingers are rubbed for until the liquid, foam or gel is dry. The finger tips must be washed well rubbing them in both palms alternatively. Apart from the use of running water the technique of hand sanitizing is similar to that of water & soap washing.

Critical times in hand-washing
There are critical times in washing hands with soap & water or using of a hand sanitizer in other to reduce the transmission of germs:

  • after using a bathroom (private or public)
  • after changing a baby's diaper or napkin
  • before feeding a child
  • before feeding yourself
  • before preparing food or handling raw meat, fish, or poultry
  • before and after tending to any sick person

Conclusion
Hand washing is recognized as an essential tool for good health and good nutrition. However, lack of reliable water supply, soap or hand sanitizer in people's homes, at schools and at the workplaces, make hand hygiene a challenge in developing countries such as ours. To achieve universal hand hygiene culture, we need to increase awareness and adopt behavior change by inculcating initiatives such as the Global Hand washing Day and introducing in our schools educational health programs on hand hygiene.

THANK YOU

Hand Wash

Hand Rub

 

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