Hand washing and hand hygiene in medical practice and day to day life

Introduction

Hand hygiene is now widely recognized as the most important factor for controlling nosocomial infections, drug- resistant infections and their cross transmission.1 Our hands are dirty at times and can transmit many pathogens to patients which can lead to devastating infections. Hand hygiene can be performed either by soap or alcohol-based hand sanitizer.

There are six or seven steps of hand hygiene.2 Proper stepwise handwashing can lower the prevalence of certain respiratory and gastrointestinal infections by up to 23% and 48%, respectively. It can also substantially lower the cases of Coronavirus infections. In fact, physical distancing, handwashing and vaccination have been the 3 pillars in controlling the COVID pandemic. In common parlance, it is not always possible to follow these steps of hand hygiene sequentially, however whenever possible they should be followed. In many cases hand washing with soap eradicates germs better than hand sanitization or scrubbing. This is especially true in case of food borne viruses like norovirus. In case of visibly soiled hands, germs are eradicated better by hand washing with soap, rather than hand sanitization.

There are two kinds of soaps that can be used for hand washing; one is a non medicated soap and the other one is medicated soap. Medicated soaps can contain chlorhexidine or chloroxylenol. Both the types of soaps can be solid or liquid; it is better to use liquid soap which covers the creases of the palms of the hand better. Nowadays powdered soaps in sachet are also available, that need to be reconstituted in specified volume of water for hand washing. In any kind of hand wash, hand should be washed for a minimum time of 25 to 30 seconds stepwise (first, hands to be moistened, soap taken, the rubbing from palm to palm, dorsum to palm, in between fingers, interlocking fingers and thumb, nail tips in palm, wrists).3

In case of hand scrubbing or hand sanitization, it should be carried out with an alcohol-based hand sanitizer that should also contain emollients like glycerol or vitamin E or aloe Vera. The latter things are added to prevent the drying up of skin of hands. As regards the alcohol used in the hand sanitizers, Isopropyl alcohol has better microbicidal property than ethyl alcohol. The effective concentration is 40% to 70% in cases of both ethanol and isopropanol. The sanitizers are effective only when the alcohol is evaporated fully. Sometimes hydrogen peroxide or chlorhexidine an be added to hand sanitizers. A minimum amount of 2 ml of liquid soap or sanitizer is needed for hand washing and scrubbing, respectively.

While performing hand sanitization rings should be removed from fingers and nails should preferably be kept short.

Source of Bacteria in Hands

Bacteria and yeasts in hands come usually from picking external nose or from unclean and unhygienic practices, or by touching dirty objects. The bacteria flora in hands can of 2 types: transient flora and resident or permanent flora. Only the transient hand flora can be removed by hand washing.

Types of Bacteria Found in Hands

Commonly Staphylococci, Enterococci and Candida spp. are found in the hands of the healthcare giver. We did several experiments and found similar results. Hands of nurses and attendants are slightly more contaminated than those of doctors.

The Five Points of Hand Hygiene

There are 5 points of hand hygiene, or that hands should be washed at 5 points or junctures:

They are also called the 5 moments of hand hygiene. They are very important to remember for the healthcare giver.

Advantage of Hand Sanitizer over Soap

A hand sanitizer takes less time than soap and water, and is also less irritating to the skin.1 However, soap and water lead to better eradication of germs. In particular, anaerobic spore bearing bacteria and norovirus are better eliminated by soap and water than alcohol-based sanitizer. Also, medicated soaps are better than non-medicated soaps in this aspect.

History of Hand Hygiene

The foundation of hand hygiene was laid down by Joseph Lister and Ignaz Semmelweis. In Vienna in the year 1846, Ignaz Semmelweis recorded that he could reduce the incidence of postpartum infections by hand wash with chlorinated lime water.4 From then onwards, hand hygiene became an important recognized factor to control infections. However, even before that, Labarraque postulated that hand hygiene can bring down significantly the instances of puerperal fever and maternal mortality.5 Joseph Lister was a surgeon who used a spray made or carbolic acid on instruments before surgery, and also used to clean his hands with it before the procedures, with great success in reducing post-operative infections.6 He published his findings in the year 1867.

Types of Hand Washing

There are 3 types of hand washing: social hand washing, antiseptic hand washing and surgical hand washing. 7 Surgical hand washing is done up to elbow while social hand washing is done till wrist. Antiseptic hand wash is a process which also kills the resident bacteria of skin. It is performed with hot water and antiseptics.

In normal day to day life, social hand washing is better and more relevant, especially before eating and after defecation.

Discussion

Hand hygiene is often neglected but is an important step for infection control. In fact, hand hygiene is a very simple way to mitigate hospital associated infections, prevent the spread of antimicrobial resistance, and enhance patient safety.11 Healthcare givers should be more compliant towards proper hand washing. General people should be made aware about the steps and importance of hand washing. Only then proper infection control can be achieved, particularly in the hospital setting. Handwashing is also termed a “do it yourself” vaccine, and handwashing with soap after visiting the washroom and before eating is the most effective and inexpensive means to prevent the death of millions of children due to diarrheal and respiratory diseases.8

Conclusion

Stepwise hand hygiene by soap or hand sanitizer is needed to break the chain of transmission of infections. Awareness need to be generated among the masses about the significance, moments and steps of hand hygiene, to halt the chain of infection transmission, more so since not many new antibiotics are coming up to tackle drug-resistant bugs.

Source of Funding

None.

Conflict of Interest

None.