The Covid-19 outbreak brought into sharp focus the need to keep hands clean by handwashing with soap and water, or the use of alcohol hand sanitisers.
Clean hands, not masks, are more vital in the avoidance of illness and spreading microorganisms to others.
Many infectious diseases are spread by not washing hands with soap and clean running water.
How they spread
There are various ways in which microorganisms can get onto human hands and cause illness.
The faeces of humans and animals often contain microorganisms like Escherichia coli and Salmonella, which cause diarrhoea.
In addition, faeces can also spread some respiratory infections like adenovirus, and hand, foot and mouth disease, in children.
These microorganisms find their way onto our hands after we go to the toilet or change a diaper.
It can also occur after the handling of raw animal meats that can have invisible amounts of animal faeces on them.
Microorganisms can also find their way onto our hands if anyone touches an object that contains microorganisms on it.
This occurs as a result of an infected person coughing or sneezing on the object, or another contaminated object touching the object.
When microorganisms on the hands are not washed off, they can be passed from one person to another, thereby spreading and causing illness.
A healthcare-acquired infection (HAI) is an infection acquired by a patient during healthcare delivery in a hospital or other healthcare facilities, which was not present or incubating on admission.
It is the most frequent adverse event in healthcare and affects patients in any care setting during and after discharge.
A HAI leads to prolonged hospital stays; antibiotic resistance; disability; high costs for individuals, their families and health systems; and unnecessary deaths.
It can also lead to infections in doctors, nurses, other healthcare professionals or caregivers attending to patients.
From hands to face
The washing of hands prevents illness and spread of infection(s) to others.
When hands are washed with soap and water, there is removal of a substantial number of microorganisms from their hands.
There are several ways in which handwashing prevents infections.
Microorganisms from unwashed hands can get into drinks and food during preparation or consumption.
In addition, microorganisms can multiply in some types of drinks or foods under certain conditions, then cause illness.
They can cause illness when they get into the human body through the eyes, nose and mouth.
People often touch their eyes, nose and mouth without realising it.
A study of medical students at the University of New South Wales in Australia, published in 2015 in the American Journal of Infection Control, reported that the subjects touched their faces 23 times per hour.
“Of all face touches, 44% involved contact with a mucous membrane, whereas 56% of contacts involved non-mucosal areas.
“Of the mucous membrane touches observed, 36% involved the mouth, 31% involved the nose, 27% involved the eyes, and 6% were a combination of these regions.
Another study, published in 2014 in the Journal of the American Board of Family Medicine, observed hand hygiene and face touching in family doctors and their staff in Cincinnati, United States.
The participants touched their eyes, nose and mouth a mean of 19 times in two hours (a range of zero to 105 times) with family doctors doing so significantly less often than their staff.
Microorganisms from unwashed hands can be transferred to other objects like door knobs, table tops, hand rails etc, then transferred to other people’s hands.
The transmission of healthcare-associated microorganisms from one patient to another through caregivers’ hands involves the following sequence:
- Microorganisms are present on the patient’s skin or have been shed onto inanimate objects in the patient’s immediate vicinity.
- The microorganisms are transferred onto the hands of caregivers, where they are capable of survival for several minutes.
- Handwashing or antisepsis by the caregivers is inadequate or omitted, or the agent used for hand hygiene is inappropriate, and
- The contaminated hand or hands of the caregivers come into direct contact with another patient or with an inanimate object that will come into direct contact with a patient.
Protection against infection
There is substantial evidence that widespread handwashing significantly reduces the incidence of diarrhoeal illnesses, particularly in those with weakened immunity, as well as the incidence of respiratory infections in the community.
Handwashing with soap can protect about one out of every three young children with diarrhoea, and almost one out of every five young children with respiratory infections like pneumonia.
Handwashing can prevent about 30% of diarrhoea-related illnesses and about 20% of respiratory infections, both of which are often prescribed antibiotics.
The reduction of these infections helps prevent antibiotic overuse, which is the single most important factor that leads to antibiotic resistance globally.
Handwashing can also prevent antibiotic-resistant infections that are difficult to treat.
There is substantial evidence that hand antisepsis reduces the transmission of healthcare-associated microorganisms and the incidence of HAI.
Improvement in hand hygiene practices may reduce transmission of microorganisms by half.
In short, the removal of microorganisms through handwashing helps in the prevention of diarrhoea and respiratory infections, and may even prevent skin and eye infections in the community setting.
In the healthcare settings, handwashing reduces HAIs significantly.
Hand hygiene at the right time has saved, saves, and will continue to save millions of lives globally.
It is a quality indicator of safe healthcare systems as infections can be stopped by good hand hygiene practices.
The World Health Organization (WHO) estimates that the harm to patients and healthcare professionals can be prevented by less than US$10 (RM42.25) and that alcohol-based hand sanitisers, which cost about US$3 (RM12.67) per bottle, can prevent HAIs and millions of deaths annually.
How to wash hands
WHO recommends frequent handwashing with soap and water, or the use of an alcohol-based hand sanitiser, if your hands are not visibly dirty, as one of the basic protective measures against Covid-19 infection.
The US Centres for Disease Control and Prevention (CDC) spells out the details of handwashing for the general public in five steps: “Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap.
“Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers and under your nails.
“Scrub your hands for at least 20 seconds. Need a timer? Hum the Happy Birthday song from beginning to end twice.
“Rinse your hands well under clean, running water.
“Dry your hands using a clean towel or air dry them.”
WHO has guidelines for hand hygiene in healthcare too.
Handwashing with soap and water must be used when the hands are visibly soiled or potentially contaminated with body fluids, and when caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn.
A hand sanitiser containing 70%-95% alcohol is used for hand decontamination in healthcare settings, as it is better tolerated than handwashing with soap and water.
Non-alcohol-based hand sanitisers are not recommended.
The message on clean hands in the Covid-19 outbreak should be carried forward into the cultivation of frequent handwashing as a daily habit for everyone.
This will also reduce diarrhoeal diseases and some respiratory diseases in the medium to long term.
In summary, clean hands not only protect against infections, but also saves lives.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.