HANDWASHING: A MODEST MEASURE WITH UNIMAGINABLE UPSHOTS

A MODEST MEASURE WITH GREAT RETURNS

A MODEST MEASURE WITH GREAT COROLLARY

INTRODUCTION

Hand washing also known as hand hygiene, is the act of cleaning hands for the purpose of

removing soil, dirt, and microorganisms to minimize the spread of influenza, prevent infectious

causes of diarrhea, decrease respiratory infections, and decrease infant mortality rate at home

birth deliveries (Hand washing - Wikipedia, n.d.). The importance of handwashing has been long
recognized such that there are yearly designated dates for its emphasis and celebration. For
example October 15 each year is designated as Global Handwashing Day and May 5 is also
celebrated each year as hand hygiene day respectively. The theme for the 2020 hand hygiene day
was "SAVE LIVES: Clean your hands”. The main idea of observing the day is to
recognize hand washing as one of the most effective actions that can be taken to avoid a huge
range of infections including the COVID-19 virus.
Historically, the importance of hand washing for human health was first recognized in the mid
19th century by a Hungarian physician, Ignaz Semmelweis and Florence Nightingale, an English
who was also tagged as the founder of modern nursing. These two were considered the pioneers
of handwashing at a time when most people still believed that infections were caused by foul
odours called miasmas.

Subsequently, a lot of foodborne outbreaks and healthcare-associated infections around the

1980s led to the promotion of hand hygiene as an important way to prevent the spread of
infections. The outbreak of swine flu in 2009 and the COVID-19 pandemic in 2019 led to
increased awareness in many countries of the importance of washing hands with soap under
running water to protect oneself from such infectious diseases.[6]

In a religious sense, hand washing has been regarded for hygienic and symbolic purposes.[4]
Symbolic hand washing, using water but no soap to wash hands, is a part of ritual hand washing
featured in many religions, including Bahá'í Faith, Hinduism, tevilah and netilat yadayim in Judaism,
Lavabo in Christianity, and Wudhu in Islam.[4]
Religions also prescribe hygienic hand washing, especially after certain actions. Hinduism, Judaism
and Islam mandate washing of hands after using the toilet. And, Hinduism, Buddhism, Sikhism,
Judaism and Islam mandate washing of hands before and after every meal. [4]
Doing the Handwashing

Hand hygiene is basically carried out with soap or detergents and water. The soaps and
detergents aids to reduce barriers to solution, and increase solubility. It is also noted that water
alone is not sufficient to remove the soil, dirt, and microorganisms simply because these
components are not readily dissolved in water.

Many low-income settings do use ash or sand and sometimes clay with water to wash their hands
The World Health Organization in a 2014 study titled, Water Sanitation Health. How can personal
hygiene be maintained in difficult circumstances, recommended ash or sand as an alternative to
soap when soap is not available. However, there is no quality evidence to support the use of ash to
wash hands to be safer and it is not clear if washing hands with ash is effective at reducing viral or
bacterial spreading compared to washing with mud, not washing, or with washing with water alone.
One concern is that if the soil or ash is contaminated with microorganisms it may increase the
spread of disease rather than decrease it. Like soap, ash is also a disinfecting agent because in
contact with water, it forms an alkaline solution(Howard, 2002).

Though the practice of handwashing has been in existence for long, there has not been a widely
established procedure in its performance until the Center for Disease Control and Prevention in
December 2019 came out with a standard procedure in carrying out handwashing. This
procedure involves the commonly used materials, soap and water. The procedure includes the
following:

1. Wet hands with warm or cold running water.[53] Running water is recommended because
standing basins may be contaminated, while the temperature of the water does not seem to
make a difference.[36]
2. Lather hands by rubbing them with a generous amount of soap, including the backs of
hands, between fingers, and under nails.[53] Soap lifts germs from the skin, and studies show
that people tend to wash their hands more thoroughly when soap is used rather than water
alone.[36]
3. Scrub for at least 20 seconds.[53] Scrubbing creates friction, which helps remove germs from
skin, and scrubbing for longer periods removes more germs. [36]
4. Rinse well under running water.[53] Rinsing in a basin can recontaminate hands.[36]
5. Dry with a clean towel or allow to air dry.[53] Wet and moist hands are more easily
recontaminated.[36]
The most commonly missed areas are the thumb, the wrist, the areas between the fingers, and
under fingernails. Artificial nails and chipped nail polish may harbor microorganisms. [54] Moisturizing
lotion is often recommended to keep the hands from drying out.

A study by Dangour(1996) showed that improved hand washing practices may lead to small
improvements in the length growth in children under five years of age. In developing countries,
childhood mortality rates related to respiratory and diarrheal diseases can be reduced by
introducing simple behavioral changes, such as hand washing with soap. This simple action can
reduce the rate of mortality from these diseases by almost 50 percent.

Interventions that promote hand washing can reduce diarrhoea episodes by about a third, and this

is comparable to providing clean water in low income areas and 48% of reductions in diarrhoea

episodes can be associated with hand washing with soap.

Hand washing with soap is the single most effective and inexpensive way to prevent diarrhea and

acute respiratory infections (ARI), as automatic behavior performed in homes, schools, and

communities worldwide. According to UNICEF, turning hand washing with soap before eating

and after using the toilet into an ingrained habit can save more lives than any single vaccine or

medical intervention, cutting deaths from diarrhea by almost half and deaths from acute
respiratory

infections by one-quarter.

Critical Moments for Handwashing

Handwashing has come to stay with us and is essential for everyone including children all the
time, even in moments when the need is more than compelling for its absolute relevance. Even
though the need to wash the hands has become an untimed event in cases and moments such as
with the covid-19 pandemic, there are still very critical moments when handwashing becomes a
must than an exercise of routine performance. These critical moments for hand washing which
has been endorsed by the World Health Organization recommends washing hands [2]:

 Before, during, and after preparing food.

 Before eating food.
 Before and after caring for a sick person.
 After using the toilet.
 After changing the diapers or cleaning up a child who has used the toilet.
 After blowing your nose, coughing or sneezing.
 After touching animal, animal feed, or animal waste.
 After touching garbage.

Benefits of Handwashing
 Keeping our hands hygienic is one of the best ways to adopt to avoid getting sick and
spreading germs among ourselves. Diseases are mostly spread by not washing our hands
with soap and water.
It is a single act that
 minimizes the spread of influenza, corona virus and other infectious diseases, (Cowling,
Benjamin et al, 2009), preventing infectious causes of diahrroea, decreasing respiratory
infections and reducing infant mortality at home birth deliveries.
Getting people to wash their hands will help them stay healthy as it
 reduces the number of people who get sick with diarrhoea by 23-40%
 reduces diarroeal illness in people who have weakened immune systems by 58%
 reduces respiratory illnesses like colds, in the general population by 16-21%
 reduces absenteeism due to gastrointestinal illness in school children by 29-57%

Reducing the number of infections by handwashing helps prevent the overuse of antibiotics-
which has become the single most important factor leading to antibiotic resistance around
the world. Finally, handwashing can also prevent people from getting sick with germs that
are already resistant to antibiotics and that can be difficult to treat.

^ "The Global Public-Private Partnership for Handwashing". globalhandwashing.org. Retrieved 18 April 2015.

Rhee, V.; Mullany, L. C.; Khatry, S. K.; Katz, J.; Leclerq, S. C.; Darmstadt, G. L.; Tielsch, J. M. (2008). "Impact
of Maternal and Birth Attendant Hand-washing on Neonatal Mortality in Southern Nepal". Arch Pediatr Adolesc
Med. 162 (7): 603–08. doi:10.1001/archpedi.162.7.603. PMC 2587156. PMID 18606930.

^ a b c d e f "When and How to Wash Your Hands". www.cdc.gov. 4 December 2019. Retrieved 6 March 2020.

Water Sanitation Health. How can personal hygiene be maintained in difficult circumstances?". WHO. 2014.
Retrieved 12 March 2020.

Howard et al. 2002: Healthy Villages A guide for communities and community health workers; Chapter 8
Personal, domestic and community hygiene. WHO. Accessed Oct. 2014.
http://www.who.int/water_sanitation_health/hygiene/settings/hvchap8.pdf
Dangour, Alan D (1996). "Interventions to improve water quality and supply, sanitation and hygiene practices,
and their effects on the nutritional status of children" (PDF). Reviews (8): CD009382.
doi:10.1002/14651858.CD009382.pub2. PMID  23904195

https://www.youtube.com/watch?v=3PmVJQUCm4E

^ Cowling, Benjamin J.; et al. (2009). "Facemasks and Hand Hygiene to Prevent Influenza Transmission in
Households". Annals of Internal Medicine. 151 (7): 437–46. doi:10.7326/0003-4819-151-7-200910060-00142.
PMID 19652172.

Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Handwashing for preventing diarrhoea. Cochrane Database
Syst Rev.2008;1 :CD004265.

Aillo AE Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community
setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-81.

Huang DB, Zhou J. Effects of intensive handwashing in the prevention of diarrhoeal illness among patients with
AIDS: a randomized controlled study. J Med Microbiol.2007;56(5):659-63.

Rabie T and Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop
Med Int Health. 2006 Mar; 11(3):258-67.

Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J et al. Hygiene and healt: Systematic
review of handwashing practices worldwide and update of health effects. Trop Med Int Heal 2014; 19: 906-916.

Wang Z, Lapinski M, Quilliam E, Jaykus LA, Fraser A. The effect of hand-hygiene interventions on infectious
disease-associated absenteeism in elementary schools: A systematic literature review. Am J Infect Control
2017; 45: 682-689.