Why a hand wash will keep the doctor away

Asking someone to wash hands after visiting the toilet or before eating food may come off as belittling, yet ignoring this seemingly simple practice of hygiene is stifling the fight against microbial infections.
Students wash their hands. Proper hand hygiene before eating food is very crucial. (Solomon Asaba)
Students wash their hands. Proper hand hygiene before eating food is very crucial. (Solomon Asaba)

Asking someone to wash hands after visiting the toilet or before eating food may come off as belittling, yet ignoring this seemingly simple practice of hygiene is stifling the fight against microbial infections. The results are evident, especially due to the soaring cases of fecal contamination. More concerns are now growing about similar negligence from health workers.

While hospital regulations globally stipulate that one must clean up before handling any medical procedures, health workers must ensure sterility from germs. For surgical rooms, safety standards should even be higher and this necessitates surgeons, nurses and anesthetics to take a shower, put on disinfected gear and keep washing hands regularly between breaks of operations. For one reason or another, proper hand washing may not happen even in the hospital setting and the results are grave.

Dr Emile Rwamasirabo, a senior surgeon and chief executive officer of King Faisal Hospital, Kigali, says that poor hand hygiene by health workers is promoting the spread of infections to patients who come to hospitals seeking treatment.

“They visit hospitals to treat illnesses only to end up contracting other infections just because of poor hygiene practices. Sometimes it is realised upon discharge and this is a worldwide problem as most of the microorganism are picked up by the hands,” he says.

Dr Rwamasirabo adds that the use of antibiotics within the hospitals worsens the situation since on exposure, most germs acquire infections and later develop into more resistant strains.

“This is why we are emphasising cleanliness and mostly within surgery rooms. Hand-washing is well known for limiting the number of infections that are passed to patients through contact. This means that when these infections are acquired in the hospital, they are passed to the patients through the health care providers despite the fact that washing hands would have been the cheapest and most effective way of fighting antimicrobial contamination,” he says.

In fact most of these hospital-acquired infections (nosocomial infections) are transmitted to patients from other patients or staff members who practice poor hand-washing techniques.

Research shows that if hospital staff members don’t wash hands between patients, they carry bacteria and viruses from one patient to another. Some of the microorganisms that are difficult to eradicate include methcillin-resistant staphylococcus aureus clostridium difficile and vancomycin-resistant enterocci, contaminant escherichia coli.

The burden is huge and in some cases, patients can die. For instance, a study carried out in the United States found that approximately 10 per cent of hospitalised patients are infected with a nosocomial infection during their stay and 20,000 people in the United States die from them each year.

Hands pick dirt from all surfaces

Louise Ingabire, a nurse from Masaka District Hospital, explains that the biggest roadblock in ensuring proper hygiene remains in the practice of handling equipment and materials with a perception that all appear clean because they are microbiologically safe.

“You may be working from a place that appears clean but it may not be safe from germs. People ignore the fact that every time they touch their body, clothes or shoes, their hands leave with microorganisms. In case such a person seeks access to a patient, then chances are high that they will contaminate them with the acquired infections,” she explains.

According to Mayo Clinic, as one touches people, surfaces and objects throughout the day, they accumulate germs on hands. In turn, they can infect themselves by touching their eyes, nose or mouth.

Mayo Clinic goes ahead to suggest that the best ways to avoid getting sick and spreading illness is through hand-washing that requires only soap and water or an alcohol-based hand sanitiser - a cleanser that doesn’t require water.

A 2014 study carried out by the World Health Organisation in neighbouring Uganda involving more than 650 surgical patients found that the rate of infections halved after the new measures of hand washing were introduced. As a result, patients started spending less time in hospital, resulting in a cost saving both to them and the hospital.

Besides the surgical areas, one of the most sensitive places where good hygiene is needed is the nursery.

In the pediatrics section

Globally, about 3.5 million children die before the age of five due to diarrheal diseases, which can be prevented through effective hand-washing practices.

Dr Tharcise Ngambe, a pediatrician at King Faisal Hospital, says that hand-washing within the paediatric department is a necessity for the caretakers, nurses and doctors since young ones do not have fully developed systems to fight the germs.

“There is easy contamination during nursery care; even with feeding every contact, be it in food preparation for the little ones, some other person has to be involved and once those helping come with infections, the life of the young ones can be compromised. Hand-washing is just one simple thing that can prevent such infections,” says Dr Ngambe.

A medic demonstrates how proper hand disinfection is done. (Solomon Asaba)

The other problem the pediatrician points out is that most respiratory infections that affect young people are caused by contamination and without frequent hand-washing; these contagious infections find their way into the body.

“If you clean one baby and you don’t clean yourself properly there is a risk and we have seen some cases. When someone comes with diarrhea and does not maintain proper hand hygiene, spreading this to the whole unit won’t take time. For the premature babies, that would mean extra costs in trying to deal with these infections,” he adds.

Lack of effective hand washing is a problem in most communities and while several studies have concluded that good hand-washing saves lives, many people continue living recklessly despite the fact that proper disinfection using ordinary soap could be enough even to save a person from contracting infections as deadly as cholera.



When to wash your hands

Always wash your hands before:

- Preparing food or eating
- Treating wounds, giving medicine, or caring for a sick or injured person
- Inserting or removing contact lenses

Always wash your hands after:

- Preparing food, especially raw meat or poultry
- Using the toilet or changing a diaper
- Touching an animal or animal toys, leashes or waste
- Blowing your nose, coughing or sneezing into your hands
- Treating wounds or caring for a sick or injured person
- Handling garbage, household or garden chemicals, or anything that could be contaminated — such as a cleaning cloth or soiled shoes
- Shaking hands with others
- In addition, wash your hands whenever they look dirty.

How to wash your hands

It’s generally best to wash your hands with soap and water. Follow these simple steps:

- Wet your hands with running water — either warm or cold.
- Apply liquid, bar or powder soap.
- Lather well.
- Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.

- Rinse well.
- Dry your hands with a clean or disposable towel or air dryer.
- If possible, use a towel or your elbow to turn off the faucet.

Keep in mind that antibacterial soap is no more effective at killing germs than is regular soap. Using antibacterial soap might even lead to the development of bacteria that are resistant to the product’s antimicrobial agents – making it harder to kill these germs in the future.

How to use an alcohol-based hand sanitiser

Alcohol-based hand sanitisers, which don’t require water, are an acceptable alternative when soap and water aren’t available. If you use a hand sanitiser, make sure the product contains at least 60 per cent alcohol. Then follow these simple steps:

- Apply enough of the product to the palm of your hand to wet your hands completely.
- Rub your hands together, covering all surfaces, until your hands are dry.
Antimicrobial wipes or towelettes are another effective option. Again, look for a product that contains a high percentage of alcohol. If your hands are visibly dirty, however, wash with soap and water.

Children need clean hands too

Help children stay healthy by encouraging them to wash their hands properly and frequently. Wash your hands with your child to show him or her how it’s done. To prevent rushing, suggest washing hands for as long as it takes to sing the “Happy Birthday” song twice. If your child can’t reach the sink on his or her own, keep a step stool handy.

Alcohol-based hand sanitisers are okay for children and adolescents, especially when soap and water aren’t available. However, be sure to supervise young children using alcohol-based hand sanitisers. Remind your child to make sure the sanitizer completely dries before he or she touches anything. Store the container safely away after use.

Hand hygiene is especially important for children in child care settings. Young children cared for in groups outside the home are at greater risk of respiratory and gastrointestinal diseases, which can easily spread to family members and other contacts.

Be sure your child care provider promotes frequent hand-washing or use of alcohol-based hand sanitisers. Ask whether the children are required to wash their hands several times a day — not just before meals. Note, too, whether diapering areas are cleaned after each use and whether eating and diapering areas are well-separated.

Hand-washing doesn’t take much time or effort, but it offers great rewards in terms of preventing illness. Adopting this simple habit can play a major role in protecting your health.