Hand Washing: Reflections of a Doctor.

By Dr. Deborah Lee

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As a doctor, what’s my view on the current health advice about hand washing? Am I following the current expert advice correctly myself?

Here’s the good news – If we understand the rationale for washing our hands and use the best hand washing technique, defeating the coronavirus is perfectly possible.

/ READ AHEAD

Hand washing working in clinical medicine.

Can you wash your hands too much

The importance of proper hand washing as the first line in infection control is something that was drummed into me during medical training. Therefore, the advice to wash hands frequently as a means of preventing the transmission of coronavirus made absolute sense to me. And I should be good at it.

In my role as a doctor working in the sexual health clinic, I would wash my hands 20 – 30 times a day. I was no doubt washing them more frequently than doctors in other branches of medicine,  because of the nature of the work. I was working in a genitourinary medicine clinic, dealing all day long with sexually transmitted infections (STI’s).

I would wash my hands; on arrival in the morning, before and after each new patient, examining a patient, preparing a slide, taking blood, or doing any clinical procedures.  And of course,  I also wore protective, and as was sometimes required, sterile, gloves.

In fact, as I’ve only recently discovered, I was washing my hands too frequently.

Hand washing in the COVID-19 pandemic.

So, what’s changed?

During this COVID-19 outbreak, it simply means I am doing the same at home. For example,  I wash my hands first thing in the morning. Then, before and after; making drinks, preparing meals, doing housework, going to the toilet, going to the supermarket, and even when I stretch my legs once an hour – when my Fitbit reminds me that it’s time to move away from my computer screen!

We used to have spot-checks on hand washing in our department.  I was shocked to find out that even though I was sure I had washed my hands thoroughly and believed them to be clean when they were exposed to U/V light in a light box there was still a frightening number of bacterial and other organisms stuck on my hands. I was dismayed.

This,  I hasten to add – was also the case for the other medical staff too – not just me!

The best hand washing in the world does not make hands sterile. The lightbox is a salient reminder. It is impossible, to ever remove all the micro-organisms from your hands, by washing. However, if we are all washing our hands correctly, this will give us the best chance of controlling a wide variety of infections, including COVID-19.

COVID-19 – the truth about preventing viral transmission.

The experience of the COVID-19 outbreak in China has been carefully studied. From this, scientists know that COVID-19 is spread person to person

Airborne spread by exhaled droplets – The most common way to become infected with COVID-19 is by inhaling droplets in the air, when an infected person breathes out, coughs or sneezes.  This is called aerosol transmission.

So you may be wondering if this is the case, how on earth does washing your hands prevent the spread of the virus?

Hand-to-hand transmission – Here’s the answer. The second most common way for the virus to enter your body is through your nose or mouth. And the virus gets into these orifices because, without being aware of it, you put it there, with your own, virus-contaminated hands.

How often are viruses found on peoples’ hands? – This is surprisingly common. For example, one study showed that 65% of people with a common cold caused by a rhinovirus, will have the virus present on their hands. 

If an infected person has a virus organism on their fingertip and they touch another person, for example by giving them a handshake, or a hug, they can pass the virus on. Once the virus has passed to the other person’s hands, they then unknowingly allow it to enter their body, simply by putting their fingers to their mouth or nose.

Did you know we unconsciously touch our faces many times during the day? A 2015 study of American medical students showed they touched their faces an average of 23 times an hour!  In 36% of these episodes, they were observed putting their hands in their mouths.

Let’s say you have the virus on your fingers, and you pour a cup of tea and pass the cup to your friend –  that’s all it takes for them now to be infected.

In fact, COVID-19 can be transmitted in this way, even if you don’t have any symptoms and don’t know you are infected. Once the virus infects you, it has an incubation period of up to 14 days, during which you may feel completely well, but you will be excreting virus which could infect other people.

The average person infected with COVID-19 will infect 2.5 other people during their period of illness.

COVID-19 survives on inanimate objects – COVID-19 survives outside the body for up to 9 days, and lives on inanimate objects such as worktops, door handles, kettles, mobile phones, and computer keyboards! Things we touch every day without even thinking.

It’s well known that people can acquire infections from touching these sorts of objects. For example, in one German study, a single door handle, exposed to an artificial virus, resulted in 14 people becoming infected from touching the same door handle!

How can we prevent transmission of COVID-19?

Self-isolation, Staying at Home, Distancing, and Keeping Hands Clean.

However, watching the news last weekend, it seems many people think self-isolation is just an opportunity not to go to work and have a holiday! 

Nothing could be further from the truth.

Hand washing and prevention of transmission of COVID-19?

Regular hand washing – keeping hands clean –  has huge benefits. There are numerous research studies to prove this.

The CDC: Hand Washing Clean Hands Saves Lives report states that regular hand washing reduces diarrhoeal illnesses by 23-40%, and respiratory illnesses, such as colds,  by 16-21%.

These may not seem large percentages but they represent a significant reduction in numbers of cases.

Hand washing and prevention of transmission of COVID-19?

Hand Washing instructions.

You can watch how to wash your hands properly on YouTube

However, here are some useful tips –

  • Use plain, non-medicated, soap and water. This has been shown to be an effective health measure. For example, an Indian study of hand washing in children showed that regular use of plain (not anti-bacterial) soap, reduced respiratory infections by 53%. 

The use of soap during hand washing is vital. This is because the virus has a fatty outer shell. Soap also consists of fat, and two interact, causing damage to the viral coating, and disabling the virus. Just washing with water does not have the same effect.

  • Rub vigorously to dislodge debris, grease, and dirt, creating foam or lather. Take care not to miss any areas. Do this for at least 20 seconds.
  • The areas most often missed out are the thumbs, the fingertips and between the fingers.  
  • Wash under your nails. The use of a nail brush is advised once a day. Keep your nails short. Keep the nail brush clean.
  • Don’t think because you have worn gloves you don’t need to wash your hands!
  • Then run your hands under the tap. Water does not need to be scalding hot – the water temperature is not so important.
  • Dry your hands on either a single-use paper towel or a clean towel, which you launder frequently.
  • Apply a moisturizer. 

Can you wash your hands too much?

Yes, you can wash your hands too often and I’ve probably been doing it all wrong for years!

If you repeatedly wash your hands, you remove the natural oils from the skin, and skin then loses water, your hands dry out and the skin becomes cracked.  It is then at increased risk from allergens, and organisms which may cause a secondary infection. This is called dermatitis.

The British Association of Dermatologists advise using emollients regularly after hand washing and throughout the day to keep skin well-hydrated, supple,  and to protect the barrier function of the skin. If the skin is very dry, apply the emollient and wear cotton gloves overnight.

Emollients can be obtained as creams, sprays, lotions, and ointments (oil-based). There is a huge variety. 

When to not wash your hands but use a sanitizing hand gel instead?

If your hands are not visibly dirty, you are advised to use a hand sanitizer instead. This should contain 62-71% alcohol. Take care to apply it all over the hands, exactly as if you were washing your hands.

When you purchase a hand sanitizer, remember that to be effective against COVID-19,  it must contain at least 62-71% ethanol (alcohol). Many advertised products contain no alcohol at all!

If you can’t find any hand sanitizer to purchase you can do it yourself.

Here’s a suggestion of how to do it –

‘Do it yourself ‘-  Hand Sanitizer.

Start by getting together what you will need.

Take care only to use ingredients for which you have no known allergies.

It’s important to make sure you have 2/3 isopropyl alcohol and 1/3 aloe vera gel. Too little alcohol it won’t work. Too much alcohol may irritate your skin. Adding too much aloe vera will dilute the alcohol. So, measure carefully.  

  • Isopropyl alcohol (this can be purchased from online retailers or pharmacies)
  • Aloe vera gel
  • A spray/liquid soap bottle
  • A mixing bowl
  • A measuring jug
  • A mixing spoon
  • A funnel
  • A few drops of an essential fragrant oil 

Method

  1. With clean hands, clean all the equipment first. 
  2. Pour 60 – 70  ml of isopropyl alcohol into the measuring jug, then pour into the bowl.
  3. Squeeze around 40 ml of aloe vera gel into the measuring jug, then add to the bowl.
  4. Mix vigorously with the spoons so it’s well blended.
  5. Add a few drops of your fragrant oil. 
  6. Insert the funnel into the spray/liquid soap bottle and pour in the mixture. Screw on the lid.
  7. Shake this vigorously to make sure it’s completely blended.

Final thoughts.

Hand washing is an essential part of modern life. Even after this COVID-19 pandemic is over, we must all continue to wash our hands frequently and thoroughly.

If there are any good things that result from this catastrophic outbreak, perhaps it will be this permanent improvement in our personal care and hygiene.

If we don’t continue to wash our hands, after all – there may be another pandemic just around the corner!

Sexual & Reproductive Healthcare Specialist & Freelance Healthcare Writer / Blogger.