Happy #GlobalHandwashingDay on October 15!
Do you know what pathogens use as their most common mode of transmission? Yup...our HANDS. Hand-washing may be the most simple and accessible way to prevent disease from spreading. A recent study showed that hand washing was significantly correlated with reduction in infections. Especially as pandemic concerns peaked this year, handwashing was highlighted once more as the incredibly effective preventative measure it has always been. Correct methods as well as having a well-designed “sanitation station” can help both you and your loved ones avoid infection and stay healthy, especially as we head into a season when viruses can peak (1,2).
The following quote comes directly from a recent study on hand-washing in the time of COVID-19, though I have formatted certain parts of the text in bold to add emphasis (1):
“washing hands thoroughly with soap and water is the most effective method for decreasing transmission of infection...proper handwashing reduces acute respiratory illnesses in the general population by at least 20%....research suggests individuals with COVID‐19 may spread the virus even without showing any symptoms ...handwashing is important even after interacting with people who are symptom‐free.”
How to properly wash your hands
Use water AND soap.
Vigorously scrub all areas of the hands (including palms, tops, between your fingers, under your fingernails, etc.).
A brush designed for handwashing may be helpful in removing dirt from underneath fingernails and crevices.
Wash for at least 20 seconds. (This is often the length of the chorus of a song, or the length of a short tune such as “Happy Birthday” or “The ABC’s -- although this article has plenty of ideas, including Beyonce hits to hum while you wash).
Be sure to moisturize your hands with lotions created of clean products. Don’t know if your products are clean? You can explore the EWG Skin Deep database or Think Dirty App to learn more about potential products, or ones you already use. Products made with wholesome ingredients are less likely to irritate or dry your hands out in the long-run. Inflamed hands are more prone to infection, and as we discussed before, infection can quickly lead to illness (1).
How effective is hand sanitizer?
Hand sanitizers that are alcohol-based can be used if soap and water are not available. However, hand-washing with soap and water is a more effective method in protecting against pathogens and the infections they could cause (1). A recent study found that 74% of patients preferred an easy-access sanitizing towelette to other forms of hand-sanitation. Mealtime hygiene improved in the study when reminders were given before eating and combined with the easy-access method of sanitation(3).
Currently, effective hand sanitizer products are alcohol-based formulas that contain 62-95% of alcohol. Alcohol contents of this level denature the proteins that make up the microbe, which essentially allows for the ability to inactivate the virus (4). You can locate the alcohol amount by finding the “Drug Facts” section of a hand sanitizer label, which I have indicated in the image below:
Setting up your own Sanitation Station
Determine your needs
Depending on your job, risk of exposure, or other factors, your home sanitation system may differ. For example, if you work from home and have minimal contact with people day-to-day, a tray or basket next to the kitchen sink may be sufficient to cleanse and sanitize properly. However, if you work in healthcare or in direct contact with COVID-19 units, a portable car cleansing station may be necessary. You could also consider making a sanitizing area towards a bathroom or mudroom away from the main areas (and especially cooking areas) of the home. You can trust that companies and organizations are doing the best they can to respond to the risks of infection and disease, however, it can be helpful to evaluate your needs and your families needs and set up an extra measure of protection and precaution in your home. Again, be cautious but not fearful. Do what you can to understand the risks, but make decisions based in confidence that you can protect yourself and your loved ones by intentionally making small but significant choices that help add a layer of protection against infection.
Decide on a Location
Pick a logical location, usually in close proximity to a sink or somewhere where there is ample space to set up a moveable cart. Think about your needs and the purpose this station will serve. It may make sense to set up a small station complete with disposable masks in your car, another by the front or back door, one in the guest bathroom, and one in the kitchen if those are areas where having easy, accessible stations could improve hand hygiene. Think about potential pathways where your hands come in contact with the outside world and then could track germs in. Set up your station to be a barrier and protection against outside threats to your inside world.
Pick a method of containment
A sanitation station can differ. Think of your designated space and what might work. Remember-- it needs to be easy to access and help in the process of sanitizing your space. It also needs to be set up in a way that flow with proper hygiene. For example, many bathrooms have hand sanitizer dispensers by the door since germs may be on the handle of the door. The dispensers allow for an extra measure of cleanliness since your recently washed hands may come in contact with the dirty door handle.
Keep items needed often clearly labeled and on the most easy-to-access shelf. Back-stock (extra or related items that don't have an immediate use) or other items can be stored on shelves further away, or even in another location until needed. Many items work well as methods of containment, including:
Bar carts
Trays
Hooks
Baskets
Signs before symptoms
Display a visual reminder to wash your hands. Signs aren’t just cute -- studies show visual reminders can increase handwashing by up to 15% (5). The following signs were created for the United Nations Covid-19 Response and are great options to hang up in your home.
You are also welcome to use something you already have on hand, like a letterboard, to create a visual reminder. The important thing is that some aspect of your station catches your attention enough to make proper hand-washing a habit.
Items to include
Just like people, every sanitation station will be different. Don’t be afraid to customize yours according to your wants and needs! For example, I love artisan soaps and the smell of lavender always calms me down. I like to include lavender scented sanitizers and soaps in my hygiene routine to add a level of comfort after a crazy, busy day. I also prefer disposable masks to cloth ones because my skin is prone to inflammation, and my acne worsens when I wear cloth masks beyond one use. Find what works for you, and customize your sanitation station accordingly.
You can explore the EWG Skin Deep database or Think Dirty App to learn more about cleaning and sanitizing products. Potential items to include in your sanitation station:
Clean water
Soap
Lotion
Disposable or reusable gloves
Masks (disposable and/or cloth)
Bins labeled for freshly cleaned items
Bin for dirty items that need to be laundered
Signs or visual reminders about hand-washing and hygiene
Tissues
Mini tissue packs
Antibacterial wipes
Hand sanitizing wipes or spray
Hand washing and food washing references/guides (this one I consulted on for Kim Braly Nutrition is very helpful!)
Hand sanitizer
Mini/attachable hand sanitizers for children’s backpacks, purses, etc.
Lotion or moisturizer to protect skin
These, of course, are just ideas. Please adjust them as necessary according to what works for you and your home. The most important aspect is that you set something up that has the power to protect you and your loved ones.
How to teach hand hygiene for children
Make sure products for hand-washing are as accessible as possible. For example, stools and clearly labeled products can help children reach the sink and use the right protection when taking preventative measures. Modeling hand washing, emphasizing good technique, creating catchy tunes, and explaining why we wash our hands are all ways to help children better understand the significance and meaning behind why hand hygiene is so important (1).
How to promote hand hygiene in public places
Promotion of hand hygiene in public places can lead to greater availability of resources, such as water and soap. One study found that as many as 25% of infant deaths can be attributed to infections, and that mothers who practice proper handwashing with soap may be able to prevent neonatal sepsis, which is a type of infant infection (6). Hospitals and high-traffic areas are especially prone to risk of infection. Those in leadership positions can do their part to put policies, procedures, and emergency plans in place. In turn, patrons of these places can respect the guidelines and do their part to minimize the risk of infection.
f you are on a council or committee with public leadership, consider speaking up about hand hygiene. The following ideas are ways to adjust or improve your current plan to incorporate safer hand hygiene in public areas (7):
Evaluate the location of sinks, soaps, products, and other hand-washing equipment. Are these things accessible and easy to use?
What impact does the current hand-washing facility have on the environment? For example, consider switching to hand dryers instead of using paper products. You can also invest in smart technology that is motion activated. This allows for less waste and more effective product use over time.
Model good hand hygiene yourself!
Place public sinks or sanitizing stations in your community.
Place posters or other visual reminders in areas that are easily seen and can prompt hand-washing among patients, employees, or others.
Wash On
Hand-washing has been, and will continue to be, an integral part of human and food safety. It's vitally important to integrate a well-designed and accessible sanitizing area into our spaces and ultimately our public places to lower the risk of disease and infection, especially to vulnerable populations. What can you do to help in the hand hygiene effort? What is one thing you can commit to today to improve and protect your health?
References
Jess, R.L. and Dozier, C.L. (2020), Increasing handwashing in young children: A brief review. Jnl of Applied Behav Analysis, 53: 1219-1224. doi:10.1002/jaba.732
Stacy Haverstick, Cara Goodrich, Regi Freeman, Shandra James, Rajkiran Kullar, Melissa Ahrens; Patients’ Hand Washing and Reducing Hospital-Acquired Infection. Crit Care Nurse 1 June 2017; 37 (3): e1–e8. doi: https://doi.org/10.4037/ccn2017694
Rai H, Knighton S, Zabarsky TF, Donskey CJ. Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene. American Journal of Infection Control. 2017:45(9);1033-1034. https://doi.org/10.1016/j.ajic.2017.03.018.
Jing JLJ, Pei Yi T, Bose RJC, McCarthy JR, Tharmalingam N, Madheswaran T. Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations. International Journal of Environmental Research and Public Health. 2020; 17(9):3326.
Blackwell, Calvin and Goya-Tocchetto, Daniela and Sturman, Zachary, Nudges in the Restroom: How Hand-Washing Can Be Impacted by Environmental Cues (July 24, 2017). Available at SSRN: https://ssrn.com/abstract=3007866 or http://dx.doi.org/10.2139/ssrn.3007866
Ram PK, Nasreen S, Kamm K, Allen J, Kumar S, et al. Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal Period: Findings from a Randomized Controlled Trial in Rural Bangladesh. Hindawi, BioMed Research International. 2017. https://doi.org/10.1155/2017/6081470
Bezerra, TB, Valim, MD, Bortolini, J, Ribeiro, RP, Marcon, SR, Moura, MEB. Adherence to hand hygiene in critical sectors: Can we go on like this?. J Clin Nurs. 2020; 29: 2691– 2698. https://doi.org/10.1111/jocn.15293