Hand washing techniques (The beginning of infection control)

Hand washing techniques (The beginning of infection control)

Hand washing techniques (The beginning of infection control)

Introduction

There are hundreds of thousands of bacteria that live on our hands. We keep on adding and removing them with our hand washing methods. We keep adding some from the things we handle, the greetings we get and many more. Most bacteria are harmless but gain entry to the body after a small weakness in our defence systems. If you imagine all the places you visited today, from your office to the washroom, you must have handled many things. By frequently washing your hands the right way you will wash away germs, i.e. bacteria and viruses. Improper hand washing techniques is one of the many ways we breach our immune defence systems. The skin is one of the body’s defence organs against such germs, by washing your hands; you are performing one of the single most important-infection prevention procedures.

What is hand washing?

Hand washing is the removal of dirt, germs or micro-organisms and other organic materials that may be present on the hands by using water.

Why do we wash hands?

By performing this procedure, we are able to remove about 99% of micro-organisms with simple soap, water and friction. This helps to reduce the rate of infection from person to person or patient to patient, patient to health worker. By reducing the rates of transmission of these organisms, we are able to directly influence the rates of infections and complications that arise.

When should we wash hands?

Basically your hands should be washed after you have performed every act or procedure, whether domestic or at the place of work. The most important times are after:

  • After blowing your nose or coughing/sneezing
  • After using toilet
  • Before handling food
  • After handling food
  • Before and after handling patients
  • After handling pets and other animals
  • Before and after procedures
  • Before changing a diaper
  • Before touching newborns (neonates) as their immunity is not well developed.
  • When physically dirty

What to use when washing hands

The three most important things you need are:

  • Water
  • Soap
  • Antiseptic solution

Water is responsible for removing and rinsing all dirt from the hands. Soap helps dissolve some of the particles and materials that cannot dissolve in water and the antiseptic soaps hep I killing the germs.

How to wash hands

The most important thing to remember is never to touch the tap with dirty hands, wash the hands than return to the tap with clean hands to close it. Basically you end up having done nothing. In most health institutions, the types of taps used are different from the taps at home for the purpose of minimizing the risk of transfer of infections. You may use a paper towel to open the tap and let it flow especially if your hands are completely dirty. After doing this;

  1. Wet hands with running water
  2. Apply soap and distribute it over the hands.
  3. Away from running water rub the palm, back of hands, between fingers, back of  fingers, thumbs, finger tips and wrist and remove debris from under the finger  nails if any.
  4. Do this for at least 20 seconds.
  5. Thoroughly rinse and dry your hands using disposable towels or hand dryer
  6. Close the tap to save on water.

The use of antibacterial / antiseptic soaps

What is an antibacterial soap?

Antibacterial soaps are agents used to clean with the aim of removing or killing bacteria that are logged in the skin, nails and hair. The soaps contain the following antibacterial agents:

  • Triclosan
  • polyhexamethylene biguanide
  • benzethonium chloride
  • farnesol

Any benefits antibacterial soaps?

Most antibacterial soaps come with ingredients in combination or as triclosan alone. There may be other kinds of antibacterial agents. Research done in the department of Surgery, Columbia College of Physicians and Surgeons, Columbia University, New York, New York showed that the combination of Triclosan, polyhexamethylene biguanide, and benzethonium chloride-TPB or farnesol polyhexamethylene biguanide, and benzethonium chloride-PB showed superior rapid and broad-spectrum reduction of risk of organisms developing resistance than do soaps containing triclosan alone. Hand washing with TPB and FPB soaps by healthcare workers and the general population may reduce the transmission of germs, with a lower risk of promoting the emergence of resistant organisms.

When are the antibacterial soaps effective?

A study was done in the Dial Corporation, Microbiology Department, in Scottsdale Rd., Scottsdale,  USA ( link Janice.Fuls@us.henkel.com ) and found that the antibacterial soaps effectiveness depend on the following

  • The compliance of the person using them. If used on an on and off basis, the effectiveness is reduced and the chance of bacterial resistance increased. This is because the bacteria get clever and develop mechanisms of resistance or eliminating the antibacterial agents from inside their cells
  • The soap volume. The higher the amount of soap volume the better. Less amounts are more or less ineffective in destroying the bacteria altogether
  • How much time do you spend washing? It has been studied and found that the more time spend (minimum of 15 seconds) significantly reduced the bacteria transmission.

Unacceptable hand washing methods

About the antibacterial soaps

Much has been written about the potential hazards versus benefits of antibacterial (biocide)-containing soaps. A study be the department of epidemiology university of Michigan, Ann Arbor concluded that soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%-0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria.

Please note the following

  • Triclosan is used in higher concentrations in hospitals and other clinical settings, and may be more effective at reducing illness and bacteria than the home setting
  • There are other soap ingredients that help fight bacteria such as savlon, peroxide hydrogen, povidone iodine or Betadine.
  • A combination of several drug ingredients is far much better than a single ingredient since it leads to faster bacterial resistance.
  • When using the soaps, allow at least 15 seconds or more wash time to be sure of the effectiveness
  • Most soaps contain only one type of ingredient ( always read the insert) and this becomes a problem when trying to reduce hand or skin bacteria
  • Not all that is seen in an advert may be true concerning eh effectiveness of some products. A lot of consumer knowledge and follow up is important

Based on the above details and research findings one should always ask him/herself; how long do I take to wash hands? Most of the time is after the dirt is gone or when the water that comes out of the hands is clear. These are practices that are not effective in removing bacteria and other organisms from the hands:

  • Not washing hands after every procedure
  • Irregular use of antibacterial soaps
  • Washing hands for less that accepted time. It is advised that you wash for at least 20 seconds
  • Using soaps that have not been medically tested and or registered as antiseptics
  • Using soaps that do not contains enough antibacterial ingredients
  • Reusing the water that is already contaminated
  • Using towels that are dirty and not frequently cleaned
  • Using wet towels to dry hands. Wet towels tend to adsorb dirt and accumulated more germs
  • Using the same towels for more than one purpose e.g. one towel for the washrooms being used in the kitchen