Infection Prevention: The Role of Proper Hand Hygiene

Experts view hand washing as the single most important way to stop the transmission of disease from one person to another.

• By Lindsay Tippin
• Feb 01, 2015

In 1864, Ignaz Semmelweis, a Hungarian physician, became known as the father of infection control. He won this title when he demonstrated that proper and effective hand washing--using soap and warm water and vigorously washing hands for 15 to 20 seconds--could prevent the spread of disease and infections.

By now, it would seem that almost everyone should know about the necessity for proper hand washing, especially after using the restroom, yet 150 years later we are still trying to remind people of its importance. In fact, according to a study led by Carl Borchgrevink, an associate professor at Michigan State University's School of Hospitality and Business, and reported in USA Today in June 2013, "only 5 percent of people washed their hands enough to kill infection and illness causing germs after using the bathroom. To make matters worse, 33 percent of hand washers didn't use soap, and 10 percent skipped [hand washing] altogether."

This type of hand hygiene is simply not adequate, especially with flu and cold season right around the corner. While it may be overlooked because everyone has concerns about Ebola spreading around the world, the reality is that the flu virus or complications from it kill an estimated 36,000 people a year in the United States, according to the Centers for Disease Control and Prevention (CDC).

While there are many ways that Ebola, the flu, and other viruses are transmitted, very often these germs are spread when people touch mucus droplets from a contaminated person on a surface and then touch their own eyes, mouth, or nose before washing their hands, according to WebMD.com, based on information provided by the CDC. Some viruses, such as the flu, can live for several hours on surfaces such as cafeteria tables, doorknobs, and desks. This makes proper hand hygiene crucial.

The Hand Washing 'Lucky Seven'
Proper basic hand washing involves using soap and warm water to wash hands for about 20 seconds. Experts view hand washing as the single most important way to stop the transmission of disease from one person to another. While hand soaps may not kill all viruses and bacteria, thorough hand washing will decrease microorganisms, helping to keep them below infection thresholds.¹ The different methods and types of soaps are discussed below.

As to drying hands, many public health experts suggest that hands should be dried using paper towels, not electric hand dryers. This final step in the hand washing process helps ensure hands are more effectively cleaned. According to a report in the Halifax Courier, drying hands with paper towels has been shown to be more effective at removing bacteria and stopping the spread of contamination in several studies.²

On a day-to-day basis in the workplace, administrators should be sure that workers wash their hands at least seven times during the course of the workday. This is sometimes referred to as the "lucky seven," but luck really has nothing to do with it. Proper hand hygiene and taking steps to prevent the spread of disease cannot be left to luck; it requires the following specific actions:

1. Wash hands before starting work. Many microorganisms are brought into facilities on the hands of staff. Insist that all wash their hands before beginning their work.
2. Wash hands after contact with bodily fluids.
3. Wash hands after removal of gloves. Many industrial workers especially believe wearing gloves will protect them from contaminants. However, gloves often have imperfections, even minute openings that allow contaminants to come into contact with the skin. Further, many workers do not properly remove gloves after working. Because of this, workers should always wash their hands after removing gloves (see "Putting Gloves On and Taking Them Off Properly," below).
4. Workers should wash their hands after completing one work task in one area of a facility before moving on to another task in another area. Even after picking up debris off a desk or floor, workers should wash their hands.
5. Wash hands before eating, smoking, or preparing food. Microorganisms typically enter the body through the mouth; hand washing helps prevent this.
6. Wash hands after using the restroom.
7. Wash hands before leaving work. Just as microorganisms can be brought into the workplace, they can be taken home.

Experts also advise removing all hand and arm jewelry before washing hands and putting the items back on only once hands are thoroughly clean and dry.

Methods and Soaps
Not all hand washing methods and soaps are the same. Administrators should be aware of this and encourage--if not require--staff to adhere to the following hand washing types and guidelines as called for:

• For routine hand washing during the course of the work day, use a non-antibacterial hand soap (regular soap), which will remove most microorganisms if hands and fingers are washed in warm water for 15 to 20 seconds.
• For an antibacterial hand wash, use an antibacterial soap to remove or destroy most microorganisms. Wash in warm water for 15 to 20 seconds.
• An antiseptic hand wash is more thorough than an antibacterial hand wash; it requires an alcohol-based sanitizer. Wash in warm water for 2 or more minutes.
• A surgical antiseptic hand wash may not be necessary in a traditional work setting, but administrators should know this involves using an antibacterial soap and washing hands, fingers, and arms in warm water for 2 to 6 minutes.

Finally, administrators should encourage workers not to have long fingernails. Long fingernails can harbor more germs and bacteria than shorter nails because they are more difficult to clean. Also, some experts suggest that fingernails should not be polished, especially in work situations where the transfer of microorganisms is a key concern. Scratches or chips in nail polish can become home to germs and bacteria that are difficult to remove, endangering the health of the worker and others in the facility.

Putting Gloves On and Taking Them Off Properly
How to put gloves on:

• Make sure the gloves are the right size.
• Wash your hands. The goal is prevent the possible spread of contamination from hands to gloves.
• Starting with the left-hand glove, use your right hand to pull the glove up by the end--the part that will rest on your wrist--with two fingers over your left fingers.
• Still working on the left glove, use your right hand to pull the glove up by the end so that it fits comfortably over your hand to the wrist. Avoid touching the fingers of the glove with your bare fingers.
• Repeat the process with the right glove.

How to remove gloves:

• Grasp the outside edge of the left-hand glove at its highest point, near the wrist.
• Peel the glove off your hand, essentially turning the glove inside out.
• Leave the removed glove in the gloved right hand and discard.
• For the right-hand glove, slide your index finger under the glove at its highest point, near the wrist.
• Peel the glove off from the inside out and then discard.
• Wash hands using soap and water.

References
1. "Get the Facts on Hand Hygiene." Betco.com
2. "Paper Towels May Be More Hygienic than Air Dryers." Study conducted in June 2013 by Queensland University of Technology, Brisbane, Australia.

This article originally appeared in the February 2015 issue of Occupational Health & Safety.