HANDWASHING: The Advanced Class

Author’s Note: Over the past week to ten days, I’ve put pen to paper (well, I am admittedly using a laptop keyboard) to write about the Corona Virus / COVID-19 more times than I care to admit.  Every time I walked away from the writing and took even the shortest pause, the information changed. It continues to change daily—even hourly.  So, rather than post an article which will be outdated by the time the “submit” button is hit, here’s some timely, relevant information on one of the easiest and most effective preventive measures.

As a respiratory therapy student, in the semester before we started our clinical rotations—where we’d encounter real patients in real settings for the first time—we were run through a series of classes on basic clinical skills.  These were essentially the things a person needed to know about patient care in the broad sense and included skills every person who provides healthcare needs to know.  The topics ranged from patient rights and confidentiality (decades before HIPAA) to experiencing death and dying to communicating with people of all ages. 

One topic that I remember a few of us laughing about prior to class was “handwashing.” The session was two hours long and I remember many years later that we students wondered what they’d talk about for that long.  It was even presented by multiple professors including a microbiology teacher, a physician specializing in infectious disease, and a nurse from the local hospital.  The class session, for the record, turned out to be fascinating as well as useful.  The fact that I remember the class session to this day is a good indication of how hard they hammered home the points they wanted to make. 

Turns out handwashing is one of the most basic, yet most important infection control strategies in any healthcare setting.  This practice is important in all aspects of patient care from surgeries to invasive and noninvasive medical procedures.  It is also important in community health situations such as clinics, pharmacies, home health, and home medical equipment instruction and assessment.  Cleaning your hands is a simple process that can have profound effects on preventing illness, disease, and even death. 

The class session talked about “nosocomial infections,” which are basically hospital acquired infections.  In other words, these are illnesses a patient picks up while in the hospital for something else.  We were taught about immunocompromised patients and their higher propensity to pick up infections.  We were taught about different types of patient isolation in facilities and at home.  And we were taught about infection control procedures that were used to combat the spread of germs, and the associated health issues such as infections and illness that came with them. 

Handwashing, it turns out, is straightforward and simple.  However, there are some basic concepts to understand in order to realize how to wash your hands properly. 

The Centers for Disease Control (CDC) talks about handwashing and describes it in five steps:

• WET hands with clean running water. Warm water is very good, but cold water works as well. 
• LATHER. This is the act of rubbing soap onto the hands. Be sure to get soap between fingers, on the back of the hands, and under the fingernails. 
• SCRUB at least 20 seconds. CDC says if you have to time it, simply hum the “Happy Birthday to You” song twice. 
• RINSE using clean running water.
• DRY using a clean towel (or air dry).

Good, old fashioned soap is the most effective.  Brand is unimportant.  Perfumes and lathering agents aren’t what makes it effective.  Nothing beats plain soap.  

So, what about those hand sanitizers that have come along in the last twenty years?  Well, they weren’t around when I went to my class on handwashing.  But it turns out there is some science associated with them now.  Hand sanitizers are NOT as good as soap and water.  However, in situations where soap and water are not available, it is a good, viable alternative.  If you are using a hand sanitizer, keep the following facts in mind:

• To be effective, the hand sanitizer should be at least 60% alcohol. You can check this on the label.  If it isn’t clearly marked on the front label, look at the ingredients.  (Alcohol is often listed as “ETOH” in ingredient lists).
• Remember that it doesn’t kill all germs, nor does it remove some chemicals such as pesticides.
• It is less effective on hands that have grease or heavy dirt on them.
• To be most effective, rub your hands together with the sanitizer for at least 20 seconds.
• When you get to a place where there is soap and water, wash your hands the old-fashioned way.

Hopefully, this information is helpful in this era of COVID-19.  Remember, though, that this is an important practice in your every day work.  Universal precautions, infection control procedures, and the importance of good handwashing technique have always been important for all of us in healthcare and they always will be. 

Be sure to watch for updates on COVID-19 from legitimate sources such as the CDC and CMS.  As an industry, let’s stay safe out there as we continue to do what we do best: Take care of patients and provide the best-possible, high-quality medical equipment and supply services.