What's the Best Way to Wash Hands?

Here's how to scrub those germs away. Teach this to your kids — or better yet, wash your hands
together often so they learn how important this good habit is:
1. Wet your hands with clean, running water (warm or cold). Make sure the water isn't too
hot for little hands.
2. Use soap and lather up for about 20 seconds. Antibacterial soap isn't a must — any soap
will do.
3. Make sure you get in between your fingers, on the backs of hands, and under the nails
where germs like to hang out. And don't forget the wrists!
4. Rinse and dry well with a clean towel.
When Should We Wash Our Hands?
To stop the spread of germs in your family, make regular hand washing a rule for everyone. It's
especially important:
 before eating and cooking
 after using the bathroom
 after cleaning around the house
 after touching animals, including family pets
 before and after visiting or taking care of any sick friends or relatives
 after blowing one's nose, coughing, or sneezing
 after being outside (playing, gardening, walking the dog, etc.)
How Do Clean Hands Help Health?
Good hand washing is the first line of defense against the spread of many illnesses — from the
common cold to more serious infections, such as meningitis, bronchiolitis, the flu, hepatitis A,
and many types of diarrhea.
How Do Germs Spread?
Germs can spread many ways, including:
 touching dirty hands
 changing dirty diapers
 through contaminated water and food
 through droplets in the air released during a cough or sneeze
 on contaminated surfaces
 through contact with a sick person's body fluids
When kids come into contact with germs, they can become infected just by touching their eyes,
nose, or mouth. And once they're infected, it's usually just a matter of time before the whole
family comes down with the same illness.
So don't underestimate the power of hand washing! The time you spend at the sink could save
you trips to the doctor's office.

Show Me the Science - Why Wash Your Hands?

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Keeping hands clean is one of the most important steps we can take to avoid getting sick and
spreading germs to others. Many diseases and conditions are spread by not washing hands with
soap and clean, running water.

How germs get onto hands and make people sick

Feces (poop) from people or animals is an important source of germs like Salmonella, E. coli
O157, and norovirus that cause diarrhea, and it can spread some respiratory infections like
adenovirus and hand-foot-mouth disease. These kinds of germs can get onto hands after people
use the toilet or change a diaper, but also in less obvious ways, like after handling raw meats that
have invisible amounts of animal poop on them. A single gram of human feces—which is about
the weight of a paper clip—can contain one trillion germs 1. Germs can also get onto hands if
people touch any object that has germs on it because someone coughed or sneezed on it or was
touched by some other contaminated object. When these germs get onto hands and are not
washed off, they can be passed from person to person and make people sick.
Washing hands prevents illnesses and spread of infections to others

Handwashing with soap removes germs from hands. This helps prevent infections because:

 People frequently touch their eyes, nose, and mouth without even realizing it. Germs
can get into the body through the eyes, nose and mouth and make us sick.
 Germs from unwashed hands can get into foods and drinks while people prepare or
consume them. Germs can multiply in some types of foods or drinks, under certain
conditions, and make people sick.
 Germs from unwashed hands can be transferred to other objects, like handrails, table
tops, or toys, and then transferred to another person’s hands.
 Removing germs through handwashing therefore helps prevent diarrhea and respiratory
infections and may even help prevent skin and eye infections.

Teaching people about handwashing helps them and their communities stay healthy.
Handwashing education in the community:

 Reduces the number of people who get sick with diarrhea by 23-40% 2, 3, 6
 Reduces diarrheal illness in people with weakened immune systems by 58%  4
 Reduces respiratory illnesses, like colds, in the general population by 16-21% 3, 5
 Reduces absenteeism due to gastrointestinal illness in schoolchildren by 29-57% 7

Not washing hands harms children around the world

About 1.8 million children under the age of 5 die each year from diarrheal diseases and
pneumonia, the top two killers of young children around the
world 8.

 Handwashing with soap could protect about 1 out of every 3 young children who get
sick with diarrhea 2, 3 and almost 1 out of 5 young children with respiratory infections
like pneumonia 3, 5.
 Although people around the world clean their hands with water, very few use soap to
wash their hands. Washing hands with soap removes germs much more effectively 9.
 Handwashing education and access to soap in schools can help improve attendance 10, 11,
12
.
 Good handwashing early in life may help improve child development in some settings 13.
 Estimated global rates of handwashing after using the toilet are only 19% 6.

Handwashing helps battle the rise in antibiotic resistance

Preventing sickness reduces the amount of antibiotics people use and the likelihood that
antibiotic resistance will develop. Handwashing can prevent about 30% of diarrhea-related
sicknesses and about 20% of respiratory infections (e.g., colds) 2, 5. Antibiotics often are
prescribed unnecessarily for these health issues 14. Reducing the number of these infections by
washing hands frequently helps prevent the overuse of antibiotics—the single most important
factor leading to antibiotic resistance around the world. Handwashing can also prevent people
from getting sick with germs that are already resistant to antibiotics and that can be difficult to
treat.

Wash Your Hands Often to Stay Healthy

You can help yourself and others stay healthy by washing your hands often, especially during
these key times when you are likely to get and spread germs:

 Before, during, and after preparing food

 Before eating food
 Before and after caring for someone who is sick
  Before and after treating a cut or wound
 After blowing your nose, coughing, or sneezing
 After using the toilet
 After changing diapers or cleaning up a child who has used the toilet
 After touching an animal, animal feed, or animal waste
 After touching garbage.

Follow Five Steps to Wash Your Hands the Right Way

Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of
germs. Clean hands can stop germs from spreading from one person to another and throughout
an entire community—from your home and workplace to childcare facilities and hospitals.

Follow these five steps every time.

 Wet your hands with clean, running water (warm or cold), turn off the tap, and apply
soap.
 Lather your hands by rubbing them together with the soap. Lather the backs of your
hands, between your fingers, and under your nails.
 Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song
from beginning to end twice.
 Rinse your hands well under clean, running water.
 Dry your hands using a clean towel or air dry them.

Why? Read the science behind the recommendations.

Use Hand Sanitizer Only When You Can’t Use Soap and Water

Washing hands with soap and water is the best way to get rid of germs in most situations.  You
can use an alcohol-based hand sanitizer Cdc-pdf[423 KB] that contains at least 60% alcohol if
soap and water are not available. You can tell if the sanitizer contains at least 60% alcohol by
looking at the product label.

You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water
are not available.

Remember these key facts about alcohol-based hand sanitizers.

 Sanitizers can quickly reduce the number of germs on hands in some situations.
 Sanitizers do not get rid of all types of germs.
 Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
  Hand sanitizers might not remove harmful chemicals from hands like pesticides and
heavy metals.
 Be cautious when using hand sanitizers around children. Swallowing alcohol-based hand
sanitizers can cause alcohol poisoning if more than a couple mouthfuls is swallowed.

How to Use Hand Sanitizer

 Apply the gel to the palm of one hand (read the label to learn the correct amount).
 Rub your hands together.
 Rub the gel over all surfaces of your hands and fingers until your hands are dry.

In the healthcare setting, handwashing is often cited as the primary weapon in the infection
control arsenal. The purpose of handwashing in the healthcare setting is microbial reduction in
an effort to decrease the risk of nosocomial infections.

Hand hygiene can also be a problem in busy health centers and clinics where patients are seen
both in increasing numbers and treated in rapid succession.1 Prevention and control of infectious
activities are designed to limit the spread of infection and provide a safe environment for all
patients, regardless of the setting.2 In light of the emergence of antibiotic resistant organisms,
effective infection control measures, such as handwashing, are essential to prevention.

At a recent Global Consensus Conference, participants were charged with the overall purpose of
achieving consensus on infection control practice across healthcare settings and international
boundaries related to caring for patients with methicillin-resistant Staphylococcus aureus
(MRSA) and vancomycin-resistant Enterococci (VRE). The conference provided a major
opportunity for professionals and scientists in the infection and prevention control field to
discuss trends and develop strategies for best practice. The aim was to examine the infection
control problems associated with these antibiotic-resistant organisms (AROs) and to consider
possible solutions.3 One estimate places the direct cost of nosocomial infections caused by six
different strains of AROs to be minimally $1.3 billion (1992 dollars)/year in the US.4 According
to the Center for Disease Control and Prevention (CDC), each year an alarming 2,400,000+
nosocomial infections occur in the US alone. They are estimated to cause directly 30,000 deaths
and contribute to another 70,000 deaths each year. Nosocomial infections cost over $2,300 per
incident and $4.5 billion annually in extended care and treatment.

The goal of the Global Consensus Conference was to focus on specific issues that come under
the direct influence of infection control professionals. Among the issues of focus was hand
hygiene. Participants in the conference started with the premise that the ultimate goal of
cleansing the skin of care providers, regardless of specific product used, is to prevent the
transmission of infection, including AROs, from their hands. Skin workshop final
recommendations included:

1. Hand hygiene is the single most important procedure for preventing the transmission of AROs.

2. Evidence suggests that the removal of AROs from hands with soap/detergent and water is less
effective than with the application of an antiseptic agent.

3. An antiseptic product shall be used in high-risk areas, with high-risk patients, and with known
ARO patients. High risk areas may include:

 Intensive care units

 Transplant units
 Burn units
 Hematology/oncology units
  Hemodialysis units
 Patients at risk were identified as those:

--Receiving multiple antibiotics or repeated treatments

--With prolonged hospital stay

--With frequent admissions

4. High-risk areas and high-risk patients shall be identified by regular assessment.

5. Risk assessment for acquisition/transmission of AROs may include patient surveillance

cultures.

6. In the absence of sufficient handwashing facilities and where there is no visible soil on the
hands, an antiseptic product formulated for use without water shall be used. In the absence of
sufficient or adequate handwashing facilities where there is visible soil on the hands, soil must
first be removed by some means (e.g., rinsing, mechanical, rubbing, and wipes) before use of an
antiseptic product formulated for use without water.3

The CDC has identified handwashing as the single most important means of preventing the
spread of infection.5 The premise of the handwashing CDC guideline is infection control. The
CDC recommendations for handwashing are as follows:

Handwashing Indications

In the absence of a true emergency, personnel should always wash their hands:

1) Before performing invasive procedures (Category I).

2) Before taking care of particularly susceptible patients, such as those who are severely
immunocompromised and newborns (Category I).

3) Before and after touching wounds, whether surgical, traumatic, or associated with an invasive
device (Category I).

4) After situations during which microbial contamination of hands is likely to occur, especially
those involving contact with mucous membranes, blood or body fluids, and secretions or
excretions (Category I).

5) After touching inanimate sources that are likely to be contaminated with virulent or
epidemiologically important microorganisms; these sources include urine-measuring devices or
secretion collecting apparatuses (Category I).

6) After taking care of an infected patient or one who is likely to be colonized with
microorganisms of special clinical or epidemiologic significance, for example multiple-resistant
bacteria (Category I).

7) Between contacts with different patients in high-risk units (Category I).

Handwashing Technique

For routine handwashing, a vigorous rubbing together of all surfaces of lathered hands for at
least 10 seconds, followed by thorough rinsing under a stream of water is recommended
(Category I).
The aim of handwashing is to remove microorganisms from the hands, preventing their potential
transfer. It is known that organisms survive and multiply on human hands, creating the
opportunity to infect others or the host.6 Handwashing reduces the number of transient organisms
on the skin surface. Although hands cannot be sterilized, most transient organisms can be
removed by 30 seconds of proper scrubbing with soap and water. Proper scrubbing would
include vigorous motion with the hands rubbing together and fingers working in between the
finger web space and inclusive of the dorsal and ventral surfaces of the hands. Microbes that
reside in sweat ducts and hair follicles of the skin, however, cannot be dislodged readily. Surveys
show that one in five medical professionals carry potentially pathogenic antibiotic-resistant
pathogens on his or her hands. Handwashing by medical professionals occurs at only 30% of the
ideal rate. Failure to wash one's hands before and after each patient contact is probably the most
important contributor to the spread of infections.7 These microbes pose a threat to patients with
reduced defenses, so scrubbing with an antiseptic prior to contact with these patients is usually
recommended.

In one study, hospital-acquired infections were reduced 25% by handwashing with soap plus
antiseptic compared to a control group who washed with soap alone.7 The absolute indications
for handwashing with plain soaps and detergents versus handwashing with antimicrobial-
containing products are not known because of the lack of well- controlled studies comparing
infection rates when such products are used.5

The effects of handwashing in the prevention of disease transmission from person to person are
undeniable; however, the goal of effective compliance remains unmet.

Education and training of staff has been a central focus of infection control programs with
marginal impact. Compliance testing devices may spark awareness in the healthcare work force.
The effects of verification and feedback as a mechanism for increasing the probability of
handwashing in the clinical setting appear to be quite dramatic. Compliance Control Center
(Forestville, Md) conducted a study with the intent to measure the impact of individual
measurement and verification of overall handwashing compliance. At each location, each
individual employee for whom handwashing was deemed critical to the prevention of infection
and cross contamination either chose or was assigned an individual and unique verification
number to be used with the Compliance Control electronic handwashing verification system
(e.g., HyGenius) throughout the study. In each of the locations, despite the fact that both
supervisors and employees expressed that they believed they were doing a good job of
handwashing, in actuality, observed handwashing frequency was low during the observation
period. The overall average was 68 handwashing events per location per week, which resulted in
an average of less than one handwash per day per employee.

During the next phase or pre-reporting phase, a time in which the electronic devices were
installed, handwashing frequency increased by an average of 214% going from 68 in the
assessment phase to 213.63% in the pre-reporting phase. The results were likely due to the fact
that a means for handwashing measurement requiring individual employee self-identification
was introduced at each site. For a period of 35 weeks, a sustained average of 603 handwashes per
week was performed in the study locations. On average, through the conclusion of the reporting
period, there was an 890% handwashing rate increase over the initial observation period
measurements. This study indicates that reinforcement and regular performance feedback using
empirical data significantly improves handwashing compliance.8

While the healthcare worker may have the convincing data or argument for handwashing as an
infection control preventive activity, handwashing remains an activity of self-monitoring.
Barriers to effective monitoring may be related to education, level of awareness, the
development of an aseptic conscience, lack of motivation, lack of facilities such as access to
sinks, soap, antibacterial detergents, time, etc. If one accepts handwashing as the primary
weapon in the infection control arsenal, then personal choice for handwashing rests with the
individual foot soldier in the battle against the transmission of infection or disease.