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Many infectious diseases are spread by not washing hands.
Ensuring that hands are clean is essential to avoid acquiring and spreading infectious microorganisms to others such as family members, friends or contacts.
There are many sources of microorganisms.
Human or animal faeces is one source.
Microorganisms can get onto the hands after using the toilet, changing diapers or handling meats with animal faecal material.
A gramme of human faeces, which is about the weight of a paper clip, can contain one trillion microorganisms.
Other sources are objects that have microorganisms on them from coughs, sneezes or touches from other contaminated material.
When the microorganisms get onto the hands and are not washed off, this leads to the spread of human infections from one person to another caused by those microorganisms.
For example, microorganisms on the hands can get into the body when the eyes, nose and mouth are touched unconsciously.
Microorganisms on unwashed hands can get into food and drinks during its preparation and consumption.
Some microorganisms multiply in certain foods and drinks under certain conditions.
Microorganisms on common inanimate objects like table tops, door knobs, hand rails or toys, can be transferred to whoever touches the object(s).
In the healthcare setting, the spread of infections through unwashed hands can have more serious consequences.
Healthcare-associated infections (HAIs) are one of the most common adverse events.
Sepsis, hospital-acquired pneumonia and surgical site infections can all be prevented by improved hand hygiene.
Benefits of handwashing
Washing hands with soap and water prevents diseases and its spread to others in many ways.
There is evidence that handwashing in the community setting reduces the incidence of diarrhoeas by up to over 20%, particularly in those with impaired immunity (by about 60%), and respiratory infections by up to 20%.
The two major causes of global deaths in children below five years are diarrhoeal diseases and pneumonia.
There is evidence that handwashing with soap can protect one in every three children from diarrhoea and one in every five children from respiratory infections like pneumonia.
Although many people wash their hands with water, the usage of soap is much less, despite soap being more effective at the removal of microorganisms.
Antimicrobial resistance (AMR), which is increasing globally, is due to the overuse and unnecessary prescription of antibiotics.
Handwashing prevents infections, thereby helping to reduce antibiotic prescriptions, which is the single most effective factor in reducing the incidence of AMR.
Handwashing can also prevent infections from microorganisms that are already resistant to antibiotics, which are not easy to treat.
Hand hygiene involves handwashing with soap and water, or alternatively, the use of hand sanitisers containing at least 60% alcohol.
There is a strong economic case for hand hygiene.
Hand hygiene saves millions of lives annually when performed at the right times in healthcare.
Data from the Organisation for Economic Co-operation and Development (OECD) found that in 34 OECD and European Union/European Economic Area (EU/EEA) countries, an investment of US$1 (RM4.73) in improving hand hygiene in healthcare settings returns about US$24.60 (RM116.56) in economic returns (i.e. both in health expenditure and productivity gains in the broader economy).
According to the World Health Organization (WHO), “hand hygiene improvement programmes can prevent up to 50% of avoidable infections acquired during healthcare delivery and generate economic savings on average 16 times the cost of implementation”.
Keeping up the practice
World Hand Hygiene Day (WHHD) has been commemorated on May 5 since 2009.
Its theme for 2024 was “Promoting knowledge and capacity building of health and care workers through innovative and impactful training and education, on infection prevention and control, including hand hygiene”.
The objectives of WHHD 2024 were to:
- “Strengthen learning approaches to enable implementation of innovative and effective training to empower health and care workers to improve hand hygiene and IPC [infection prevention and control] at point of care with enhanced knowledge, skills and behaviours.
- “Promote access to innovative hand hygiene and IPC training resources for health and care workers.
- “Raise awareness about the importance of knowledge and learning on hand hygiene at the right times to prevent a range of infectious diseases.
- “Encourage measurement and evaluation mechanisms to assess the impact of training and education on IPC standards and practices, including hand hygiene, including their effect on the prevention of HAI and AMR”.
The Covid-19 pandemic underscored the crucial role of IPC, particularly hand hygiene, which was practised diligently by healthcare professionals (HCPs) and the public during that period.
However, since then, there is an impression that enthusiasm for hand hygiene has waned.
It is pertinent to note that the WHO is emphatic that: “Sharing knowledge about hand hygiene and IPC is still so important because it is ultimately a very effective way to stop the spread of harmful germs in healthcare”.
Remind one another
The message for HCPs is simple.
Hand hygiene protects the HCP and the recipient of care.
Hand hygiene can prevent the spread of microorganisms, including those with AMR.
Some HCPs may need to clean their hands countless times during work.
Keeping the hands clean and healthy is a challenge that requires all HCPs to be knowledgeable about how to care for their hands and when hands should be cleaned.
Sharing knowledge about hand hygiene with other HCPs, patients, their caregivers and the public is critical to ensure its acceptance and compliance.
The message for patients and their families, friends, colleagues and visitors is also straightforward.
Practise hand hygiene yourselves. including before eating, after using the restroom and after touching any surface in the healthcare facility.
Visitors should also adhere to any additional IPC measures like wearing an isolation gown made available by HCPs.
Ask the HCP if they washed their hands prior to entering the patient’s room and/or prior to and after touching the patient.
Stay safe with hand hygiene, which saves lives when performed at the right times, particularly in healthcare.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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