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Practicing thorough hand hygiene is key to avoiding the virus

Frequent and thorough hand washing with soap and water is one of the best ways to prevent the spread of infectious

diseases, including COVID-19. Like a cold, coronaviruses are spread through droplets from a person coughing or

sneezing and potentially via contaminated surfaces. Good hygiene is key to avoiding spreading it – or catching it.

However, whereas hand washing has been part of the medical belief system for decades and promoted extensively by the World Health Organization (WHO), it is surprising how many people have not made it a regular habit. During 2020 with the rapid spread of the novel coronavirus around the globe, hand washing enjoys a newfound awareness. Now politicians are stressing the importance of hand washing as a key to preventing coronavirus infection and celebrities are talking about it. New memes show up on social media platforms and television programmes that are dedicated to what was once regarded as a menial task rather than what it should be – a habit.

While awareness of the importance of thorough hand hygiene has grown with the onset of the COVID-19 pandemic, many healthcare facilities and communities are struggling to offer adequate access to hand-hygiene facilities. For public and private healthcare facilities, the WHO recommends strengthening multimodal hand-hygiene improvement programmes by providing refresher hand-hygiene training, and giving reminders and communications on the importance of hand hygiene in preventing the spread of the COVID-19 virus. Functional hand-hygiene stations should be available to all healthcare workers at all points of care, in areas where personal protective equipment is put on or taken off, and where healthcare waste is handled. In addition, functional hand-hygiene stations should be available for all patients, family members, and visitors, and within 5 m of toilets, as well as at entrances and exits, in waiting and dining rooms, and other public places.

According to the WHO, all public buildings, including schools, healthcare facilities, and offices, should have handhygiene stations placed at their entrances. The WHO argues that practising thorough hand hygiene – using either soap and water or alcohol-based hand rubs – can interrupt the transmission of COVID-19 and other viruses and bacteria to keep people safe from infection.

Soap and water versus alcohol-based hand rub

Hand washing’s effectiveness to wash away viruses and other microorganisms emanates from a complete process: this is the use of soap, water, and friction. The soap is present to break down the oils on our skin, and to lift and remove ‘soil’ (dirt, dead skin debris, bacteria, viruses and oils). Water allows for the action of the soap, wetting the product and then washing the product (and soil) from our hands to a drain. Friction is a required component of hand washing, and refers to the whole rubbing and thorough rinsing process that has to be performed for at least 20 seconds. All surfaces of the skin on the hands, nails, wrists and cuticles must receive friction to remove the soil load. Drying with a paper towel also helps the effectiveness of the process. It must be noted that the removal of the skin’s natural oils can lead to skin dryness, and if frequent hand washing is expected, then a moisturising or reconditioning cream or lotion should be applied after each wash episode to help protect the skin. Damaged skin from frequent hand washing can lead to poor hand washing. The lotion helps keep skin healthy and allows for hand washing to be effective.

The use of alcohol-based hand rub (ABHR) is only appropriate on visibly clean hands: any sign of soiling (respiratory secretions, environmental ‘dirt’, black of newsprint, soil) requires hand washing. ABHR only kills microorganisms on our hands (if we get an exposure to the product of at least 20 seconds), it does not ‘remove’ anything and requires friction to all surfaces of the hands and nails to increase the effect of the alcohol.

Which to use?

Hand washing with soap and water remains the most effective prevention measure, together with other precautions or good hygiene practices that reduce the infection risk. If we cough or sneeze, even using a tissue, our hands can be exposed to respiratory secretions – soil – and we need to wash our hands. If we wear gloves to protect our hands (work gloves, medical grade gloves) and our hands show evidence of the gloves when they are removed (lint, debris, powder) we need to wash our hands. Many people are self-quarantining, staying or working from home, and have readily available handwashing facilities. Washing our hands in these circumstances is effective, and in this period of higher than usual demand, it leaves ABHR available for distribution among healthcare facilities. There are certain occasions where professionals or the general public will require ABHR. For instance, if we have to travel on public transport systems where there is no hand washing available, these members of the public will want to have ABHR available while in transit; once at their destination there should be readily available sinks for hand washing.

Front-line healthcare workers have contact with many surfaces (and patients)

that may harbour microorganisms in smaller numbers. Their hands will appear visually clean and they will use ABHR frequently to kill microorganisms on their hands. For this specific group, who is focused on saving lives, among others, time is of the essence. Also, since the use of ABHR doesn’t require water and can be performed on the go, it’s proven to be more effective, accessible and quicker-to-perform than hand washing

(when hands are visibly clean). Because of all those reasons, ABHR needs to be available in healthcare settings including hospitals, assessment clinics and medical clinics.

Prioritising for the distribution of ABHR should focus on these settings. Personal use of ABHR during a pandemic, when sinks and soap are readily available, should be limited so that ABHR stocks can be directed to healthcare settings.

Best practice hand-hygiene tips

Wash hands regularly using soap and water for at least 20 seconds Increase hand hygiene by using alcohol-based hand rubs or alternatively high-efficacy hand sanitisers Check the label on alcohol-based rubs to ensure that you are using the appropriate amount Place tissues in the waste bin immediately after use Increase the frequency of cleaning high-touchpoint surfaces including door handles and workstations and in washrooms and kitchen areas Cleaners should use gloves to protect themselves from the repeated use of harsh chemicals. Dispose of gloves regularly to avoid any contamination Keep front-line cleaners safe with face masks and thorough, ongoing hand-hygiene education

Germs are no match for good, old-fashioned soap, and here’s the science behind it

“Soap works better than alcohol, sanitisers or disinfectants to destroy viruses because soap contains fat-like molecules known as amphiphiles. Some amphiphile molecules are structurally similar to the fatty membrane that holds a virus together. These similarities make the soap amphiphiles compete with the fat molecules in the virus membrane. This dissolves the membrane holding the virus together, causing the virus to fall apart and become inactive,” says Initial South Africa’s Nathalie Leblond.

Alcohol-based products also dissolve the virus’ fatty membrane, but not as effectively as soap. A fairly high concentration (60% plus) of alcohol is needed to get a rapid dissolution of the virus. Alcohol-based products are an excellent alternative when soap is not available, but should never replace effective handwashing and drying practices.

Initial is a specialist provider of the correct soap for specific requirements (food safe, antibacterial or regular) for use in their award-winning Signature range of dispensers that feature silverion antibacterial technology to further enhance good hand hygiene.

Initial also stresses that while you can’t beat the science of soap, you need to take adequate precautions to ensure that hands are dried properly after washing, as research has shown that damp hands spread 1 000 times more germs than dry hands*.

The options available to dry hands in a workplace washroom are usually limited to paper towels or hand dryers and have changed very little in the past 100 years. Paper towels date back to 1907, and the first electric hand dryer was patented in 1922. Science has tried – and failed – to come to a consensus about the hygienic

superiority of paper vs dryers. Several studies (nearly all funded by paper companies) claim that warm air dryers turn bathrooms into a breeding ground for bacteria, but the WHO seemingly doesn’t agree, stating that “once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer.”

With specific treatments or a vaccine not yet available, preventing the spread of COVID-19 from person to person is vital to reduce the outbreak’s impact on people’s lives, health, livelihoods and the healthcare systems we all rely on. Therefore, hand hygiene has never been more important than now as a primary factor in the war to combat the rapid spread of the coronavirus.

Sources:

Who.int, Diversey.com, Initial South Africa, *Patrick, D.R., Findon, G., Miller, T.E., Epidemiology and Infection