Handwashing

By Harrison Bolter

Influenza (flu) season is underway in many parts of the country. The federal Centers for Disease Control and Prevention (CDC) estimates that every year 5–20 percent of the U.S. population gets this very contagious and potentially life-threatening illness. CDC also estimates that as many as 200,000 persons will be hospitalized because of flu-related complications, and up to 36,000 people will die from flu.

The best way to help protect against flu is to get flu vaccine each year. The groups for which vaccination with inactivated influenza vaccine (TIV) is recommended are listed below:

• Children aged 6–59 months (Note that preservative free [no thimerosal] is required by California law for those 6–35 months of age and for pregnant women. However, the Secretary of the California Health and Human Services Agency granted a temporary exemption from November 2, 2006 – December 14, 2006 to this restriction for influenza vaccine used in children 6–35 months of age that contains thimerosal in excess of the legal limit. During this period, children in California 6–35 months of age may receive influenza vaccine that is licensed in the U.S. regardless of thimerosal level, though thimerosal-free product should be used whenever possible. The exemption was requested by the California District of the American Academy of Pediatrics, California Medical Association, California Academy of Family Physicians and Kaiser Permanente to protect young children against influenza. The exception was granted because of the dangers posed by influenza to young children, and because of a temporarily insufficient supply of the thimerosal-free influenza vaccine formulation licensed for use in young children. The exemption does not apply to pregnant women.)
  Persons aged > 50 years;
• Women who will be pregnant during the influenza season (see note in first bullet);
• Children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk for experiencing Reye syndrome after influenza infection;
• Adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma (hypertension is not considered a high-risk condition);
• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunodeficiency (including immunodeficiency caused by medications or by human immunodeficiency virus);
• Adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions, or that can increase the risk for aspiration; and
• Residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions.

Vaccination with influenza vaccine (TIV or Live, Attenuated Influenza Vaccine—nasal spray [LAIV] if indicated) is also recommended for the following persons:

• Persons living with or caring for persons at high risk for influenza-related complications;
• Household contacts and caregivers of children aged 0–59 months; and
• Health-care workers (HCWs):
  • Physicians, nurses, and other workers in both hospital and outpatient-care settings,
  • Medical emergency-response workers (e.g., paramedics and emergency medical technicians),
  • Employees of nursing home and chronic care facilities who have contact with patients or residents.

Also, health care professionals are asked to remind their patients that since the flu season often lasts until March or later, getting immunized against the flu in December or later is not too late.

There is another simple practice to help control the spread of flu and other contagious diseases, not just during flu season, but all year long. That practice is proper and frequent handwashing (hand hygiene).

December 3–9 is National Handwashing Awareness Week (an observance to encourage handwashing in promoting health and preventing disease), and a good time to emphasize the importance of handwashing as a tool in flu prevention campaigns. Thorough handwashing, done regularly with plenty of soap and warm water, can help reduce the spread of contagious diseases like influenza, as well as colds, hepatitis A, meningitis, and infectious diarrhea. Handwashing can also play an important role in maintaining overall good health, especially when combined with other behaviors, such as getting enough sleep; exercising regularly; and eating a healthy, balanced diet.

Unfortunately, observation indicates that handwashing may not be as widely practiced as it should be. In a 2005 survey (sponsored by the American Society for Microbiology and the Soap and Detergent Association), 91 percent of adults said they always wash their hands after using public restrooms; however just 83 percent were observed doing so. The survey reported that Americans who said they “always wash their hands” after using the bathroom in their home (83 percent) and before handling or eating foods (77 percent) was reported. However, smaller percentages of Americans always wash after petting a dog or cat (42 percent), after coughing or sneezing (32 percent), or after handling money (21 percent).

It is estimated that that some bacteria and viruses can live from up to 20 minutes to two hours or more on surfaces like doorknobs, desks and cafeteria tables. Therefore, it’s logical to conclude that poor handwashing (or a lack of it) plays a factor in the spread of contagious diseases like influenza, colds, and other infections.

Handwashing is most effective at reducing the chances of getting and spreading disease if it is done properly and often — especially after using the restroom, before eating, and anytime the hands get dirty. The following are tips physicians and other health professionals can use to inform their patients about proper and thorough handwashing:

1. Wet hands with warm running water.
2. Apply liquid or clean bar soap.
3. Away from the running water, rub hands together vigorously and make a soapy lather. Scrub all surfaces, the front, the back, under your fingernails, and around the wrists. Take about 15–20 seconds (for instance, instruct children to sing the song “Happy Birthday” twice). A fast splashing does not remove germs.
4. The soap together with the scrubbing action dislodges the germs.
5. Rinse well under warm running water to remove the germs and dry hands with a clean towel. Turn off the water with a paper towel.
6. The paper towel should be thrown in a wastebasket when finished.

If soap and running water are not available, hand wash gels containing at least 60 percent alcohol significantly reduce the numbers of germs on skin and are fast acting.

Adults and children should be advised not to sneeze or cough into their bare hands, but to use a tissue (and dispose of it immediately), or their sleeve, whenever possible, and to avoid putting their fingers into their eyes, nose, or mouth.

Health professionals as well as the general public benefit from proper and frequent handwashing. Studies have shown that proper handwashing is the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care-associated infections. However, research also has shown that hand hygiene practices in health care personnel may be less than desired. A 2004 Annals of Internal Medicine article indicated that physicians’ adherence to hand hygiene was low in most hospitals. Developing a positive attitude about hand-hygiene by health care staff is important to promote these behaviors in patients.

Changing hand hygiene behavior requires time and effort, but it has the potential to pay important dividends in reducing illness through prevention of disease transmission of infections such as the flu.