Handwashing

Given the increased concern about influenza, and especially avian influenza and the prospects of an influenza pandemic, it seems an auspicious time to highlight an important tool in the fight against colds, influenza, and other contagious diseases: handwashing.

National Handwashing Awareness Week (December 4–10, 2005) is an observance designed to draw attention to the importance of handwashing in promoting health and preventing disease. The simple act of washing one’s hands thoroughly, with plenty of soap and warm water, when practiced regularly, can help reduce the spread of contagious diseases like influenza and colds. In concert with other good health practices — such as getting enough sleep, exercising regularly, and eating a healthy, balanced diet — handwashing can play a valuable role in maintaining overall good health.

Perhaps because handwashing is so simple, it is taken for granted, and probably not practiced nearly as widely as it should be. In an August 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. 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) (1). According to the Centers for Disease Control and Prevention (CDC), some viruses and bacteria can live from 20 minutes up to 2 hours or more on surfaces like cafeteria tables, doorknobs, and desks (2).

It seems likely that poor handwashing can contribute to the spread of influenza and colds. CDC estimates that 5–20 percent of Americans come down with the flu during each flu season, which typically lasts from November to March. Although most people recover from flu, CDC estimates that in the United States more than 200,000 people are hospitalized and about 36,000 people die from the flu and its complications each year (3). According to CDC, nearly 22 million school days are lost due to the common cold alone (4).

However, handwashing is most effective at reducing the chances of getting and spreading disease if it is done properly and often. Proper handwashing consists of washing the hands (including wrists, palms, backs of hands, fingers, and under fingernails) for 20 seconds, using soap and warm water (5). Hands should be dried with a paper towel. Use the paper towel to turn off the water to avoid contaminating the hands and then spreading those germs. The paper towel should be thrown in a wastebasket when finished. This procedure should be followed after using the restroom, before eating, and anytime the hands get dirty.

Children should be taught not to sneeze or cough into their bare hands but to use a tissue (or their sleeve) whenever possible and to avoid putting their fingers into their eyes, nose, or mouth. Adults, too, should be advised to follow these practices to reduce the spread of germs that can cause colds and flu.

Lastly, hand hygiene is not only important for the general public but is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of healthcare-associated infections (6, 7). However, research finds that this group falls short of optimal behavior. In a 2004 article in the Annals of Internal Medicine, physicians’ adherence to hand hygiene was low in most hospitals (8). This observational study of 163 physicians in a university hospital found that overall adherence to hand hygiene guidelines was only 57 percent and varied markedly across medical specialties. In this study adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, and a positive attitude about hand hygiene after patient contact. Alternatively, high workload, performing activities with high risks for cross-transmission, and certain medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for non-adherence. Development of a positive attitude about hand hygiene by healthcare staff is instrumental in transference of these behaviors to patients in an effort to safeguard against transmission of diseases such as the flu or colds.

Therefore, healthcare staff is encouraged to practice good hand hygiene between patients and to promote this behavior by patients to help prevent the spread of disease. For more information on this subject, please visit the CDC’s Infection Control in Health Care Facilities website at: www.cdc.gov/flu/professionals/infectioncontrol/index.htm.

Physicians and other healthcare staff are encouraged to share general advice about hand hygiene information with patients. Following these simple steps will greatly contribute to the protection of patients’ health:

1. Wash hands often with soap and warm water;
2. Avoid touching eyes, nose, or mouth as much as possible;
3. Stay away from people who are sick;
4. Cover the mouth and nose with a tissue or sleeve when coughing or sneezing; and
5. Get regular exercise, enough rest, and eat healthy, balanced meals.

These habits can help protect individuals and their family, friends, co-workers, casual contacts, and others from diseases like the flu and colds all year long.

While behavioral change is seldom easy, getting into the habit of proper handwashing, practiced often, can result in reduced incidence of disease and enhancing overall good health. Isn’t this well worth the time and effort required?

References:

• American Society for Microbiology website, (www.washup.org/index.html).
• CDC website, Preventing the Flu, Fast Facts, June 13, 2005, (www.cdc.gov/flu/school/).
• CDC Fact Sheet, Key Facts about Influenza and the Influenza Vaccine, Sept. 28, 2005, (www.cdc.gov/flu/keyfacts.htm).
• CDC website, Preventing The Flu, Fast Facts, June 13, 2005, (www.cdc.gov/flu/school/).
• CDC website, Stopping Germs at Home, Work and School, February 1, 2004, (www.cdc.gov/germstopper/home_work_school.htm).
• Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et at. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356:1307-12.
• Boyce JM, Pittet D. Guidelines for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of American. MMWR Recomm Rep. 2002;51:1-45.
• Pittet D, Simon A, Hugonnet S, et al. Hand Hygiene Among Physicians: Performance, Beliefs, and Perceptions. Annals of Internal Medicine. 2004;131:1-8. (www.annals.org/cgi/content/abstract/141/1/1).

San Diego County Health Stats: Influenza

• As part of the CDC’s influenza surveillance program, about 80 World Health Organization (WHO) and 50 National Respiratory and Enteric Virus Surveillance System (REVSS) collaborating laboratories located throughout the United States report the total number of respiratory specimens tested and the number positive for influenza types A and B each week (1).
• A study conducted in 2004 by the CDC concluded that the rates of influenza-associated hospitalization during an influenza season are highest when influenza A (H3N2) viruses predominate compared to years when influenza A (H1N1) or influenza B viruses predominated (2).

To request additional health statistics describing health behaviors, diseases and injuries for specific populations, health trends and comparisons to national targets, please call the County’s Community Health Statistics Unit at (619) 285-6479. To access the latest data and data links, including the 2004 Core Public Health Indicator document, go to www.sdhealthstatistics.com.

References:

1. CDC website, Influenza Summary Update, Week ending October 8, 2005 — Week 40, www.cdc.gov/flu/weekly/.
2. CDC website, Flu Home, Questions & Answers: Influenza-associated Hospitalizations in the United States, September 22, 2004, www.cdc.gov/flu/about/qa/hospital.htm.